This was a prospective, single-blinded randomized study. We enrolled 500 parturients in active labour. The primary outcome was complete relief of labour pain assessed at 30 min. We also assessed the occurrence of paresthesias, intravascular and intrathecal placement, catheter replacement, and treatment of breakthrough pain during labour. Comparisons were made using Pearson's ², with significance determined at the 0.05 level.

Four hundred and ninety-three subjects completed the study. Initial analgesia was similar (complete labour analgesia: end-holed=85% vs 80% 95% CI of difference: 13% to –3%; P=NS). The incidence of paresthesia was similar (end-holed=3.6% vs 5.3%; P=NS). There was one intrathecal and three intravascular catheters in the three-holed group and two intravascular catheters in the end-holed group. The number of supplemental boluses and catheter replacements required during labour was similar between the groups.

There were no differences in the initial analgesia success rate, complications, or labour analgesia between end-hole vs multi-hole flexible epidural catheters.

Fifty-two adult patients undergoing open appendicectomy were randomized to undergo standard care (n=26) or to undergo a right-sided TAP block with bupivacaine (n=26). In addition, all patients received patient-controlled i.v. morphine analgesia, regular acetaminophen, and non-steroidal anti-inflammatory drug, as required, in the postoperative period. All patients received standard anaesthetic, and after induction of anaesthesia, the TAP group received an ultrasound-guided unilateral TAP block. Each patient was assessed after operation by a blinded investigator at 30 min and 24 h after surgery.

Ultrasound-guided TAP block significantly reduced postoperative morphine consumption in the first 24 h [mean (sd) 28 (18) vs 50 (19) mg, P<0.002]. Postoperative visual analogue scale pain scores were also reduced in the TAP block group soon after surgery [median (IQR) 4.5 (3–5.3) vs 8.5 (7.5–10), P<0.001] and at 24 h [5.2 (4–6.2) vs 8 (7–8.5), P<0.001]. There were no complications attributable to the TAP block.

Ultrasound-guided TAP block holds considerable promise as a part of a balanced postoperative analgesic regimen for patients undergoing open appendicectomy.

We conducted a retrospective analysis of theatre logbook data from 62 Specialist Registrars (SpRs) who had completed a 12 month period of advanced training in paediatric anaesthesia in our institution between 2000 and 2007.

After the implementation of the WTD 56 h week in 2004, the mean total number of cases performed by SpRs per year decreased from 441 to 336, a 24% reduction. We found a statistically significant reduction across all age groups with the largest reduction in the under 1 month of age group. The post-WTD group did not meet the RCoA recommended total minimum caseload or the minimum number of cases of <1 yr of age.

Since the implementation of the WTD, there has been a significant reduction in the number of cases performed by SpRs in paediatric anaesthesia and they are no longer achieving the RCoA recommended minimum numbers for advanced training.

We prospectively studied 3093 adult patients (aged 18–77 yr), over a 3 yr period who required tracheal intubation. Postoperative hoarseness was assessed on the day of operation and on postoperative days 1, 3, and 7 by standardized interview by the resident anaesthetist managing the patient. If postoperative hoarseness was still present on postoperative day 7, the patient was followed up until complete resolution. We evaluated age, gender, weight, Cormack grades, duration of intubation, and the anaesthetic agents used as factors affecting the duration of hoarseness after tracheal intubation.

Hoarseness was observed in 49% of patients on the day of surgery and in 29%, 11%, and 0.8% on 1, 3, and 7 postoperative days, respectively. Multiple regression analysis showed that patient age and duration of intubation, but not gender, weight, Cormack grades, or the agents used, were significant predictors of increased duration of hoarseness after tracheal intubation. We found three patients with arytenoid cartilage dislocation (0.097%) in our study population.

The age of the patient and duration of intubation were significant factors in the duration of hoarseness after tracheal intubation. In addition, the incidence of arytenoid cartilage dislocation was 0.097%.

Twelve patients were recruited with a mean (sd) symptom duration of 13.7 (8.2) years. Bilateral DRG blocks of L1 and L2 were performed using methylprednisolone 80 mg, clonidine 75 µg and 0.5% bupivacaine 4 ml in each patient.

