Admixture of propofol and alfentanil. Use for intravenous sedation and analgesia during transvaginal oocyte retrieval

An admixture of propofol and alfentanil provides adequate sedation and analgesia during transvaginal oocyte retrieval in the absence of a paracervical block. In 100 patients the technique provided haemodynamic stability, sedation which was easily controlled, rapid recovery and universal patient acceptance.

Total intravenous anaesthesia with propofol and alfentanil protects against postoperative nausea and vomiting

The incidence of postoperative nausea and vomiting and requirements for anti-emetic medication were assessed in 80 female patients undergoing day-case anaesthesia during assisted conception therapy. Anaesthesia was induced with alfentanil 50 micrograms.kg-1 and propofol 1 mg.kg-1; atracurium 0.5 mg.kg-1 was given to facilitate tracheal intubation. The patients were allocated to receive either total intravenous maintenance of anaesthesia with an infusion of propofol and increments of alfentanil (Group P) or inhalational maintenance of anaesthesia with nitrous oxide and enflurane (Group E). Postoperative nausea, retching, vomiting, requirements for anti-emetic therapy, and unplanned admission for overnight stay in hospital were recorded. Overall incidence of nausea was 64% in group E and 39% in Group P (P less than 0.05). Incidence of vomiting was 67% in Group E and 34% in Group P (P less than 0.05). Metoclopramide was requested by 62% of patients in Group E, and 32% of those in Group P (P less than 0.05); 21% of the patients in Group E were admitted to hospital overnight, while only 5% of the patients in Group P required unscheduled admission to hospital (P less than 0.05). We conclude that total intravenous anaesthesia with propofol and alfentanil is superior to inhalational maintenance with nitrous oxide and enflurane in that it is associated with less nausea and vomiting, less requirement for anti-emetic medication, and a lower probability of unplanned admission to hospital after day-care gynaecological surgery.

Trends in skiing injury type and rates in Australia. A review of 22,261 injuries over 27 years in the Snowy Mountains

OBJECTIVE

To show the trends in the rate and type of skiing injuries in Australia.

DESIGN

A retrospective analysis of skiing injuries in the Snowy Mountains from 1962 to 1988.

SETTING

All injuries were seen and treated at the Ski Injury Clinic in Perisher Valley.

PATIENTS

A total of 22,261 injuries were seen over this 27 year period (data for 1963, 1964, 1966, 1977, 1978, 1981 and 1982 were missing).

INTERVENTIONS

Injured skiers were treated at the Clinic with a small number sent to main centres for tertiary care.

MAIN OUTCOME MEASURES

The overall injury rate (1962-1988) and the specific injury rate for six subgroups of injuries (1974-1988) were calculated.

RESULTS

The overall injury rate declined dramatically over this period. The incidence of tibial fractures, ankle injuries and lacerations also declined. Upper body injuries continue to rise although this trend was not statistically significant. There was a statistically significant increase in knee injuries.

CONCLUSIONS

The trends reported here are similar to those overseas except that the incidence of thumb injuries has not changed in Australia. The changes in the rates of lacerations, and tibial and ankle injuries can be related to improvements in ski bindings and boots.

Project Orbis

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Deaths associated with skiing in Australia: a 32-year study of cases from the Snowy Mountains

We present the first study of skiing-related deaths in Australia--a 32-year study of skiing-related deaths in the Snowy Mountains. We have reported 29 such cases; eight subjects died of trauma, 15 subjects died of cardiovascular causes, and six subjects died of hypothermia. The over-all incidence of death was 0.87 deaths per million skier-days; the specific incidence for trauma-related deaths was 0.24 deaths per million skier-days; for cardiac-related deaths was 0.45 deaths per million skier-days; and for hypothermia-related deaths was 0.18 deaths per million skier-days. These findings compare most-favourably with US figures. Death that is associated with skiing in the Snowy Mountains is a rare event.

Nordic (cross-country) skiing injuries in Australia

A retrospective study of 88 nordic skiing injuries from the 1984 and 1985 skiing seasons in Australia is presented. To our knowledge, this is the largest study to date of such injuries. These injuries are compared with alpine skiing injuries from the same medical clinic for the 1985 skiing season. There was a much lower incidence of injury from nordic skiing; however, when injuries did occur, they tended to be more serious than those of alpine skiing and frequently required immediate evacuation to hospital for treatment. As the nordic skier is relatively isolated from medical services, these findings need to be considered in the future planning of rescue services for such skiers.

