The long QT syndrome is a disorder of myocardial electrical conduction that leaves the heart vulnerable to the ventricular tachydysrhythmia torsade de pointes. Clinically, this results in syncope or sudden death. The long QT syndrome may be congenital, if caused by abnormal myocardial potassium or sodium ion channels, or acquired, if due to drugs, electrolyte abnormalities or metabolic conditions. Triggers for the development of torsade de pointes include both anaesthesia and surgery. Some anaesthetic agents prolong the QT interval. The condition is reviewed and suggestions are made for the anaesthetic management of affected patients.

Background and objective: The effects of administering albumin 5%, hydroxyethylstarch 6% and succinylated gelatine 4% on oxygen transport and left ventricular function were prospectively investigated in different experimental conditions: baseline, fluid load, after 10 min of myocardial ischaemia and after reperfusion.

Methods: Twenty-seven rabbits received at random one of three colloids in escalating boluses over 10–15 min to achieve left ventricular end-diastolic pressures (LVEDP) between 8 and 10 mmHg. A branch of the left anterior descending coronary artery was then temporarily occluded by a ligature and released after 10 min. Myocardial function was assessed using left ventricular pressure recordings and dimension data obtained from ultrasound crystals inserted onto the ventricular wall. Blood was sampled for the determination of oxygen delivery and consumption, the oxygen extraction ratio, acid-base status, and glucose and lactate concentrations.

Results: Administration of the colloids similarly increased oxygen delivery and improved left ventricular function in all groups. Peak rate of pressure development (dP/dtmax) and oxygen delivery were reduced during ischaemia and reperfusion. The decrease in dP/dtmax was more pronounced in the hydroxyethylstarch group.

Conclusions: Administration of albumin 5%, hydroxyethylstarch 6% and succinylated gelatine 4% had similar effects on oxygen delivery and myocardial function. After ischaemia and during reperfusion, the decrease in myocardial function was most pronounced with hydroxyethylstarch 6%.

Background and objective: Liver transplantation is characterized by several changes in intravascular blood volume due to vasodilatation based on neurohumoral mediators, intraoperative bleeding and anaesthesia technique effects. Today, with the transpulmonary indicator dilution technique, cardiac index (CIart) can be evaluated and preload assessed in terms of the intrathoracic blood volume index (ITBVI). The aim was to analyse in patients undergoing liver transplantation two preload variables, pulmonary artery occlusion pressure (PAOP) and ITBVI with respect to cardiac index (CIpa) and stroke volume index (SVIpa), the correlation between ITBVI and PAOP, and secondary the relationship between the changes (Δ) of ITBVI and PAOP and the changes of CIpa and SVIpa, and the relationships between ΔITBVI and ΔPAOP. The reproducibility and precision of all CIart and CIpa measurements were also evaluated.

Methods: A prospective study was performed in 60 patients monitored with a pulmonary artery catheter and with the PiCCO® system. The variables were evaluated with a linear regression model.

Results: Linear regression analysis between ITBVI-CIpa and ITBVI-SVIpa were r2 = 0.47 (P < 0.0001) and r2 = 0.55 (P < 0.0001) respectively, while PAOP poorly correlated to CIpa (r2 = 0.02), SVIpa (r2 = 0.015) and ITBVI (r2 = 0.002). Only changes in ITBVI were correlated with changes in CIpa (Δ1, r2 = 0.37; Δ2, r2 = 0.32), and SVIpa (Δ1, r2 = 0.60; Δ2, r2 = 0.47). The mean bias between CIart and CIpa was 0.13 L min−1 m−2 (2 SD = 1.04 L min−1m−2) (r2 = 0.86, P < 0.0001).

Conclusions: In comparison with PAOP, ITBVI seems a more reliable indicator of cardiac preload in patients undergoing liver transplantation.

Background and objective: To elucidate the effects of various degrees of hypotension induced by the calcitonin gene-related peptide (CGRP) on the splanchnic circulation, we investigated the renal and hepatic blood flow during hypotension induced by either the calcitonin gene-related peptide or sodium nitroprusside in the isofluraneanaesthetized dog.

Methods: Anaesthesia was maintained with 1.3% isoflurane in oxygen. After the baseline period, mean arterial pressure was reduced to 60 mmHg in the CGRP60 and nitroprusside groups, and to 50 mmHg in the CGRP50 group. The splanchnic organ blood flow was measured by hydrogen clearance.