Analysis of Brief Pain Inventories showed no significant change in pain scores.

We conclude that blocks of this nociceptive pathway in humans using bilateral DRG blocks has no therapeutic value.

Forty-eight patients were randomly assigned to two groups. The GA group received general anaesthesia PCA and PCA with opioids (fentanyl 6 µg ml^–1 and tramadol 3 mg ml^–1). The GEA group received combined general/epidural anaesthesia plus patient-controlled epidural analgesia (PCEA). Holter recording was completed for 12 h before operation and 12 and 48 h after operation. The incidence of supraventricular tachycardias (SVT), atrial fibrillation, and supraventricular ectopic beats (SVEBs) was evaluated.

The incidence of postoperative SVT was significantly lower in the GA group than in the GEA group (3/22 vs 10/22, P=0.021). The incidence of postoperative SVEBs was not statistically different between the groups, but the frequency of postoperative SVEBs increased less in the GA than the GEA group (7/22 vs 15/22, P=0.016).

PCA with opioids (fentanyl and tramadol) can reduce postoperative SVA after pulmonary resection compared with PCEA with ropivacaine.

We conducted an audit of transthoracic and transoesophageal echocardiograms, performed by an anaesthetist at a tertiary referral centre over a 9-month period, to identify the effect of echocardiography on clinical decision-making in patients undergoing non-cardiac surgery. The indications for echocardiography followed published guidelines.

Echocardiographic examinations of 97 patients included 87 transthoracic, and 14 transoesophageal studies. Of 36 studies conducted in the preoperative clinic, eight revealed significant cardiac pathology, necessitating cardiology referral or admission before surgery. Preoperative transthoracic echocardiograms performed on the day of surgery (n=39) led to two cancellations of surgery owing to end-stage cardiac disease, the institution of two unplanned surgical procedures (drainage of pleural and pericardial effusions), and to significant changes in anaesthetic and haemodynamic management, or both in 18 patients. Greater influence on management occurred with emergency surgery (75%) than elective surgery (43%). Intraoperative transthoracic (n=10) and transoesophageal (n=14) echocardiography also altered management (altered surgery in two patients, cancellation in one, and altered haemodynamic management in 18 patients).

Anaesthetist-performed point-of-care TTE and thoracic ultrasound may have a high clinical impact on the perioperative management of patients scheduled for non-cardiac surgery.

We investigated the effects of DEX on ion channels in NG108-15 neuronal cells differentiated with dibutyryl cyclic AMP and in cultured cerebellar neurones.

DEX suppressed the amplitude of delayed rectifier K⁺ current [I_K(DR)] in a concentration-dependent manner with an IC₅₀ value of 4.6 µM in NG108-15 cells. No change in the steady-state inactivation of I_K(DR) was evident in the presence of DEX. A minimal binding scheme was also used to evaluate DEX-induced block of I_K(DR). Inhibition of I_K(DR) by DEX was still observed in cells preincubated with yohimbine (10 µM) or efaroxan (10 µM). DEX depressed the peak amplitude of Na⁺ current (I_Na), whereas it had minimal effect on L-type Ca²⁺ current. Under current-clamp configuration, DEX increased the duration of action potentials (APs). I_K(DR) and I_Na in response to AP waveforms were more sensitive to block by DEX than those elicited during rectangular pulses. In isolated cerebellar granule cells, DEX also effectively suppressed I_K(DR).

The effects of DEX are not limited to its interactions with ₂-adrenergic receptors. Inhibitory effects on I_K(DR) and I_Na constitute one of the underlying mechanisms through which DEX and its structurally related compounds might affect neuronal activity in vivo.

Seventy consenting patients were randomized to have tracheal intubation with the GlideScope^® (n=35) or the Airway Scope^® (n=35). In all patients, we applied manual in-line stabilization of the cervical spine throughout airway management. All the airway procedures were carried out by two anaesthetists experienced in the use of both videolaryngoscopes.

The tracheal intubation time was 34.2 (sd 25.1) s with the Airway Scope^® compared with 71.9 (47.9) s with the GlideScope^® (P<0.001). Tracheal intubation was successful with the Airway Scope^® in 35 (100%) patients compared with 31 (88.6%) patients with the GlideScope^® (P=0.114). Tracheal intubation was successful within 60 s in 33 (94.3%) patients with the Airway Scope^® and 22 (62.9%) patients with the GlideScope^® (P=0.003).

