The Association of Anaesthetists of Great Britain and Ireland's most recent publication on controlled drugs notes that the Environmental Protection Act (1992) does not permit the disposal of controlled drugs into the water sewerage system. The Association suggests that, in order to conform to the Misuse of Drugs Regulations (1985), controlled drugs may best be disposed of using some sort of absorbent material, for example a small amount of cat litter or wallpaper paste, in the bottom of a sharps bin. The absorbent capacity of three types of cat litter, wallpaper paste and a commercial absorbent material were tested. Both the commercial absorbent and wallpaper paste displayed limited absorbent qualities unless the container was agitated. The cat litter, Snowflake, absorbed more controlled drug than the others (one-way ANOVA, F2,12 = 250.85, p < 0.01). The use of absorbent materials in sharps bins for the disposal of controlled drugs in clinical areas has limitations and may not be suitable. It is concluded, therefore, that small volumes of controlled drugs should be disposed of directly into clinical waste and that large volumes should be dealt with using a commercial absorbent in its own container.

AnaesthesiaVolume 49, Issue 1 p. 92-92 Free Access Dr John Snow—the name of the rose J.M. Strunin, J.M. Strunin The Grange, Firsby, Spilsby, Lincolnshire PE23 SQLSearch for more papers by this authorL. Strunin, L. Strunin The Grange, Firsby, Spilsby, Lincolnshire PE23 SQLSearch for more papers by this author J.M. Strunin, J.M. Strunin The Grange, Firsby, Spilsby, Lincolnshire PE23 SQLSearch for more papers by this authorL. Strunin, L. Strunin The Grange, Firsby, Spilsby, Lincolnshire PE23 SQLSearch for more papers by this author First published: January 1994 https://doi.org/10.1111/j.1365-2044.1994.tb03357.xAboutPDF 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 onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume49, Issue1January 1994Pages 92-92 RelatedInformation

Fifty patients scheduled for cataract surgery under peribulbar block were randomised to receive either plain (pH 5.4) or pH-adjusted (pH 6.8 range 6.7–6.9) 0.75% bupivacaine. Hyaluronidase was added to both solutions prior to peribulbar block. The time of onset of akinesia of the globe and the need for supplementary injections were recorded by an independent observer. Patients who returned for surgery to the second eye received the alternative local anaesthetic solution for the second peribulbar block. The relative efficacy of the different anaesthetic solutions was compared in patients who underwent unilateral surgery (Group A, n = 50). In 12 patients (Group B) who underwent bilateral surgery, direct comparisons between eyes in the same patient were possible. In both groups of patients, eyes receiving peribulbar block with the pH-adjusted solution showed a shorter time to partial akinesia of the globe (P < 0.05). However, there was no difference between the solutions in the time to complete akinesia of the globe, but the number of supplementary injections required for an effective block with the pH-adjusted solution was increased. Onset time to akinesia of the lateral and superior rectus muscles was shortened in patients receiving the pH-adjusted solution but there were minimal effects on the medial and inferior recti.

A prospective randomized clinical trial of enflurane, fentanyl, halothane, and isoflurane is described. The 17,201 patients were stratified into two groups (preanesthetic medication and no preanesthetic medication) and were randomized to one of four study agents: enflurane, fentanyl, halothane, and isoflurane. Fifteen university-affiliated hospitals in the United States and Canada participated. All patients were first assessed preoperatively. Data were collected during anesthesia, in the immediate recovery period, and for up to 7 days after anesthesia/surgery. The mean age of the patients was 43 yr, the mean height 167 cm, and the mean weight 68 kg. Sixty-five percent of patients were female. In this study 90.7% of patients were classified as ASA Physical Status 1 or 2, and 34.7% of patients smoked. It is concluded that pooling of data across institutions was valid and does allow determination of the efficacy and relative safety of the four study agents.

A prospective, stratified, randomized clinical trial of the safety and efficacy of four general anesthetic agents (enflurane, fentanyl, halothane, and isoflurane) was conducted in 17,201 patients (study population). Patients were studied before, during, and after anesthesia for up to 7 days. Nineteen patients died (0.11%), and in seven of these (0.04%) the anesthetic may have been a contributing factor. The rates of death, myocardial infarction, and stroke in the study population were so low (less than 0.15%) that no conclusions regarding the relative rates of these outcomes among the four anesthetic agents could be reached. The rates of 16 of 66 types of adverse outcomes in the study population were significantly different among the four study agents. Most of these outcomes were minor. However, severe ventricular arrhythmia (P less than 10(-6)) was more common with halothane, severe hypertension (P less than 10(-6)) and severe bronchospasm (P = 0.028) were more common with fentanyl, and severe tachycardia (P = 0.001) was more common with isoflurane. Recovery from anesthesia during the first 30 min was slowest in those patients who received halothane (P less than or equal to 0.001). In addition, patients who received fentanyl experienced less pain during the first hour in the recovery room (P less than 10(-6)). In conclusion, clinically important differences do exist for some outcomes among the four study agents.

