Despite advantages of induction and maintenance of anaesthesia with sevoflurane, postoperative nausea and vomiting occurs frequently. Fentanyl is a commonly used supplement that may contribute to this, although it may alrove analgesia.

This double-blind study examined the incidence and severity of postoperative nausea and vomiting and pain in the first 24 h after sevoflurane anaesthesia in 216 adult day surgery patients. Patients were randomly allocated to either receive or not receive 1 μg kg−1 fentanyl, while a third group received dexamethasone in addition to fentanyl.

Omission of fentanyl did not reduce the overall incidence of postoperative nausea and vomiting, but did reduce the incidence of vomiting and/or moderate to severe nausea prior to discharge from 20% and 17% with fentanyl and fentanyl-dexamethasone, respectively, to 5% (P = 0.013). Antiemetic requirements were reduced from 24% and 31% to 7% (P = 0.0012). Dexamethasone had no significant effect on the incidence or severity of postoperative nausea and vomiting. Combining the two fentanyl groups revealed further significant benefits from the avoidance of opioids, reducing postoperative nausea and vomiting and nausea prior to discharge from 35% and 33% to 22% and 19% (P = 0.049 and P = 0.035), respectively, while nausea in the first 24 h was decreased from 42% to 27% (P = 0.034). Pain severity and analgesic requirements were unaffected by the omission of fentanyl. Fentanyl did reduce minor intraoperative movement but had no sevoflurane-sparing effect and increased respiratory depression, hypotension and bradycardia.

As fentanyl exacerbated postoperative nausea and vomiting without an improvement in postoperative pain and also had adverse cardiorespiratory effects, it appears to be an unnecessary and possibly detrimental supplement to sevoflurane in day surgery.

Rheumatoid arthritis is a lifelong systemic disease that can affect any joint with a synovium. Managing intubation in patients with rheumatoid disease is a special challenge in these patients especially if specific joints, which play an important role during intubation, are affected. We aimed to investigate if there was a correlation between the activity and duration of the disease and the commonly used predictors of difficult intubation in rheumatoid arthritis.

Sixty-six patients with the diagnosis of rheumatoid arthritis and 60 control patients were included in the study. Patient characteristics were recorded. Body mass index, disease activity scores, Mallampati classification, sternomental distance, thyromental distance, inter-incisor distance and atlanto-occipital joint extension were measured for each patient. Every patient was asked to complete the Stanford Health Assessment Questionnaire (HAQ score). Disease activity score (DAS 28 score) including 28 joints was used to assess the activity of the disease. Correlation between the predictors of difficult intubation and activity was assessed and was compared with the control group.

Mallampati scores were higher (P = 0.000), sternomental distance (P = 0.005) and inter-incisor distance (P = 0.003) were shorter and also occlusal surface–upper teeth angle (P = 0.000) and mouth corner–tragus line angle were smaller in the rheumatoid arthritis group compared with controls (P = 0.000). We did not observe a correlation between the disease activity scores and the Mallampati score (P = 0.619), sternomental distance (P = 0.195), thyromental distance (P = 0.174), inter-incisor distance (P = 0.764), angle I (P = 0.372) and angle II (P = 0.609). There was no correlation between the HAQ score and the Mallampati score (P = 0.872), sternomental distance (P = 0.455), thyromental distance (P = 0.841), inter-incisor distance (P = 0.162), angle I (P = 0.768) and angle II (P = 0.287). There was no correlation between the duration of the disease and the Mallampati score (P = 0.619), sternomental distance (P = 0.505), thyromental distance (P = 0.426), inter-incisor distance (P = 0.813), angle I (P = 0.377) and angle II (P = 0.600).

Tests of disease activity and the duration of the disease were not found to be correlated with the predictors of difficult intubation in this study. Thus, performing the predictive tests for difficult intubation especially in patients with very low scores or short disease is recommended.

To investigate the effect of urinary flow rate on the urinary bladder temperature, we compared the accuracy and precision of urinary bladder temperature with oesophageal temperature at both high and low urine flow rates.

