As the title suggests, this book is about neural block. It is stated in the preface that it is not a traditional textbook brim full with facts, rather it is a portable manual intended to provide practical details. The first edition appeared in 1989 as a formalized version of inhouse guidelines produced for residents in anaesthesiology at the Virginia Mason Medical Center, Seattle, Washington. This is the third editon, which is testimony that it is being regularly updated. There are 24 chapters ranging from introductory pharmacology, equipment, patient monitoring, and a comprehensive yet concise chapter on complications. The sequence of subsequent chapters has a natural flow through central neural block, thoraco-abdominal nerve blocks, plexus blocks, and special chapters dealing with the airway, face, head, and eye. Specific applications are also covered in paediatrics and obstetric practice. Unlike many rival texts on regional anaesthesia, this book has black and white line drawings only. The lack of colour illustrations gives a plain and uninteresting first glance appearance, yet it is surprisingly comfortable to read and easy to dip into. This reviewer could find no important omissions and the index is comprehensive. It is refreshingly uniform and non-repetitive with the hallmark of a single author, except for the last two chapters on chronic pain and postoperative pain management. Though these are trimmed down to summary outlines of their subject, they do fit with the overall style of the book. As a North American publication intended for that readership, the references are mainly to the North American literature. There is, of course, much common ground and similarity of practice in regional anaesthesia between North America and Britain. Consequently, the book is likely to be well received by a UK readership, especially as it is good value for money. It complements the existing range of books on the subject, with something in it for everyone from trainees to experienced anaesthetists. It is a credit both to Dr Mulroy and his predecessors at the Mason. Recommended!

We have compared gastric aspirate pH and volume at induction of anaesthesia in 222 patients who had received either omeprazole or ranitidine before elective operations. Omeprazole was given orally either as 40 mg on the evening before and 40 mg on the morning of surgery or as 80 mg on the morning of surgery. Ranitidine 150 mg was given orally on the evening before surgery and 2 h before anaesthesia. Treatment success was defined as aspirate pH > or = 2.5 and volume < 25 ml at induction of anaesthesia. Treatment was successful in 84% (95% confidence interval (CI) 73-91%) of patients in the omeprazole 40 + 40 mg group, 84% (95% CI 73-91%) in the ranitidine group and 73% (95% CI 61-83%) in the omeprazole 80 mg group. There were no statistically significant differences between the groups. Twelve patients in the omeprazole 80 mg group had gastric pH < 2.5 and four had volume > 25 ml. Only three patients had a gastric pH < 2.5 in the omeprazole 40 + 40 mg group and none had volume > 25 ml, which compared well with the ranitidine group. Omeprazole, given as 40 mg in the evening and 40 mg on the morning of operation, has a potential role for use in patients at risk for aspiration during general anaesthesia.

SummaryA simple and inexpensive force transducer made from a stainless steel table knife is described. Construction is straightforward and utilises strain gauges that are readily available. Amongst its attributes are lightness, ease of application, low sensitivity to postural changes and linearity over extended periods of time.

In an open sequential pharmacodynamic study in 40 patients, the rate of onset of neuromuscular blockade using tubocurarine or vecuronium was measured. Comparison was made between groups of 10 patients who received thiopentone followed by either blocker and a "reverse" sequence where the blocker was injected before thiopentone. There was a small difference between groups, amounting to a few seconds in rate of onset of block, but this was not suggestive of a systematic effect of the drug sequence.

A single i.v. bolus dose of propofol 3 mg kg-1 was compared with methohexitone 2 mg kg-1 as the sole anaesthetic agent for simple dental extraction in outpatients. Induction of anaesthesia was smoother with propofol, with a lower incidence of excitatory phenomena. Pain on injection was a common complication of both drugs and related to the site of injection. The Leeds Psychomotor Tester was used to assess psychomotor performance during the recovery. Rate of recovery from anaesthesia was similar with both agents, and there was little residual impairment of psychomotor function 40 min after induction.