These results suggest that the Airway Scope^®'s tube guide system enables more rapid tracheal intubation compared with the GlideScope^® in patients with cervical spine immobilization.

After obtaining parental consent, 120 paediatric patients were allocated randomly into one of the three groups (n=40, in each). The patients in the alfentanil group received alfentanil 15 µg kg^–1 90 s before the propofol injection. The patients in the lidocaine group received propofol 3 mg kg^–1 premixed with lidocaine 0.1% over a 15 s period. The patients in the combination group received both alfentanil and lidocaine.

The incidence of propofol injection pain (severity 2 or more) in the combination group (2.6%) was significantly lower than that in the alfentanil and lidocaine groups (30% and 38.5%, respectively) (P=0.001 and <0.001, respectively). No patient in the combination group complained of moderate or severe pain from propofol injection.

Our study demonstrated that the combination treatment of two different analgesic modalities, alfentanil and lidocaine, could prevent the moderate and severe pain on propofol injection, and reduce the incidence of mild pain compared with each drug alone.

BIS and SE/RE indices were recorded continuously in elderly (≥65 yr) and young (≤40 yr) surgical patients who received propofol until loss of consciousness (LOC) using stepwise increasing effect-site concentrations. LOC was defined as an observer assessment of alertness/sedation score <2, corresponding to the absence of response to mild prodding or shaking.

We analysed 35 elderly [average age, 78 yr (range, 67–96)] and 34 young [35 (19–40)] patients. At LOC, all indices were significantly higher in elderly compared with young patients: BIS_LOC, median 70 (range, 58–91) vs 58 (40–70); SE_LOC, 71 (31–88) vs 55.5 (23–79); and RE_LOC, 79 (35–96) vs 59 (25–80) (P<0.001 for all comparisons). With all three monitors, only a minority of elderly patients lost consciousness within a 40–60 index range: two (5.7%) with BIS and RE each, and seven (20%) with SE. In young patients, the respective numbers were 20 (58.8%) for BIS, 13 (38.2%) for SE, and nine (26.5%) for RE.

In adults undergoing propofol induction, BIS, SE, and RE indices at LOC are significantly affected by age.

Children having anaesthesia for elective surgery lasting longer than 90 min in ambient temperature 21°C were warmed by a ‘Bair Hugger’ attached to a custom-built heat dissipation unit. Relationships between child and procedure characteristics and various thermal measures were analysed, and a thermodynamic model was evaluated.

Thirty-nine children (aged 2 days to 12.5 yr) were studied. There were statistically significant correlations between a number of factors (e.g. height and weight) and heating efficacy. Our model demonstrated the impact of changing patient characteristics on temperature profiles. Neither the morphological characteristics nor our model could predict an individual's T_core behaviour.

(i) Although the effectiveness of this warming technique is influenced by patient/procedure characteristics, these do not predict normothermia (uncertainty ±28 min). Effectiveness is independent of simple thermal measures. (ii) Previously described measures of vasoconstriction are not valid in children. (iii) Our model shows children's thermal properties change with their T_core._. However, key factors are unknown for an individual and our model does not predict heating efficacy. (iv) To minimize the risk of hyperthermia, we recommend continuous measurement of T_core during convection heating. The device air temperature should be turned to medium (38°C) as T_core approaches 37°C.

Sixty patients (6 months to 6 yr) were evenly and randomly assigned into three groups in a double-blinded manner. After sevoflurane in oxygen anaesthesia, each patient received a single caudal dose of bupivacaine 0.25% (1 ml kg^–1) combined with either dexmedetomidine 2 µg kg^–1 in normal saline 1 ml, clonidine 2 µg kg^–1 in normal saline 1 ml, or corresponding volume of normal saline according to group assignment. Haemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, use of analgesics, and side-effects were assessed during the first 24 h.

