The purpose of this prospective study was to identify the incidence of a distinct central anticholinergic syndrome following routine anaesthesia. For 2 months, all inpatients aged more than 15 years scheduled for elective procedures and cared for in the recovery room were investigated for symptoms of the syndrome. Patients with neuropsychiatric disease or other disorders that could alter consciousness were excluded. Prolonged action of anaesthetics or relaxants, respiratory depression and metabolic disorder were ruled out before making the diagnosis. Out of 962 patients (366 men, 596 women), 18 (4 men, 14 women) developed the syndrome. The difference between men and women was not statistically significant. Six out of 60 women developed the syndrome after a hysterectomy with or without adnectomy/oophorectomy, and this high incidence was significantly different from that observed after all other procedures in women (P = 0.003) or all other gynaecological procedures (P = 0.013). The reason for this is unknown. In six of the 18 cases, untreated prolonged somnolence lasted for more than 2 h. All patients woke up after an injection of physostigmine, but six of them relapsed into somnolence and needed a second, and in one case a third, injection. The findings of the study emorders phasize that, when there is delayed recovery from anaesthesia, the diagnosis of central anticholinergic syndrome should be considered if other accessible causes for that condition have been excluded.

In two consecutive, randomized, double-blind studies the effect of ondansetron on the time to induction of anaesthesia with propofol and, subsequently, thiopentone was assessed. In each study 40 patients received either ondansetron 8mg or placebo immediately before induction of anaesthesia with a standardized dose of propofol (2.5 mg kg−1) or thiopentone (5 mg kg−1). Times to induction of anaesthesia were determined by assessing loss of verbal response, motor power and eyelash reflex. There was no difference in either study in times to induction of anaesthesia between immediate pre-treatment with ondansetron or placebo. Side effects were minor and of similar incidence in the ondansetron and placebo groups.

A double-blind and randomized study design was used to investigate 100 healthy children, aged 1–5 years. Intubating conditions and cardiovascular changes duraning deep halothane anaesthesia, defined as an endtidal concentration of 2%, were compared with those changes during 1% halothane and suxamethonium relaxation. Intubating conditions were graded according to the ease of laryngoscopy, vocal cord position, coughing and jaw relaxation. In each group 96% of the children demonstrated acceptable intubating conditions. Jaw relaxation was worse in the 1% halothane/-suxamethonium group (P < 0.01). When anaesthesia with 2% or 1% halothane was compared there was a more pronounced decrease in systolic blood pressure (18 vs. 8%, (P < 0.001). Junctional rhythm occured more frequently during deep halothane anaesthesia (46 vs.18%, (P < 0.01). Intravenously (i.v.) administered atropine attenuated blood pressure depression significantly and reinstituted sinus rhythm in most cases.

Fourteen patients who underwent Charnley or Howse total hip replacement using CMW bone cement were studied. Mean values of C4 and C3 determined before the induction of anaesthesia and insertion of bone cement and also after this procedure showed no significant difference and were within the normal range. Furthermore, no evidence of C3 breakdown products was found. It was therefore concluded that neither the general anaesthetic technique nor the insertion of bone cement activated the classical or alternative complement pathways and such a mechanism was not responsible for the hypotension which occurred shortly after the insertion of bone cement in 10 cases studied.

The effect of the addition of clonidine 2 μg kg−1 to prilocaine 0.57% for intravenous regional anaesthesia (IVRA) in the arm was investigated in 56 healthy patients using a randomized, double-blind study. The characteristics of the sensory and motor block, quality of analgesia, development of post-operative pain sensations and haemodynamic variables were studied in three groups (IVRA with prilocaine, IVRA with prilocaine and clonidine, IVRA with prilocaine and systemic application of clonidine at tourniquet release). There were no significant differences between the groups concerning the onset and recovery characteristics of sensory and motor blockade, post-operative pain or side effects. In those patients receiving clonidine, mean arterial pressure decreased significantly (24–28%, respectively) after tourniquet release, while heart rate remained unchanged. Clonidine as an adjunct to prilocaine seems to be of limited benefit during and after intravenous regional anaesthesia.

Ketamine has been considered to be contraindicated for schizophrenic patients because it may induce psychological emergence reactions and psychiatric deterioration. Total intravenous anaesthesia (TIVA) with ketamine combined with droperidol and fentanyl (DFK) has been used in 14 schizophrenic patients undergoing various surgical procedures. Two patients died post-operatively of concomitant severe disease rather than from schizophrenia related pathophysiology or anaesthetic complication. One patient showed transient mild anxiety in the early post-operative period soon relieved by the patient's routine medication. However, no patient developed exacerbations of psychosis or psychological emergence reactions during the first post-operative month. The cardiovascular state during and after DFK remained stable in all cases. It is concluded that ketamine when combined with droperidol and fentanyl is a satisfactory anaesthetic for patients with schizophrenia.

A report is made of respiratory complications which occurred following the insertion of Palacos bone cement during Howse total hip replacement under spinal anaesthesia in a 78-year-old female patient. Persistent cough and tachypnoea developed 30 s after the insertion of bone cement into the acetabulum and femur and persisted for 2–3 min producing considerable passive movement of the pelvis and femur. The probable cause, disadvantages and prevention of these complications are discussed.