The effect of pre-incisional infiltration with lignocaine on postoperative pain after molar teeth extraction under general anaesthesia.

In a double-blind, placebo-controlled investigation, we studied the effects of pre-operative inferior alveolar nerve blockade and local anaesthetic intra-oral infiltration upon postoperative pain following third molar teeth extraction under general anaesthesia. Thirty six patients (12 male), mean (range) age 25.7 (18-40) years received an injection of 2% lignocaine 2 ml with 1:200,000 adrenaline around the inferior alveolar nerve and tissues adjacent to the third molar tooth on one side and of normal saline 2 ml in a similar fashion to the other side. We measured the pain on each side of the mandible on the 1st, 4th and 11th days after surgery using a visual analogue scale. The visual analogue pain score on the lignocaine and saline sides were 25/100 and 26/100 on day 1, 23/100 and 22/100 on day 4 and 0/100 and 1/100 on day 11. This study has a power of 80% to detect differences at the 5% level of significance of 11/100 on days 1 and 4 and 7/100 on day 11. We found no significant difference in the visual analogue scores between the lignocaine side and the saline side at any stage after the procedure.

Anaesthesia for a patient with tracheobronchomegaly (Mounier-Kuhn syndrome).

Tracheobronchomegaly is a rare condition in which anaesthetic experience is limited. Patients with tracheobronchomegaly are at risk of large airway collapse and obstruction, aspiration pneumonitis and tracheal trauma following airway instrumentation. We describe our anaesthetic technique and problems encountered during nephrectomy in a patient with this condition.

Acid aspiration prophylaxis in 202 obstetric anaesthetic units in the UK.

A postal survey of obstetric anaesthetic units in the UK was conducted by questionnaire to gain information about current acid aspiration prophylaxis. Information regarding the delivery rate and the caesarean section rate under regional techniques was also requested. Replies were received from 202 obstetric anaesthetic units in the UK, a 75% response rate. The results are compared to similar surveys carried out in 1984 and 1988. Sodium citrate and the H(2) antagonist ranitidine remain the drugs most commonly used for acid aspiration prophylaxis. However, the number of departments carrying out routine prophylaxis for patients in active labour has fallen from 75% in 1988 to 57% in the current survey.

Delayed excitatory reaction following interaction of cocaine and monoamine oxidase inhibitor (phenelzine).

A case report is presented in which a patient receiving the monoamine oxidase inhibitor, phenelzine, developed a delayed excitatory reaction following administration of topical cocaine spray during anaesthesia for vocal cord surgery. The pharmacological basis of the drug interaction is discussed.

Acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom.

The choice of drugs for acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom was determined by questionnaire. The results are compared with a similar survey of anaesthetic departments 5 years ago. The prescription of sodium citrate and the H2 receptor antagonist ranitidine has superseded that of Mist. magnesium trisilicate.

Intravenous cannulae colour coding. A perennial source of confusion.

There is no standard colour code for intravenous cannulae in the United Kingdom. A questionnaire was sent to the manufacturers to compile a table of available cannulae, and to assess their views and plans with regard to colour coding. Present moves to establish an international standard are outlined. A simple colour coding standard is proposed.