AnaesthesiaVolume 41, Issue 3 p. 332-332 Free Access Difficult tracheal intubation I.D. LEVACK, I.D. LEVACK Department of Anaesthetics, Royal Infirmary, Edinburgh.Search for more papers by this authorA.H.B. MASSON, A.H.B. MASSON Department of Anaesthetics, Royal Infirmary, Edinburgh.Search for more papers by this author I.D. LEVACK, I.D. LEVACK Department of Anaesthetics, Royal Infirmary, Edinburgh.Search for more papers by this authorA.H.B. MASSON, A.H.B. MASSON Department of Anaesthetics, Royal Infirmary, Edinburgh.Search for more papers by this author First published: March 1986 https://doi.org/10.1111/j.1365-2044.1986.tb12814.xCitations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume41, Issue3March 1986Pages 332-332 ReferencesRelatedInformation

In a double-blind trial, 50 patients with subcostal incisions performed for cholecystectomy or splenectomy, received 10 ml of either 0.5% bupivacaine plain or physiological saline twice daily by wound perfusion through an indwelling drainage tube for 3 days after operation. Analgesia, assessed by visual analogue score (VAS) and forced vital capacity (FVC), was significantly improved after perfusion with bupivacaine. Perfusion with physiological saline produced an analgesic effect comparable to that of bupivacaine as indicated by improvement in VAS. There was, however, no improvement in FVC, and opioid requirements were greater, in the patients whose wounds had been perfused with saline.

The direct perfusion of surgical wounds with local anaesthetic solution Messrs Thomas, Lambert and Lloyd Williams (Annals, July 1983, vol 65, p 226) present observations of this technique and cite its early descriptions in the literature of the 1950s. More recently Samarji (1) reported a series of 142 patients having upper abdominal surgery and compared intramuscular methadone, 0.5%/ bupivacaine in the rectus sheath and epidural analgesia; he concluded that 'chest infection and complications were significantly lower' in the rectus sheath group and recommended the technique for patients with 'existing airway disease'. No results of lung function measurements were given and pain assessment was based on the patient's ability to sit up, take deep breaths and to cough. The report concluded that pain relief was complete in the rectus sheath group. We have recently completed a similar study to that of Thomas et al. and wish to comment on their methodology and results. The precision of their mean vital capacity values and postoperative papaveretum requirements is reduced because males and females are included; it is well recognised that standardisation with respect to sex is essential in studies of this type (2). Furthermore, the timing of vital capacity measurements during days 1, 2 and 5 is not indicated; these measurements are known to be influenced by physiotherapy and prior opiate administration (3). Spirometry and assessment of pain immediately before wound perfusion and again at an interval of 30 minutes after perfusion would allow a more definitive evaluation. Standardisation could be improved by withholding papaveretum during the preceding 3 hours. Although they conclude that their claims of pain relief with saline and 0.5% bupivacaine are based upon clinical impression, their demonstration of a statistically significant reduction in postoperative papaveretum requirements in these two groups compared to the control group who received papaveretum only is convincing albeit subject to patient demand and nursing discretion. In our study of 50 patients with subcostal incisions whose wounds were perfused in a similar manner with either 0.5% bupivacaine or normal saline, we measured FEV1, FVC and visual analogue pain score (4) twice daily for 3 days after operation. We found that in the bupivacaine group FEV1 and FVC were improved after perfusion compared with measurements made immediately prior to perfusion (P< 0.01). There were significant improvements in visual analogue scores in both groups (P<0.01) which supports the claim by Thomas et al. of an apparent analgesic effect of saline perfusion. We agree that saline had no effect on FEV1 or FVC. Assessment of pain need not be the sophisticated measurement they suggest and the linear visual analogue score is simple to use and suitable for any District General Hospital. Whether wound perfusion is better than narcotics or epidural block in reducing postoperative hypoxaemia or improving functional residual capacity remains to be established but we agree that its analgesic efficacy and safety justify wider application and evaluation. IAIN D LEVACK MD FFARCS Senior Registrar in Anaesthetics Royal Infirmary Edinburgh G S ROBERTSON MD FFARCS Consultant Anaesthetist Aberdeen Royal Infirmary

A propos de 2 accidents dans des cloches de plongee de la recherche petroliere en mer du Nord. Ces cloches sont fournies en un melange d'oxygene et d'helium sous pression. Dans un cas l'apport d'oxygene etait bloque, mais pour quelques instants seulement. Dans l'autre cas l'apport d'helium bloque provoque une intoxication par l'oxygene avec crise de type epileptique