Addition of dexmedetomidine or clonidine to caudal bupivacaine significantly promoted analgesia time [median (95% confidence interval, CI): 16 (14–18) and 12 (3–21) h, respectively] than the use of bupivacaine alone [median (95% CI): 5 (4–6) h] with P<0.001. However, there was no statistically significant difference between dexmedetomidine and clonidine as regards the analgesia time (P=0.796). No significant difference was observed in incidence of haemodynamic changes or side-effects.

Addition of dexmedetomidine or clonidine to caudal bupivacaine significantly promoted analgesia in children undergoing lower abdominal surgeries with no significant advantage of dexmedetomidine over clonidine and without an increase in incidence of side-effects.

We configured nine virtual patients within the Nottingham Physiology Simulator, each with a unique pulmonary configuration but identical arterial blood gases at Fi_o2 30%, Pa_co2 6.0 kPa and Hb 8.0 g dl^–1. Factors (Fi_o2, P_co2, Hb) were varied independently and indices of oxygenation including calculated venous admixture (Qs/Qt), arterial oxygen tension (Pa_o2/Fi_o2), arterio-alveolar gas tension gradient (Pa–a_o2), and respiratory index (Pa–a_o2/Pa_o2) were recorded.

All indices varied with Fi_o2, with greatest variation with lung defects having least true (absolute) shunt. Calculated Qs/Qt resisted induced variation best of all the indices, but varied by 30% of its mean value during Fi_o2 variation. Pa_o2/Fi_o2 varied greatly, especially during variation in Fi_o2 (up to 74% of its average value), and most markedly in defects with little true (absolute) shunt. Pa_co2 and Hb variation caused small, consistent changes in all indices that were similar between lung-states.

No existing index of oxygenation adequately describes the severity of gas exchange defect. Existing indices of oxygenation vary with disease severity, disease type, and external factors such as Fi_o2. A novel and robust index is needed.

A cohort of patients with hip fractures were extracted from a prospective observational study of high-risk patients (ASA class III or IV) undergoing emergency surgery. NT-proBNP and troponin I were measured before operation. An NT-proBNP ≥3984 ng litre^–1 was set as the cut-off level for significance. Perioperative adverse cardiac events and 30 day and 3 month mortality were recorded.

Sixty-nine subjects were included. Thirty-four subjects (49%) had an NT-proBNP ≥3984 ng litre^–1 before surgery. Thirty-four subjects (49%) had a perioperative adverse cardiac event. Of these, 22 subjects (65%) had NT-proBNP above the diagnostic threshold compared with 12 subjects (34%) who had an NT-proBNP below the diagnostic threshold (P=0.01). Preoperative NT-proBNP ≥3984 ng litre^–1 [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.0–8.9] and congestive heart failure (OR 3.0; 95% CI 1.0–9.0) were independent predictors of perioperative adverse cardiac events. A total of eight subjects (12%) died within 30 days after operation.

There is a high incidence of elevated NT-proBNP in subjects undergoing non-elective hip fracture surgery. Preoperative NT-proBNP is a valuable predictor of cardiac complications in the perioperative period.

Forty patients undergoing laparoscopic cholecystectomy were studied. All patients were monitored with both monitors and were randomly allocated into two groups according to the monitor used to titrate propofol administration. Propofol was administered to maintain BIS or CSM within 40 and 60. Propofol consumption and clinical markers of recovery were assessed after surgery.

In the CSM group, the values of cerebral state index (CSI) and BIS were 47 (5) and 38 (6), respectively (P=0.00054). In the BIS group, the values of CSI and BIS were 47 (5) and 45 (2), respectively (P=0.15). In the BIS group, the total amount of propofol used was lower [109 (20) µg kg^–1 min^–1] than in the CSM group [130 (27) µg kg^–1 min^–1] (P=0.018). The time to eye opening was lower in the BIS [7.2 (3.5) min] than in the CSM group [10.7 (6.6)] (P=0.038). There were no differences in fentanyl consumption, or in other clinical markers of recovery.

Compared with BIS, propofol anaesthesia guided with CSI resulted in 20% higher propofol doses. This, however, does not lead to clinically relevant differences in recovery times.

Data were obtained from a randomized controlled study of 80 pregnant women undergoing an elective Caesarean section. All women had an arterial line inserted, and LidCOPlus was used for measuring cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR).

