The management of caesarean section in a patient with an intracranial arteriovenous malformation

The anaesthetic management of elective Caesarean section in a 25-year-old woman with an inoperable intracranial arteriovenous malformation is described. The literature is reviewed.

Anaesthesia for trans-sternal thymectomy in myasthenia gravis

A retrospective review is presented of the thirty patients who underwent trans-sternal thymectomy for myasthenia gravis in our unit from 1980-85. The clinical status of these patients is contrasted to that of more severely debilitated patients described by other authors. The problems encountered by the anaesthetist in the perioperative care of patients with mild myasthenia gravis are discussed. Management of the perioperative anticholinesterase regime is described and a case presented for the use of suxamethonium for intubation. A less invasive postoperative regime is advocated in which tracheostomy and nasotracheal intubation are avoided, and anticholinesterase therapy is re-introduced orally as soon as possible after surgery.

Alfentanil for caesarean section complicated by severe aortic stenosis. A case report

Alfentanil 35 micrograms kg-1, was used successfully in a patient with severe aortic stenosis, in order to minimize the haemodynamic responses to intubation and surgery during Caesarean section. The baby was delivered apnoeic, unresponsive and with poor muscle tone, but responded rapidly to naloxone. Plasma alfentanil concentrations and percentage binding to plasma proteins were measured in both maternal and neonatal blood. Free drug concentrations were similar in both mother and neonate, but maternal plasma proteins had a higher affinity for alfentanil. Only 67.26% of neonatal plasma alfentanil was bound to plasma protein. This value did not differ significantly from those estimated from the blood of a further 12 healthy neonates.

Blood glucose in anaesthetised children. Comparison of blood glucose concentrations in children fasted for morning and afternoon surgery

Blood glucose levels were measured immediately after induction of anaesthesia and again intraoperatively in 26 children fasted overnight for operations in the morning and 28 children fasted from 8.00 a.m. for afternoon surgery. The mean post-induction glucose concentration of the afternoon surgery group was significantly lower than that of the morning group. However, no child in either group was hypoglycaemic. Anesthesia and surgery caused significant increases in blood glucose levels. It is concluded that pre-operative fasting is well tolerated in healthy pre-school children, regardless of the timing of surgery.

Incremental propofol for short procedures

Propofol was used to induce and maintain anaesthesia in patients undergoing minor gynaecological procedures. Quality of anaesthesia, the rate of recovery and the influence of different methods of premedication were assessed. Unpremedicated patients required a higher induction dose than those premedicated with either lorazepam or papaveretum and hyoscine, but maintenance dose requirements were comparable. Regardless of premedication, there were similar decreases in mean arterial pressure, although respiratory function recovered more rapidly in patients premedicated with lorazepam. No significant changes in heart rate were noted in any group. The overall incidence of pain on injection was 3.7% (lignocaine 0.5 mg added to each 9.5 mg of propofol) and a skin rash occurred in 6% of patients. All patients recovered rapidly and uneventfully.