Twenty-four patients ASA physical status I or II who were undergoing tympanoplasty were randomly assigned to two groups with different intravenous fluid volumes: high (10 mL kg−1 h−1, n = 12) and low (3 mL kg−1 h−1, n = 12). General anaesthesia was induced with propofol and maintained with sevoflurane (1.5–2.5%) in nitrous oxide and oxygen. Urinary bladder temperature was measured using a Foley urinary catheter; distal oesophageal temperature was measured using a stethoscope thermocouple. These temperatures were measured every 5 min during surgery and the accuracy and precision of urinary bladder temperature with oesophageal temperature were determined using regression and Bland and Altman analyses.

The correlation coefficient for oesophageal and urinary bladder temperature was 0.90 in the high urinary volume group and 0.75 in the low urinary volume group. The offset (oesophageal–urinary bladder) was −0.13 ± 0.32°C and −0.46 ± 0.45°C, respectively.

Urinary bladder temperature appears to be more accurate at high urinary flow rates than at low urinary flow rates for clinical use.

This study was designed to determine the protective effects of zinc on halothane-induced hepatotoxicity.

Forty-five male Sprague-Dawley rats were divided into three groups. The halothane group received normal drinking water and diet; the zinc-halothane group received 227 mg L−1 zinc sulphate in the drinking water and diet for 2 weeks; and the control group received normal diet and water. At the end of 2 weeks, rats were housed in an anaesthesia box and 1 MAC (minimum alveolar concentration) halothane was administered at 6 L min−1 in room air for 2 h. This was repeated 48 h later. After the rats were sacrificed, we measured alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, glutathione-S-transferase, serum electrolytes and bilirubin in samples. The degree of liver toxicity was assessed by light microscopic examination.

We demonstrated a reduction of alanine aminotransferase, aspartate amino transferase, glutathione-S-transferase levels and a reduction in liver damage in the zinc-halothane group.

The study concludes that zinc has the potential to alleviate the toxic effects of halothane in rat liver.

The anaesthetic method for intracranial neurosurgery must provide haemodynamic stability on emergence and allow early evaluation of the neurological status. In this study, we examined the effects of the α-2 agonist dexmedetomidine given at the end of the procedure to prevent hyperdynamic responses during extubation and to allow a comfortable and high-quality recovery.

Forty ASA I–III patients, aged between 18 and 75 yr, having elective intracranial surgery, were divided into two random groups. Standard procedures and drugs were used for monitoring, induction and maintenance. Isoflurane was reduced by 50% 5 min before the end of the surgery, and in Group I dexmedetomidine 0.5 μg kg−1 and in Group II 20 mL of 0.9% NaCl were administrated intravenously over 60 s. Systolic, diastolic and mean arterial pressures, and heart rate were recorded before intravenous administration and also at 1, 3 and 5 min after administration, 1 min before extubation, during extubation, 1, 3, 5, 10, 15, 20 and 30 min after extubation. Duration of extubation and recovery were noted, and the quality of extubation was evaluated on a 5-point scale.

Mean arterial pressure and heart rate were significantly higher in Group II than in Group I (P < 0.01). There were no statistically significant differences between groups regarding the duration of extubation and recovery (P > 0.05). Extubation quality score of all the patients were 1 in Group I; and in Group II, the quality scores were 1 for 35%, 2 for 45% and 3 for 20% of the patients (P < 0.001). None of the patients in Group I and Group II showed respiratory depression, nausea or vomiting.

Without interfering in recovery time, dexmedetomidine 0.5 μg kg−1 administered 5 min before the end of surgery stabilizes haemodynamics, allows easy extubation, provides a more comfortable recovery and early neurological examination following intracranial operations.

The technology of bispectral index monitoring is based on an algorithm developed from adults. This study was conducted to investigate the difference in bispectral index monitoring between paediatric and adult patients under intravenous anaesthesia.

In all, 68 patients undergoing elective surgery were divided into three groups as follows: Group A (younger children, n = 20, 3 yr ⩽yr ⩽ 5 yr), Group B (older children, n = 20, 6 yr ⩽yr ⩽12 yr), Group C (adults, n = 28, 25 yr ⩽yr ⩽50 yr). All patients were induced by plasma target-controlled infusion of propofol till loss of consciousness (loss of response to verbal commands and eyelash reflex). The plasma concentration (Cppropofol) and effect-site concentration (Cepropofol) of propofol and bispectral index values were compared at loss of consciousness and regaining of consciousness. During the operation, remifentanil was infused at a fixed rate of 0.25μg kg−1 min−1, and the minute average bispectral index values of three groups were also compared at different stable concentrations of propofol (Cepropofol = Cppropofol = 2, 3, 4 and 5 μg mL−1, respectively).

