A prospective, randomized placebo-controlled study was undertaken to compare the effects on heart rate and blood pressure during surgery and on the incidence of nausea, vomiting and headache after surgery of IM prochlorperazine 0.2 mg.kg^-1, IV prochlorperazine 0.1 mg.kg^-1 and IV ondansetron 0.06 mg.kg^-1 given at induction of general anaesthesia to patients undergoing septorhinoplasty.

The effects of the test drugs after administration on heart rate and blood pressure were similar, as were the incidences of retching and vomiting in the recovery ward after each test drug. Postoperatively, compared with placebo (7%), nausea per se was most frequent in those given IV prochlorperazine (25%, P <0.01), and less frequent in those given IM prochlorperazine (2%) and IV ondansetron (15%). Vomiting per se was reduced from 24% to 7% (P <0.025) by IV prochlorperazine and to 4% (P <0.0005) by IV ondansetron. The incidence of nausea with vomiting was reduced from 35% to 15% (P <0.025), 16% (P <0.05) and 11% (P <0.005) by IM prochlorperazine, IV prochlorperazine and IV ondansetron respectively. IM prochlorperazine and IVondansetron increased the frequency (from 35% to 64%, P <0.0005 and to 71%, P <0.0005, respectively) of those experiencing no PONV and delayed the onset of PONV, but only IM prochlorperazine reduced the severity of postoperative vomiting. Headache was frequent in the control (69%), IV prochlorperazine (62%) and IV ondansetron (69%) groups, and least frequent after IM prochlorperazine (53%; P <0.05 versus IV ondansetron). It is concluded that these drugs have no adverse cardiovascular effects within 10 minutes of administration, IM prochlorperazine and IV ondansetron reduce PONV more effectively than IV prochlorperazine and postoperative headache after septorhinoplasty occurs less frequently in those given IM prochlorperazine than in those given IV ondansetron.

This study determined the overall incidence of postoperative nausea and vomiting (PONV) in 38 patients undergoing laparoscopic gynaecological procedures who received a standardized propofol/isoflurane anaesthetic but no preoperative antiemetic. A further 166 patients similarly anaesthetized were then randomly allocated to receive either metoclopramide 10 mg, ondansetron 4 mg, or cyclizine 50 mg as an intravenous antiemetic immediately pre-induction. Overall incidence of PONV was determined for all groups and the relative efficacy of the three antiemetic agents assessed.

Fifty per cent of patients in the initial group (no antiemetic) reported significant nausea and/or vomiting up to 24 hours postoperatively. The incidence of PONV in the metoclopramide group was 24%, in the ondansetron group 20%, and in the cyclizine group 51%. There was no detectable difference in relative efficacy between ondansetron 4 mg and metoclopramide 10 mg. The incidence of PONV in the group who received cyclizine was similar to that found in the pilot group who received no PONV prophylaxis.

Both metoclopramide and ondansetron may potentially decrease the incidence of PONV following gynaecologic laparoscopy by up to 50% when administered intravenously prior to a propofol/isoflurane anaesthetic.

Intermittent parenteral bolus doses of morphine are commonly used for postoperative analgesia. Morphine is typically given by intramuscular or intravenous injection but there are theoretical advantages for the subcutaneous route of administration.

Fifty-nine patients entered a prospective randomized double-blind cross-over study comparing intermittent intramuscular and subcutaneous morphine boluses. Patients received 0.15 mg/kg of morphine by subcutaneous or intramuscular injection. They were reviewed at the time of injection, after 15 minutes and each hour for four hours.

The majority of patients indicated a strong preference for the subcutaneous route. There were no significant differences in pain scores, respiratory rate, arterial oxygen saturation, heart rate, mean arterial pressure, sedation or nausea scores between intramuscular and subcutaneous administration of morphine.

Postoperative analgesia by subcutaneous morphine bolus injection is as effective as intramuscular injection with a similar side-effect profile but with greater patient acceptance and less risk.

Radial arterial pressure, heart rate, right atrial pressure, pulmonary arterial and occluded pressures, and thermo-dilution cardiac output were measured, and cardiac index and resistance calculated, at the following times: before induction; 5 min after intubation; 2 min after sternotomy; immediately after discontinuation of bypass; 15 min afterwards; immediately after sternal closure; during suture of the skin; 5 min after arrival in the postoperative care unit; and 60 min postoperatively.

Mean arterial pressure decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction. Cardiac index decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction and after sternotomy. Neither pressure nor flow decreased in patients receiving fentanyl.

Following weaning from cardiopulmonary bypass, systemic vascular resistance decreased significantly in all groups. Cardiac index, however, did not increase above control values and arterial pressure consequently decreased; there was no significant difference between groups.

We developed and introduced into clinical practice a leaflet to improve the delivery of information to patients before obtaining their consent to anaesthesia. The amount of information needs to be what a “reasonable” patient thinks appropriate; therefore we tested patients’ responses to three levels of information: “full” disclosure, “standard” disclosure (as contained in our leaflet) and “minimal” disclosure.

Forty-five patients scheduled to undergo cardiac surgery were enrolled in the study. None of the information sheets caused a significant change in state anxiety score and only the “full” disclosure significantly increased knowledge about anaesthesia (P =0.016). All leaflets were easy to understand. When only one leaflet was provided 64 - 73% of patients thought the content was “just right”, whereas when all three leaflets were viewed together, 63% of patients thought the “minimal” leaflet withheld too much information.