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Notizen: We studied 114 female patients (ASA 1 or 2) who were within 20% of ideal body weight and who were scheduled to undergo gynaecological laparoscopy which required supplementation with an opiold (groups I A and PA), or dental procedures which did not require opioid supplementation (groups IO and PO). A computerised package of psychomotor tests was performed before surgery. Anaesthesia was induced with propofol 2.5 mg.kg−1 and all patients received atracurium 0.3 mg.kg−1 and 67% nitrous oxide in oxygen. Patients in group I A received isoflurane 1% (inspired), and alfentanil 10 μg.kg−1 as a bolus and 10 μg.kg−1.h−1 as an infusion. Patients in group PA received propofol 9 mg.kg−1.h−1 as an infusion, decreasing to 6 mg.kg−1.h−1 after 15 min, together with alfentanil 10 μg.kg−1.h−1. Patients in groups IO and PO received isoflurane and propofol in the regimens described for groups 1A and PA, but without alfentanil. Recovery was assessed by a blinded observer who recorded times to awakening (eye opening) and orientation (giving date of birth), and who repeated the psychomotor tests at 1,3 and 5 h. Linear analogue scales of mood, nausea and pain were obtained and other side effects were noted in the succeeding 48 h. A matched control group of 25 females (who were not anaesthetised) underwent psychomotor testing on four occasions in order to assess the ‘learning effect’ of repeated recovery testing. The analysis of recovery tests did not assume a normal distribution. There were no significant differences in awakening or orientation times among the groups (median values IO: 4.92 and 6.06 min; PO: 3.88 and 5.11 min; IA: 6.90 and 7.98 min; PA: 6.24 and 7.30 min). There were also no differences among groups in respect of the results of psychomotor testing during recovery. There was significantly less nausea in group PO (6132 patients) than in group IO (13/32 patients). There was also a significant difference between the performance of the control group compared with those of the study groups in most of the tests, and this emphasises the importance of including a control group in studies which involve recovery testing. We conclude that, after induction of anaesthesia with propofol in unpremedicated outpatients, maintenance of anaesthesia with nitrous oxide and either isoflurane or propofol, with or without alfentanil, provides reasonably rapid and reliable recovery and are equally acceptable to the patient.

Notizen: Patients who smoke cigarettes suffer increased postoperative morbidity. A prospective, controlled trial was designed to evaluate the effectiveness of written pre-operative advice to stop smoking before admission for elective surgery and to record the duration of abstinence immediately before the operation. Although the advice was ineffective in persuading patients to stop smoking, it was associated with a reduction in the amount of tobacco consumed. Nicotine and carbon monoxide have important short-term adverse effects but 15% of all patients continued to smoke within an hour of surgery. If patients are unable to give up cigarette smoking completely, it is still worthwhile stopping on admission to hospital.