Results: The cardiac index in the CGRP60 group increased (P < 0.01), but in the CGRP50 group it decreased (P < 0.01), and in the nitroprusside group it remained unchanged during hypotension. Mean pulmonary artery and pulmonary capillary wedge pressures in the CGRP60 group remained unchanged, but in the CGRP50 and nitroprusside groups they decreased (P < 0.01) during hypotension. Cardiac contractility in the CGRP60 group remained unchanged, whereas in the CGRP50 and nitroprusside groups it was reduced (P < 0.01) during hypotension. Renal blood flow in the CGRP60 group was relatively well maintained but in the CGRP50 and nitroprusside groups it was reduced (P < 0.01) throughout the observation. Hepatic blood flow in all three groups was reduced (P < 0.01) during hypotension. The reductions in hepatic blood flow between the Calcitonin gene-related peptide groups were associated with a dose-dependent decrease in mean arterial pressure.

Conclusions: The results suggest that calcitonin gene-related peptide acts as an arteriolar vasodilator at low doses but as a vasodilator of the arteriolar and venous systems at higher doses, and that profound hypotension induced by the calcitonin gene-related peptide may impair splanchnic circulation.

Background and objective: Non-depolarizing neuromuscular blocking agents have a shorter duration of action on the diaphragm than on skeletal muscles. It was to be tested if this also held true for rapacuronium, a shortacting, amidosteroid non-depolarizing neuromuscular blocker, lately withdrawn from the market, using a novel technique for stimulating the diaphragm and assessing its function.

Methods: Anaesthesia was induced with propofol 2 mg kg−1 and remifentanil 1 μg kg−1, and the trachea was intubated after topical anaesthesia. Rapacuronium was given at a dose of 1.5 mg kg−1. The diaphragm was stimulated by cervical magnetic stimulation of the phrenic nerves (2 Tesla, single coil) and airway pressure responses were measured at the endotracheal tube connector. The neuromuscular effects at the adductor pollicis and orbicularis oculi muscles were measured by acceleromyography.

Results: Fifteen males and five females (ASA I and II; 27 ± 8 yr; 73 ± 13 kg; mean ± SD) were recruited. Median maximal relaxation was less (P < 0.01) for the diaphragm (89%) than for the adductor pollicis or orbicularis oculi muscles (each 100%). The time to 25% recovery was shorter for the diaphragm than for adductor pollicis or orbicularis oculi (7.5 ± 3.1 versus 14.1 ± 3.7 and 15.1 ± 3.5 min, respectively, P < 0.01). Recovery from 25 to 75% was identical for the diaphragm and adductor pollicis (9.4 ± 2.9 versus 9.1 ± 3.5 min), but longer for orbicularis oculi (13.4 ± 4.2 min, P < 0.01). The median recovery time to TOF0.8 was shorter for the diaphragm (23.9 min) than for the adductor pollicis or orbicularis oculi muscles (31.5 and 28.4 min, respectively; P < 0.05).

Conclusions: As with other non-depolarizing muscle relaxants, the duration of the clinical effect of rapacuronium was shorter for the diaphragm than for skeletal muscle. The recovery index was identical for the diaphragm and adductor pollicis.

Background and objective: To assess the publication rate of full papers presented as abstracts at the 1995 meeting of the European Society of Anaesthesiologists, and to assess factors that might predict subsequent full publication.

Methods: All abstracts presented at the meeting and published in the British Journal of Anaesthesia (Suppl 1, 1995) were included. To verify subsequent full publication, a MEDLINE search was performed and validated. We studied the average time from the meeting to publication, the first author's country, the subspeciality, the publishing journal of the full report, the type of presentation (oral or poster), the object of investigation, and the quality of research design and of statistical reporting in the abstract.

Results: Of 472 meeting abstracts, 199 (42.2%) were eventually published. The average (± SD) delay between meeting and publication was 16.8 (15.6) months (range 24–60 months). Most papers (79.4%) had been published within 3 yr of the meeting. Circulation, pharmacology and intensive care papers had the highest rates of publication. Sixty-three journals attracted papers, with the British Journal of Anaesthesia publishing most (n = 29). No difference in subsequent publication was found between oral and poster presentations. Randomized trials and animal research were more likely to be published. The number of authors or their positions differed between the abstract and the full publication in 145 cases (72.9%); the first author was changed in 43 cases.

Conclusions: Less than half of the abstracts accepted at the 1995 European Society of Anesthesiologists' meeting were subsequently published in journals indexed by MEDLINE in the 3 yr following the meeting. Many changes in authorship occurred between the abstract and the full publication. The study architecture and the object of investigation predicted full publication.