At loss of consciousness and regaining of consciousness, the bispectral index values in Group A (loss of consciousness: 74.7 ± 6.3, regaining of consciousness: 81.1 ± 10.5) were significantly higher than those in Group C (loss of consciousness: 68.6 ± 9.4, regaining of consciousness: 74.5 ± 6.0) (P < 0.01). There was no statistical difference between Cppropofol in all groups at loss of consciousness and regaining of consciousness. The Cepropofol at loss of consciousness in Group A (3.57 ± 0.60 μg mL−1) and B (3.25 ± 0.44 μg mL−1) were significantly higher than those in Group C (2.15 ± 0.86 μg mL−1) (P < 0.01). At the same stable concentrations of propofol, the bispectral index values in Group A and B were significantly higher than those in Group C, and the bispectral index values in Group A were also significantly higher than those in Group B (P < 0.01). The Cepropofol when bispectral index ⩽ 40 in Group A, B, C were approximately at 6, 5 and 3 μg mL−1, respectively.

At loss of consciousness and regaining of consciousness, the bispectral index values of younger children group are significantly higher than those of adults. At the same stable concentrations of propofol, the bispectral index values are significantly different between children and adults. This study suggests that there is deviation when the adult algorithm of bispectral index monitoring is applied in paediatric patients under intravenous anaesthesia.

Pentobarbital and ketamine are commonly used in animal experiments, including studies on the effects of ageing on the central nervous system. The electroencephalogram is a sensitive measure of brain activity. The present study investigated, under anaesthesia induced by the two drugs, whether cortical electroencephalogram in aged rats differs from that in young rats.

Electroencephalogram was recorded for young (2–3 months) and aged (15–17 months) rats before and during pentobarbital (40 mg kg−1) or ketamine (100 mg kg−1) anaesthesia. The relative power in five frequency bands (delta: 2–4 Hz; theta: 4–8 Hz; alpha: 8–12 Hz; beta: 12–20 Hz; gamma: 20–100 Hz) was analysed, and then compared between the two age groups.

In both age groups, pentobarbital anaesthesia induced an increase in relative power in alpha and beta bands and a decrease in the theta band, but the degree of these power variations was more marked in aged rats. Ketamine anaesthesia increased relative power in the delta band and decreased that in the theta band; these effects were significantly different between the two age groups, with aged rats showing more markedly decreased power in the theta band.

(a) Pentobarbital and ketamine modified cortical electrical activity in a different manner as a function of age; (b) the modification of electroencephalogram relative power with anaesthesia was identical in young and aged rats but quantitatively more marked in aged rats. These findings will be useful in designing experiments that assess pathological changes in the central nervous system during ageing.

Despite evidence of their prognostic power for non-surgical patients, the value of perioperative natriuretic peptides and cardiac troponins as markers of cardiac events is incompletely defined. This study sought to examine whether perioperative N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) levels could be used for the prediction of in-hospital cardiac events in elderly patients undergoing elective coronary artery bypass grafting.

Ninety-eight elderly patients (>75 yr) undergoing elective coronary artery bypass grafting with cardiopulmonary bypass were enrolled and followed up for 12–15 months. NT-proBNP and cTnT levels were measured before induction of anaesthesia and 12, 24 and 48 h after surgery. To identify the best discriminatory level of NT-proBNP and cTnT receiver operating characteristics curves were analysed.

Thirty-four patients experienced 54 in-hospital cardiac events. Patients with complications had significantly higher NT-proBNP and cTnT levels than those without complications. Receiver operating characteristics curve analysis revealed cut-off levels of 2361 pg mL−1 and 0.66 μg mL−1 for NT-proBNP and cTnT (sensitivity, specificity, positive predictive value and negative predictive value of 84.3%, 89.4%, 78.9% and 92.4%, and 93.7%, 74.2%, 63.8% and 96.1%, respectively) at 24 h after surgery to be associated with in-hospital cardiac events. An elevation of both biomarkers above these threshold values was independently associated with individual postoperative complications (odds ratio, 18.9; 95%, CI, 2.3–106.1).