Twenty women required a second bolus of oxytocin 5 u. Both the first and the second doses produced clinically and statistically significant haemodynamic changes, but the haemodynamic changes induced by the second dose were smaller than after the first dose. The mean maximal change in CO after the first and second doses were 94% (CI 70–117) and 42% (CI 33–52), respectively (P<0.0001), and for systolic arterial pressure 31% (CI 27–35) and 23% (CI 20–27), respectively (P=0.003).

An initial bolus of oxytocin 5 u produced prominent haemodynamic changes, whereas a second bolus produced smaller changes. This could be due to desensitization of endothelial oxytocin receptors.

Before induction of anaesthesia, the degree of stress and anxiety was assessed in 135 patients using stress and anxiety questionnaires, bio-feedback, physiological measures, and serum levels for stress variables. Questionnaire responses and physiological measures such as arterial pressure, heart rate, skin conductance, cortisol, and catecholamine levels were compared for day-care patients and inpatients.

Significant preoperative anxiety was reported by 34 (45.3%) inpatients and 23 (38.3%) day-care patients. Personal responses in stress and anxiety questionnaires and mean values of arterial pressure and heart rate did not differ significantly in day-care patients when compared with inpatients. Correlation between deviations in plasma cortisol concentrations from normal diurnal distribution and anxiety scores and stress scores was also similar, and the relative increase in preoperative stress variables and measures observed in day-care patients and inpatients was also comparable. Bio-feedback measurements revealed significantly higher preoperative skin conductance (P<0.001) in day-care patients than in inpatients, indicating increased vegetative stress responses.

Preoperative anxiety and stress are common in surgical patients. Questionnaires and bio-feedback measurements may help to assess the degree of patients’ burdens. Surgeons should be aware of the personal anxiety of patients and consider patient preferences when deciding who should undergo fast-track surgery in day-care.

In perioperative and intensive care patient populations (n=68 total), double-sensor measurements were compared with measurements from a distal oesophageal thermometer using Bland–Altman analysis and Lin's concordance correlation coefficient (CCC).

Overall, 1287 measurement pairs were obtained at 5 min intervals. Ninety-eight per cent of all double-sensor values were within ± 0.5°C of oesophageal temperature. The mean bias between the methods was –0.08°C; the limits of agreement were –0.66°C to 0.50°C. Sensitivity and specificity for detection of fever were 0.86 and 0.97, respectively. Sensitivity and specificity for detection of hypothermia were 0.77 and 0.93, respectively. Lin's CCC was 0.93.

The new double-sensor thermometer is sufficiently accurate to be considered an alternative to distal oesophageal core temperature measurement, and may be particularly useful in patients undergoing regional anaesthesia.

Fifteen obese patients with a BMI of ≥30 and 23 non-obese patients (BMI 18–25) undergoing coronary artery bypass grafting (CABG) were included. Simultaneous CO measurements by bolus thermodilution and the FloTrac/Vigileo^TM device (software version 1.10) were obtained intraoperatively after induction of anaesthesia, before cardiopulmonary bypass (CPB), after CPB, and after sternal closure. Measurements in the intensive care unit (ICU) were performed upon arrival in the ICU, after 4, 8, and 24 h after surgery. CO was indexed to the body surface area (cardiac index, CI).

The analysis of 262 data pairs revealed a bias and precision of 0.19 and ± 0.66 litre min^–1 m^–2, resulting in a percentage error of 26.6%. Thermodilution CI values ranged from 1.1 to 4.2 litre min^–1 m^–2 [mean 2.4 (0.52) litre min^–1 m^–2]. Subgroup analysis resulted in a percentage error of 29.8% in obese patients and 24.4% in patients with normal BMI.

The semi-invasive FloTrac/Vigileo^TM device was found to adequately agree with bolus pulmonary artery thermodilution in both obese and non-obese patients undergoing CABG.