Children's skiing injuries in Australia

Skiing is one of the most popular winter sports for adults and children in Australia. While much is known about the epidemiology of skiing trauma in adults, little has been written about the patterns of skiing injury in children in Australia. During the 1984 ski season, the injuries and risk factors of 149 children were compared with those of 1093 adults who were injured over the same period. Although Australian children were found to be possibly less prone to injury than were adults, they did sustain more serious injuries, in particular, fractures of the tibia. The significantly different associated risk factors that are thought to be responsible were the greater number of children who were injured in collisions and ski-lift accidents, and inadequate bindings on their skis. Such shortcomings are correctable; children require better boot-bindings and greater supervision on the ski-slopes.

Hypothermia among resort skiers: 19 cases from the Snowy Mountains

Even in relatively temperate environments, accidental hypothermia is a potentially lethal complication of exposure. We have reviewed our experience of accidental hypothermia among recreational alpine skiers at an Australian resort during the 1983 and 1984 seasons. There were 19 cases of accidental hypothermia, which occurred in 10 men and nine women who were aged between six and 47 years (mean age, 15.9 years) and who had rectal temperatures that ranged from less than 35 degrees C to 36 degrees C. The temperature at presentation to the Ski Injury Clinic was less than 35 degrees C in seven cases. One patient presented to the Clinic with a gastrointestinal haemorrhage in addition to hypothermia, and one was initially thought to be suffering from alcohol intoxication. Two patients were lost in the snow overnight. All patients were removed from the snow, changed into warm dry clothes where necessary, and their body temperatures allowed to return to normal spontaneously (17 patients), or were exposed to heat actively by means of inhaled, heated, humidified air (two severely obtunded patients). All patients responded satisfactorily. There were no deaths and no sequelae. We conclude that all skiers should be advised to wear effective thermal insulation, and to ski with a partner to ensure that adequate care is taken to prevent accidental hypothermia. Inhalational "warming" is effective in the treatment of hypothermia in obtunded patients.

Skiing injuries in Australia

A prospective study of 1850 skiing injuries which occurred during the 1983 skiing season in Australia is presented. To date, it is the largest prospective review of skiing injuries in Australia. All injuries were seen and treated by the same medical practitioner. In contrast with previous reports, upper extremity injuries and lower extremity injuries were almost equally represented (36% and 42% of the total number of injuries, respectively); injuries to the head, face and neck accounted for 17% of the total number of injuries. The injury rate of 3.80 per 1000 skiers establishes skiing as a safe sport. Attention is drawn to the high incidence of facial lacerations and of disruption of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb ("skier's thumb"). It is recommended that both competitive and recreational skiers wear helmets with attached visors. With adequate medical personnel and facilities, over 90% of injuries can receive definitive primary treatment on location; this results in minimum patient discomfort, complications, and hospital costs.

Factors influencing the diagnostic sensitivity of the exercise test in coronary artery disease

A continuous multistage bicycle ergometer test was performed on 50 patients with coronary artery disease. Selective cinecoronary angiography and left ventriculography were performed within a week of the test in all patients. Overall, 62% had a positive ischemic response, defined as 1 mm or greater depression of the ST segment. Patients with 75% or greater stenosis in any vessel and those with triple-vessel involvement had a higher incidence of positive tests. Those with low systolic ejection fractions and areas of asynergy had fewer positive tests than patients with normal ejection fractions and normal or minimal segmental wall motion abnormalities. The level of exercise, location of arterial disease and the presence of collateral blood supply to the diseased vessels did not appear to influence the sensitivity of the exercise stress test.

Pyloric obstruction caused by aspirin: case report

A case of pyloric obstruction caused by ingestion of enteric-coated aspirin tablets is presented. The patient was predisposed by previous pyloric stenosis. A barium meal study was diagnostic. The patient later had a massive gastro-intestinal haemorrhage requiring surgical repair. The hazards of aspirin ingestion in such a patient are discussed.

Cholestyramine in the treatment of antibiotic associated pseudomembranous colitis: a case report

A patient with antibiotic associated pseudomembranous colitis (A-PMC) is described in whom there was a dramatic response to the administration of cholestyramine. Although it is not clear why cholestyramine should be beneficial, its use should be considered whenever the diagnosis of pseudomembranous colitis is entertained.