Prophylaxis against acid aspiration syndrome. Single oral dose of H2-antagonist on the evening before elective surgery.

We have compared famotidine 40 mg, ranitidine 300 mg and placebo given in a single oral dose at 2200 hours as the sole means of prophylaxis in 286 patients who underwent elective surgery the following day. Standardised premedication was administered and anaesthesia induced. Gastric contents were aspirated by nasogastric suction and the pH and volume measured. Median values of pH after famotidine, ranitidine and placebo were 6.17, 6.74 and 2.45 respectively; median aspirate volumes were 8, 8 and 10 ml respectively. The proportions of patients considered 'not at risk' (pH greater than 2.5) were 90% after famotidine, 91% after ranitidine and 52% after placebo. We conclude that the administration of a potent H2-antagonist in a single oral dose at night offers a convenient routine means of providing extensive prophylactic cover in patients scheduled to undergo elective surgery the following day.

"Self-taming" of suxamethonium and serum potassium concentration.

Fifty patients undergoing routine surgery were randomly divided into two groups. Group 1 were pretreated with a small (10-mg) dose of suxamethonium ("self-taming") before administration of suxamethonium 1 mg kg-1, while group 2 received no pretreatment. Potassium concentrations were measured immediately before induction of anaesthesia and, subsequently, for 7 min. A small increase in mean plasma potassium concentration was seen in the group who were not pretreated, while the patients who received a "self-taming" dose of suxamethonium showed a sustained decrease below pre-induction values. Mean plasma potassium concentrations were significantly less in the "self-taming" group than in the group not pretreated.

Celestin tube intubation for advanced esophageal carcinoma.

Nine patients with advanced esophageal carcinoma underwent intubation with Celestin tubes between July 1973 and May 1975. Our indications for intubation were inability to swallow liquids or handle secretions and tracheoesophageal fistula resulting from advanced carcinoma involving the esophagus. Eight patients received adequate palliation; one died of continuing aspiration from a tracheoesophageal fistula. Major complications were noted in two survivors. The operative technic is discussed in detail.

Postoperative analgesia for thoracotomy patients.

Severe postoperative pain, which may persist for up to 3 days and may lead to postoperative complications, due to the patient's inability to breathe deeply and cough, is frequently experienced in the area of the incision and chest tubes by thoracotomy patients. Eighteen patients undergoing routine thoracotomies were tested preoperatively for arterial blood gases and pulmonary function and given chest x-rays. Anesthesia consisted of thiopental, succinylcholine, N2O, enflurane, and pancuronium. Before incision closure, 6 intercostal spaces were injected by the surgeon with 3 ml of a randomly determined drug mixture. Patients received either bupivacaine and saline solution, bupivacaine and LMW dextran 40, or saline and LMW dextran 40. Arterial blood gases, pulmonary function, chest x-rays, narcotic dosage, sensory level, and subjective responses were evaluated for 3 days postoperatively. Results demonstrate that intercostal nerve blocks can markedly reduce postoperative pain and improve pulmonary function in such patients. Significant differences from controls were seen in Pao2, Paco2, vital capacity, forced expiratory flow rates, analgesic requirements, and patient comfort. The duration of the block with bupivacaine and saline was less than 12 hours, while the mean duration of the block with bupivacaine and dextran 40 was 36 hours.