Eighteen Landrace–Large pigs were premedicated with ketamine and anaesthetized with propofol (4.5 mg kg^–1 bolus followed by 13 mg kg^–1 h^–1). After instrumentation, an electrophysiological evaluation was performed under propofol and repeated after remifentanil (bolus of 1 µg kg^–1, followed by an infusion of 0.5 µg kg^–1 min^–1). We evaluated sinus node function [sinus node recovery time (SNRT) and sinoatrial conduction time (SACT)], atrioventricular (AV) nodal function [AH intervals during sinus rhythm (SR) and atrial pacing, Wenckebach cycle length (WCL), and effective refractory periods (ERP)], atrial, His-Purkinje, and ventricular conduction and refractoriness. Significant changes between ‘propofol protocol’ and ‘propofol+remifentanil protocol’ were evaluated.

Remifentanil caused a significant increase in sinus cycle length (21%, P=0.001) and a significant prolongation of SNRT (43%, P=0.001), corrected SNRT (136%, P=0.003), SACT (40%, P=0.005), AH interval during SR (17%, P=0.02), AH interval during atrial pacing (25%, P=0.01), and ventricular ERP (12%, P=0.004). There was a tendency towards a prolongation of WCL and AV nodal refractoriness. Similar significant changes were observed in a reference group of seven animals in which sevoflurane was used instead of propofol. No significant changes were observed in atrial parameters, His-Purkinje function, parameters of intraventricular conduction, and QT intervals.

Remifentanil depresses sinus node function and most parameters of AV nodal function. This contributes to an explanation for clinical observations of remifentanil-related severe bradyarrhythmias.

A cohort of 103 812 consecutive patients planned for tracheal intubation by direct laryngoscopy was retrieved from the Danish Anaesthesia Database. We used an intubation score based upon the number of attempts, change from direct laryngoscopy to a more advanced technique, or intubation by a different operator. We retrieved data on age, sex, ASA physical status classification, priority of surgery, time of surgery, previous DTI, modified Mallampati score, BMI, and the use of NMBA. Using logistic regression, we assessed whether avoiding NMBA was associated with DTI.

The frequency of DTI was 5.1 [95% confidence interval (CI): 5.0–5.3]%. In a univariate analysis, avoiding NMBA was associated with DTI, odds ratio (OR) 1.52 (95% CI: 1.43–1.61)%, P<0.0001. Using multivariate analysis, avoiding NMBA was associated with DTI, OR 1.48 (95% CI: 1.39–1.58), P<0.0001. Among patients intubated using NMBA, a multivariate analysis identified patients anaesthetized with only non-depolarizing NMBA to be more at risk for DTI than those anaesthetized with depolarizing NMBA alone.

Avoiding NMBA may increase the risk of DTI. However, confounding by indication may be a problem in this observational study and systematic reviews with meta-analysis or more randomized clinical trials are needed.

This study was performed on a 50-bed intensive care unit of a tertiary care university hospital. Application of a ventilator bundle consisting of semirecumbent positioning, lung protective ventilation in patients with acute lung injury (ALI), ulcer prophylaxis, and deep vein thrombosis prophylaxis (DVTP) was assessed before and after staff training in post-surgical patients requiring mechanical ventilation for at least 24 h.

A total of 133 patients before and 141 patients after staff training were included. Overall bundle adherence increased from 15 to 33.8% (P<0.001). Semirecumbent position was achieved in 24.9% of patient days before and 46.9% of patient days after staff training (P<0.001). Administration of DVTP increased from 89.5 to 91.5% (P=0.048). Ulcer prophylaxis of >90% was achieved in both groups. Median tidal volume in patients with ALI remained unaltered. Days on mechanical ventilation were reduced from 6 (interquartile range 2.0–15.0) to 4 (2.0–9.0) (P=0.017). Rate of ventilator-associated pneumonia (VAP), ICU length of stay, and ICU mortality remained unaffected. In patients with VAP, the median ICU length of stay was reduced by 9 days (P=0.04).

Staff training by an ICU change team improved compliance to a pre-defined ventilator bundle. This led to a reduction in the days spent on mechanical ventilation, despite incomplete bundle implementation.