AnaesthesiaVolume 44, Issue 6 p. 526-526 Free Access Epidural fentanyl at 4°C for analgesia after epidural Caesarean section M.J. Fairbrass, M.J. Fairbrass Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada T2N2T9Search for more papers by this authorK. Jani, K. Jani Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada T2N2T9Search for more papers by this authorL. Strunin, L. Strunin Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada T2N2T9Search for more papers by this author M.J. Fairbrass, M.J. Fairbrass Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada T2N2T9Search for more papers by this authorK. Jani, K. Jani Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada T2N2T9Search for more papers by this authorL. Strunin, L. Strunin Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada T2N2T9Search for more papers by this author First published: June 1989 https://doi.org/10.1111/j.1365-2044.1989.tb11406.xAboutPDF 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 No abstract is available for this article. References 1 Madej TH, Strunin L. Comparison of epidural fentanyl with sufentanil. Analgesia and side effects after a single bolus dose during elective Caesarean section. Anaesthesia 1987; 42: 1156– 61. 2 Welchew EA. The optimum concentration for epidural fentanyl. A randomised, double blind comparison with and without 1:200 000 adrenaline. Anaesthesia 1983; 38: 1037– 41. 3 Henry M, Graizon A, Seebacher J, Vauthier D, Levron JC, Viars P. Epidural fentanyl with and without epinephrine plasma levels and pain relief. Anesthesiology 1988; 69: A391. 4 Walmsley AJ, Giesecke AH, Lipton JM. Epidural temperature: a cause of shivering during epidural anesthesia. Anesthesia and Analgesia 1986; 65: S164. 5 Power I, Brown DT, Wildsmith JAW. The dfect of fentanyl on nerve conduction. British Journal of Anaesthesia 1988; 61: 507P. 6 Gissen AJ, Gucino LD, Datta S, Miller J, Covino BG. Effects of fentanyl and sufentanil on peripheral mammalian nerves. Anesthesia and Analgesia 1987; 66: 1272– 6. Volume44, Issue6June 1989Pages 526-526 ReferencesRelatedInformation

Fifty ASA class 1 or 2 patients scheduled for elective cesarean section had a lumbar epidural catheter inserted and sufficient carbonated lidocaine with epinephrine injected to produce a T4 sensory block. After neonatal delivery, patients were randomly assigned, by a double-blind method, to receive an epidural injection of 10, 20, 30 of 50 μg of sufentanil or 100 μg of fentanyl. The injectate volume was 10 ml. Postoperatively, additional analgesia was given as 0.2 mg/kg of morphine. Colostrum samples for opiate assay were obtained from mothers breast feeding their infants. Postoperative assessment was made of nausea and vomiting, respiratory rate, end tidal carbon dioxide, extent of sensory and motor blockade, pain, somnolence, pruritis, and overall patient evaluation of their perioperative experience.

Duration of analgesia and side effects following single bolus doses of epidural fentanyl (100 micrograms) or sufentanil (10, 20, 30 or 50 micrograms) were studied in 50 patients who underwent Caesarean section under epidural anaesthesia. Fewer patients experienced pain peroperatively in the fentanyl group than in a joint group of those given sufentanil 20 or 30 micrograms (p less than 0.05). The combined fentanyl and sufentanil 50 micrograms groups had fewer patients in pain than the sufentanil 10 micrograms group at 3 hours after injection (p less than 0.05). Patients given fentanyl also had a longer pain-free interval than those who received sufentanil 10 micrograms (p less than 0.02). The sufentanil 50 micrograms group had more patients asleep than the 10 micrograms group and also had more patients with pruritus than the 10 micrograms or 30 micrograms groups (p less than 0.02). The patients given sufentanil 30 and 50 micrograms had more emetic sequelae than those who received sufentanil 10 and 20 micrograms or fentanyl 100 micrograms (p less than 0.05). There was no detectable excretion of drug into breast milk and no significant respiratory depression at the time of first postoperative analgesia in the patients who received fentanyl or 30 micrograms or less of sufentanil.

