We have investigated the effects of midazolam and diazepam on intracellular calcium (Ca2+) handling in foetal mouse ventricular myocytes using the Ca2+-sensitive fluorescent indicator, indo-1. We also investigated separately whether flumazenil or the L-type Ca2+channel agonist, Bay K8644, antagonized these myocardial depressive effects. Midazolam and diazepam decreased the Ca2+transient and beating rate in a concentration-dependent manner, and these decreases were prevented by Bay K8644. Flumazenil did not antagonize the myocardial depressive effects. In myocytes whose sarcoplasmic reticulum was inhibited by ryanodine, midazolam and diazepam had the same potent cardiodepressive effects. Midazolam and diazepam are direct cardiac depressants, which decrease the Ca2+transient and beating rate, and the L-type Ca2+channel is important in the negative inotropism and chronotropism caused by these drugs.

The dose-response and concentration-response relation of rocuronium infusion was studied in 20 adult surgical patients during propofol-nitrous oxide and isoflurane (1 MAC) -nitrous oxide anaesthesia. Neuromuscular block was kept constant, initially at 90% and then at 50% with a closed-loop feedback controller. At 90% block the steady-state infusion of rocuronium was 0.55 ± 0.16 mg kg−1 h−1 and the corresponding concentration 1714 ± 281 ng mL−1 in patients receiving propofol. At 50% block the corresponding infusion rate was 0.27 ± 0.11 mg kg−1 h−1 and the concentration 1077 ± 244 ng mL−1, respectively. At 50% block isoflurane reduced the rate of infusion by 52% (P < 0.005) and the concentration by 59% (P < 0.001); at 90% block both the mean infusion rate and the concentration of rocuronium were reduced by 35% (P <0.005). The mean rocuronium clearance at 50% block was unaffected by the type of anaesthesia; it was 4.1 ± 1.6 and 4.9 ± 2.7 mL kg−1 min−1 in the groups receiving propofol and isoflurane anaesthesia, respectively. We conclude that isoflurane reduces the infusion requirements of rocuronium by changing the pharmacodynamic behaviour.

In this prospective study techniques for the subcutaneous ring block of the penis and subpubic block of the penis for analgesia after circumcision were compared. Forty-five boys having circumcision as day-case patients were allocated randomly to have either a subcutaneous ring block or a subpubic penile block. The blocks were inserted after induction of anaesthesia but before surgery. Pain scores at 15, 30, 45 and 60 min post-operatively were recorded. Side effects and analgesic requirements in hospital were recorded post-operatively. Analgesia (morphine, paracetamol or diclofenac) was given depending on the pain score. One patient was withdrawn from the study. Four of the 24 boys who had subpubic penile blocks and nine of the 16 boys who had subcutaneous ring blocks were given morphine for post-operative pain (P = 0.015). The surgeons complained about oedematous tissues in three patients, all of whom had had subcutaneous ring blocks. The subpubic penile block provided significantly better analgesia than the subcutaneous ring block of the penis.

We have used eltanolone and propofol to induce anaesthesia and by intermittent injection to supplement nitrous oxide during maintenance in 67 patients undergoing minor gynaecological surgery. This study was a controlled randomized phase III with two parallel groups and a blinded assessment of post-operative recovery. Complications during induction and maintenance were few. Urticaria occurred in two patients given eltanolone and in none of those given propofol. Time to orientation and time to eye opening were significantly shorter in the propofol group (P < 0.001). Systolic and diastolic blood pressure decreased in both groups but the decrease was significantly greater in the propofol group (P < 0.005 systolic blood pressure; P < 0.001 diastolic blood pressure). Heart rate decreased significantly in the propofol group (P < 0.002). We conclude that eltanolone anaesthesia is associated with a greater haemodynamic stability than propofol anaesthesia but that early recovery occurs more slowly.

All the anaesthetic machines in one District General Hospital were tested for faults on three occasions for both audit and re-audit using an extended checklist based on that devised by the Association of Anaesthetists of Great Britain and Ireland. Ninety completed checklists were analysed for the audit and 24 tests revealed 236 individual faults (range 1.1–64%). Sixty-five (27.5%) could have occurred on a day-to-day basis and 171 (72.5%) of the faults were non-recurring. Following introduction of COVERS (a pre-use checklist) re-audit of 102 completed checklists showed 20 tests revealing faults on 59 occasions (range 1.0–11.6%), 16 (27%) day to day and 43 (73%) non-recurring. COVERS supported by scheduled regular comprehensive checking delegated to another time and performer is recommended as the mandatory pre-use checklist.

The cross-sectional area of the common carotid artery bulb was measured using a 5 MHz pulse wave Doppler probe in a patient undergoing general anaesthesia using a laryngeal mask airway (LMA). A simultaneous measurement of blood velocity was performed to allow determination of the blood flow. Following inflation of the cuff on the LMA, the cross-sectional area of the right carotid artery bulb decreased from 1.09 to 0.89 cm2, flow velocity increased 120 to 176 cm s−1 and the blood flow increased from 130.8 to 156.6 cm3 s−1. On the left the cross-sectional area decreased from 1.16 to 1.13 cm2, the velocity increased 136 to 151 cm s−1 and the blood flow increased from 157·8 to 170·6 cm3 s−1 . While a reduction in cross-sectional area was observed in the carotid bulb in this patient, this was accompanied by an increase in the velocity and a consequent increase in blood flow. In patients with atheromatous disease involving the carotid arteries this decrease in cross-sectional area may prove clinically significant. The use of the LMA may not be suitable for this population.

In this case report an unusual complication is described following insertion of a Swan Ganz catheter. A 79-year-old male patient experienced knotting of the catheter. Methods of avoiding this problem and removal of a knotted catheter are discussed.