Fifteen (n=15) patients undergoing OLT were enrolled in this study. All patients were monitored with a modified pulmonary artery catheter which measured the cardiac output on a semi-continuous basis. A fluid challenge (FC) with 350 ml of colloid was attempted during the following stages of surgery: hepatectomy (TH), anhepatic phase (TA), early post-reperfusion [(TE)—during the first 30 min], late post-reperfusion [(TL)—after hepatic artery anastomosis], and at the beginning of abdominal closure (TC). PPV and stroke volume index (SVI) were recorded at baseline and 5 min after the FC. Each individual FC which raised the SVI more than 10% from baseline was classified as responsive (R); otherwise, it was considered non-responsive (NR).

Forty-one FCs were performed, with 14 (34%) classified as responsive and 27 (66%) as non-responsive. The baseline PPV did not differ significantly between the R and NR groups, showing considerable overlap of its values throughout the procedure [R vs NR; TH: 20% (inter-quartile range 7–32) vs 7% (5–14); TA: 10% (7–14) vs 19% (12–21), and TE+TL: 7% (5–11) vs 9% (7–16)].

Under the conditions of this study, the PPV index was not shown to be a reliable predictor of FR during OLT. Further studies are warranted to elucidate the role of this and other dynamic indexes in this specific setting.

We analysed parent–offspring transmission data from MH kindreds to assess whether there was any deviation from the expected autosomal dominant Mendelian inheritance pattern. We also evaluated informative single-nucleotide polymorphism (SNP) genotypes in a cohort of unrelated MH patients using genomic DNA (gDNA, prepared from leucocytes) and coding DNA (cDNA, prepared from skeletal muscle). Finally, we examined the segregation of specific mutations at the gDNA and cDNA level within MH families where positive RYR1 gDNA genotype/normal MH phenotype discordance had been observed.

In 2113 transmissions from affected parents, there was a consistent parent-of-origin effect (P<0.001) with affected fathers having fewer affected daughters (20%, 95% CI 17–22%) than affected sons (25%, 95% CI 23–26%) or unaffected daughters (27%, 95% CI 25–30%). No discrepancies were observed between the RYR1 SNP genotypes recorded at the gDNA and cDNA levels. In 14 MH negative individuals from 11 discordant families, the familial mutation was detected in skeletal muscle cDNA in all cases.

Epigenetic allele silencing may play a role in the inheritance of MH susceptibility, but this is unlikely to involve silencing of RYR1.

Forty-six consecutive patients undergoing elective cardiac surgical procedures were randomized for initial airway management with the cLMA or PLMA. Insertion time (IT), number of placement attempts, ease of placement, quality of the initial airway, maximum tidal volume (TV_max), and airway pressure at which an audible leak in the mouth (P_leak) occurred were collected. All data were recorded before performing tracheal intubations.

IT and success rate were similar for both LMAs. The initial quality of the airway was significantly better for the PLMA (P<0.05). TV_max and P_leak were significantly higher for PLMA (77 vs 58 ml, P<0.02 and 29.8 vs 24.4 cm H₂O, P<0.02). No adverse events were recorded during the study.

The size 1 PLMA forms a more effective seal than size 1 cLMA in neonates. This might allow the PLMA to be used in those newborn infants requiring high airway pressures for ventilation.

Nine diabetic and nine non-diabetic patients, undergoing routine coronary artery bypass grafting surgery, were studied using both microdialysis and the organ balance technique in the brachio-radial muscle of the forearm, and microdialysis in the pre-pectoral fat tissue. Glucose, lactate, and glycerol were measured in arterial and venous plasma and in the microdialysate before administration of heparin, at the release of the aortic cross-clamp, and before transfer to the intensive care unit.

Glucose release from the diabetic muscle at the last sampling time was detected. This was confirmed by a negative glucose A–I (arterial–interstitial difference) in the muscle. No differences were observed regarding lipolysis in the fat tissue in terms of A–I of glycerol. Intergroup differences were detected at the first sampling time, where arterial plasma glucose and plasma insulin levels were higher and muscle interstitial glucose lower in the diabetic patients. Plasma insulin was higher in the diabetic patients even at the final measurement time.

In terms of lipolysis in the fat tissue and glucose transport in the muscle, the non-diabetic patients were metabolically ‘diabetics’ during surgery. Despite strict blood glucose control, disturbances in glucose homeostasis in the diabetic muscle persist. Microdialysis was easy to use during cardiac surgery.