AnaesthesiaVolume 42, Issue 7 p. 774-774 Free Access Use of volatile anaesthetics in the New World L. Strunin, L. Strunin Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary T2N 2T9, Alberta, CanadaSearch for more papers by this authorJ. M. Davies, J. M. Davies Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary T2N 2T9, Alberta, CanadaSearch for more papers by this author L. Strunin, L. Strunin Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary T2N 2T9, Alberta, CanadaSearch for more papers by this authorJ. M. Davies, J. M. Davies Foothills Hospital at the University of Calgary, 1403 29th Street NW, Calgary T2N 2T9, Alberta, CanadaSearch for more papers by this author First published: July 1987 https://doi.org/10.1111/j.1365-2044.1987.tb05332.xAboutPDF 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 No abstract is available for this article. References 1 Stock JGL, Strunin L. Unexplained hepatitis following halothane. Review article. Anesithesiology 1985; 63: 424– 39. 2 Eger EI, Smuckler EA, Ferrell LD, Goldsmith CH, Johnson BH. Is enflurane hepatotoxic Anesthesia and Analgesia 1986; 65: 21– 30. Volume42, Issue7July 1987Pages 774-774 ReferencesRelatedInformation

AnaesthesiaVolume 41, Issue 11 p. 1156-1157 Free Access Non-vagolytic anaesthetic sequence and sinus arrest R.J. Eastley, R.J. Eastley Foothills Hospital at the University of Calgary, 1403–29th Street N. W., Calgary T2N 2T9, CanadaSearch for more papers by this authorJ.M. Davies, J.M. Davies Foothills Hospital at the University of Calgary, 1403–29th Street N. W., Calgary T2N 2T9, CanadaSearch for more papers by this authorL. Strunin, L. Strunin Foothills Hospital at the University of Calgary, 1403–29th Street N. W., Calgary T2N 2T9, CanadaSearch for more papers by this author R.J. Eastley, R.J. Eastley Foothills Hospital at the University of Calgary, 1403–29th Street N. W., Calgary T2N 2T9, CanadaSearch for more papers by this authorJ.M. Davies, J.M. Davies Foothills Hospital at the University of Calgary, 1403–29th Street N. W., Calgary T2N 2T9, CanadaSearch for more papers by this authorL. Strunin, L. Strunin Foothills Hospital at the University of Calgary, 1403–29th Street N. W., Calgary T2N 2T9, CanadaSearch for more papers by this author First published: November 1986 https://doi.org/10.1111/j.1365-2044.1986.tb12976.xAboutPDF 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 No abstract is available for this article. Reference 1 Milligan KR, Beers HT. Vecuronium-associated cardiac arrest. Anaesthesia 1985; 40: 385. 2 Rowlands DE. Correspondence on bradycardia after the use of atracurium. British Medical Journal 1983; 287: 760. 3 Carter ML. Bradycardia after the use of atracurium. British Medical Journal 1983; 287: 247– 8. 4 Hardy PAJ. Atracurium and bradycardia. Anaesthesia 1985; 40: 504– 5. 5 MAY JR. Vecuronium and bradycardia. Anaesthesia 1985; 40: 710. 6 Mcleskey CH, Mcleod DS, Hough TL, Stallworth JM. Prolonged asystole after succinylcholine administration. Anesthesiology 1978; 49: 208– 10. 7 Jensen FM, Guldager H. Changes in heart rate and impulse conduction after a single dose of succinylcholine. Acta Anaesthesiologica Scandinavica 1984; 28: 521– 2. 8 Sorensen M, Engbaek J, Viby-Mogensen J, Guldager H, Jensen FM. Bradycardia and cardiac asystole following a single injection of suxamethonium. Acta Anaesthesiologica Scandinavica 1984: 28: 232– 5. Volume41, Issue11November 1986Pages 1156-1157 ReferencesRelatedInformation

SummaryRespiratory, function following single bolus doses as well as continuous infusions of epidural fentanyl were studied in 21 patients. Respiratory rate decreased significantly and end‐tidal CO2 showed a non significant increase following single doses of epidural fentanyl (1.5 μg/kg). These changes occurred within minutes of injection, hut could not be attributed solely to rapid systemic absorption of fentanyl from the epidural space. Prior administration of parenteral morphine resulted in significantly higher end‐tidal CO2 concentrations and lower respiratory rates following epidural fentanyl. Continuous epidural fentanyl infusion (0.5 μg/kg/hour) started 60 minutes after the bolus dose had no effect on end‐tidal CO2 concentration or respiratory rate for up to 18 hours. Infusions were continued after the study terminated for up to 9 days, during which there was no clinically significant respiratory depression.