In elderly patients undergoing elective coronary artery bypass grafting surgery, high values of NT-proBNP and cTnT measured 24 h after the end of surgery were independently associated with in-hospital cardiac events.

This study aimed to investigate the effect of 0.25% levobupivacaine infiltration of the sternotomy wound and the mediastinal tube sites on postoperative pain, morphine consumption and side-effects in patients undergoing cardiac surgery.

After obtaining Ethics Committee approval and informed consent, 50 patients aged 18–65 yr, undergoing coronary artery bypass grafting, were included in this study. Anaesthesia was induced with 5 μg kg−1 fentanyl, 0.3 mg kg−1 etomidate, 1 mg kg−1 lidocaine, 0.1 mg kg−1 vecuronium and maintained with 1–2% sevoflurane, 50% oxygen in air and fentanyl. Patients were randomized into two groups before sternal wire placement: sternotomy and mediastinal tube sites were infiltrated with either 60 mL 0.25% levobupivacaine (infiltration group, n = 25) or 60 mL saline placebo (control group, n = 25). All patients received intravenous morphine patient-controlled analgesia (bolus dose: 2 mg, lock-out time: 15 min, 4 h limit: 20 mg) after extubation. Postoperative pain at rest and on coughing was assessed by a visual analogue scale (0–10). Pain scores, sedation scores (Ramsay scale), haemodynamic and respiratory parameters, arterial blood gases and morphine consumption were recorded.

The times to extubation and visual analogue scale scores were similar between groups. Morphine consumption at 24 h was significantly lower in the infiltration group compared with the control group (29.5 ± 5.1 vs. 42.8 ± 4.7 mg, respectively, P < 0.05). The sedation scores were found to be significantly higher in the control group when compared with the infiltration group at 1, 2 and 4 h after extubation (P < 0.05), whereas sedation scores after 4 h were similar between groups.

Infiltration of the median sternotomy incision and the mediastinal tube insertion sites with 0.25% levobupivacaine in addition to morphine patient-controlled analgesia was found to be effective in reducing postoperative morphine consumption when compared with morphine patient-controlled analgesia alone during the initial 24 h after cardiac surgery.

The efficacy of administering a perfluorochemical-based oxygen therapeutic such as perflubron emulsion (Oxygent™) prior to ischaemia is currently unknown, although there is evidence for potential beneficial effects for the perioperative treatment in cardiac risk patients. This experimental study investigated the efficacy of perflubron emulsion in preventing reperfusion injury and myocardial infarction size after coronary ischaemia and reperfusion. The perflubron emulsion was given either in a prophylactic manner, prior to induction of myocardial ischaemia, or as a therapeutic agent given during ischaemia.

Thirty-two anaesthetized and mechanically ventilated rats were subjected to 25 min occlusion of the left coronary artery followed by 120 min reperfusion. Animals were randomized to one of four groups: Group 1 was treated with administration of 6 g kg−1 intravenous perflubron emulsion 25 min before occlusion; Group 2 received the same dose 10 min after occlusion; and Groups 3 and 4 received no perflubron emulsion. Inspired O2 (FiO2) concentration was maintained at 1.0 in Groups 1, 2 and 3 and at 0.35 in Group 4.

Neither prophylactic nor therapeutic perflubron emulsion treatment reduced infarct size measurements by triphenyltetrazolium-chloride staining or severity of cardiac arrhythmias in comparison to the hyperoxic control group. However, prophylactic application of perflubron emulsion reduced areas of impaired perfusion vs. Group 3 assessed by in vivo staining with Thioflavin-S while no significant effect was seen in Groups 2 and 4 vs. 3. Density of DNA single-strand breaks in the ventricle was increased in all groups ventilated with 100% oxygen.

Although administration of perflubron emulsion did not reduce infarct size, areas of impaired perfusion were significantly mitigated when perflubron emulsion was administered prior to coronary occlusion. However, a high oxygen concentration may provoke DNA strand breaks during reperfusion after ischaemia. Further studies must clarify whether enhanced oxidative stress outweighs the advantage of improved areas of impaired perfusion following perflubron emulsion.