Forty patients undergoing laparoscopic prostatectomy were randomized to receive an i.v. infusion of either lidocaine 2 mg kg^–1 h^–1 during surgery and 1 mg kg^–1 min^–1 for the first 24 postoperative hours (lidocaine group) or an equivalent volume of saline 0.9% (control group). All patients received postoperative patient-controlled analgesia with i.v. morphine. Primary outcome was functional walking capacity, as assessed by distance attained during the 2 min walking test (2MWT), recorded daily for the first 3 postoperative days. Morphine consumption and pain intensity were recorded.

2MWT distance decreased by an average of 60% (P<0.01) in both groups on postoperative day 1 (from 150 m before surgery to 53 m), but the decrease was 26 m less in the lidocaine group (P=0.009). During postoperative days 2 and 3, the 2MWT distance increased to an average of 96 m, still 30% less than the preoperative values. There was a significant negative correlation on postoperative days 1 and 2 between the 2MWT distance, pain intensity and fatigue, and morphine consumption. Lidocaine infusion was an independent predictor of the degree of postoperative decrease in 2MWT distance. More patients in the lidocaine group were free from PCA on the second postoperative day (P=0.011).

Infusion of lidocaine during surgery and for the first postoperative day attenuated the deterioration in functional walking capacity, and had an opioid sparing effect.

Fifteen anaesthetized pigs [mean body weight 28 (sd 2) kg] were studied. Spiral computed tomography (CT) scans were obtained for analysis of lung tissue density. In Group 1 (n=5) mechanical ventilation (V_T=10 ml kg ^–1, Fi_o2=0.5) was applied, in Group 2 (n=5) Fi_o2 was increased for 30 min to 1.0 and in Group 3 (n=5) negative airway pressure was applied for 20 s in order to enhance development of atelectasis. Cardiopulmonary and CT data were obtained before, 10, and 90 min after induction of CO₂-PP at an abdominal pressure of 12 mmHg.

Before CO₂-PP, in Group 1 non-aerated tissue on CT scans was 1 (1)%, in Group 2 3 (2)% (P<0.05, compared with Group 1), and in Group 3 7 (3)% (P<0.05, compared with Group 1 and Group 2). CO₂-PP significantly increased atelectasis in all groups. Pa_o2/Fi_o2 fell and venous admixture (‘shunt’) increased in proportion to atelectasis during anaesthesia but CO₂-PP had a varying effect on Pa_o2/Fi_o2 and shunt. Thus, no correlation was seen between atelectasis and Pa_o2/Fi_o2 or shunt when all data before and during CO₂-PP were pooled. Pa-e'_CO2, on the other hand correlated strongly with the amount of atelectasis (r²=0.92).

Development of atelectasis during anaesthesia and PP may be estimated by an increased Pa-e'_CO2.

Pigs were randomized either to a control group, to standard CPB, to carbon monoxide+CPB, or to quercetin (a flavonoid and unspecific inhibitor of the heat shock response)+control, to quercetin+CPB, and to quercetin+carbon monoxide+CPB. In the carbon monoxide groups, lungs were ventilated with 250 ppm carbon monoxide in addition to standard ventilation before CPB. At various time points, lung biopsies were obtained and pulmonary Hsp and cytokine concentrations determined.

Haemodynamic parameters were largely unaffected by CPB, carbon monoxide inhalation, or administration of quercetin. Compared with standard CPB, carbon monoxide inhalation significantly increased the pulmonary expression of the Hsps 70 [27 (sd 3) vs 69 (10) ng ml^–1 at 120 min post-CPB, P<0.05] and 90 [0.3 (0.03) vs 0.52 (0.05) after 120 min CPB, P<0.05], induced the DNA binding of heat shock factor-1, reduced interleukin-6 protein expression [936 (75) vs 320 (138) at 120 min post-CPB, P<0.001], and decreased CPB-associated lung injury (assessed by lung biopsy). These carbon monoxide-mediated effects were inhibited by quercetin.

As quercetin, a Hsp inhibitor, reversed carbon monoxide-mediated pulmonary effects, we conclude that the anti-inflammatory and protective effects of preconditioning by inhaled carbon monoxide during CPB in pigs are mediated by an activation of the heat shock response.