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We present two case reports of patients who suffered a pulmonary embolism (PE) in the week following surgery for removal of a meningioma. Both patients were anticoagulated in the first week following surgery, and as a result, both suffered intracerebral bleeds requiring further surgery. An inferior vena caval (IVC) filter was then used in both patients to prevent further embolic events. Following our experience, we believe that it is dangerous to use intravenous anticoagulation within 6 days of cranial surgery for removal of a meningioma. We have reviewed the literature concerning the present guidelines for thromboembolic prophylaxis in patients requiring neurosurgery and believe that consideration of subcutaneous low-molecular-weight heparin should now be given to all patients requiring craniotomy for removal of a meningioma.

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Transsphenoidal operations for pituitary tumors have dramatically decreased the morbidity of pituitary surgery in a group of patients with many potential anesthetic problems. Although a good preoperative endocrine workup and anticipation of problems are the key to ensuring a good outcome, it remains a challenge to the "art" of neuroanesthesia to produce a smooth and safe anesthetic.

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Postoperative pain is one of the main barriers to increasing the range of procedures suitable for day case surgery. Effective strategies for treating postoperative pain must be developed and tested if this range is to be extended. This article examines the effectiveness of prepacked take-home analgesia in providing pain relief for patients following day case surgery. The composition of the analgesia pack was varied according to the type of operation undertaken.

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Postoperative pain following day surgery is a common problem. The prescription of appropriate analgesia with clear instructions for the patient is crucial. This article examines the effect of changing prescribing practice, backed up by a patient information leaflet, on the effectiveness of take-home analgesia after day case surgery.

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We present two patients who became unrousable within 48h after general anaesthesia for non-neurosurgical operations; both were found to have frontal meningiomas. Analysis of these and previous reports suggest that several anaesthetic and perioperative factors probably combine to contribute to the accelerated presentation of these previously "silent" tumours, and we recommend that dexamethasone should be administered early in the course of unexplained neurological deterioration after operation.

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A woman who suffered an intracerebral haemorrhage secondary to Moyamoya disease in her 33rd week of pregnancy was sedated for ventilation with propofol for 48 h until she underwent emergency Caesarean section. There appeared to be no adverse metabolic effects on the neonate from the use of propofol in the mother although sedation was prolonged.

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An audit was conducted of all serious head injured patients received at Atkinson Morley's Hospital over 1 year. One hundred and fifty-four were received, of whom 65 (42.2 per cent) had multiple injuries; 137 (89 per cent) patients were intubated and the overall incidence of hypoxia was 9.7 per cent. The incidence of hypercarbia was 25.9 per cent and was unrelated to the mode of ventilation. Hypotension was present in 11 patients (7.1 per cent) and hypovolaemia in 16 (10.5 per cent). During transfer 39 (28.9 per cent) intubated patients received no sedation, although 29 (21.5 per cent) were given neuromuscular blocking agents alone. The incidence of actual cervical injury was 3.2 per cent and in all five patients the neck was adequately stabilized pre-transfer. The incidence of thoracid injury was 19.5 per cent and of these four patients (13.3 per cent) warranted thoracotomy. Abdominal trauma occurred in eight (5.2 per cent) patients and in only one patient was laparotomy not performed pre-transfer. The accompanying doctor was a SHO with less than 6 months experience in anaesthetics in 33 per cent of transfers. Arterial blood pressure was monitored in only 50 per cent of transfers. The initial management of patients was generally satisfactory, and in particular the avoidance of hypoxia by a high rate of intubation was a significant improvement over other studies.

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The effects of high concentrations of inspired oxygen on cerebrovascular haemodynamics were studied in healthy human volunteers using transcranial Doppler measurements of middle cerebral artery blood velocity. If the end-tidal carbon dioxide level was kept constant, the measured blood velocity and the calculated Pulsatility Index showed no significant change when subjects were breathing 21, 40, 75 or 100% oxygen.

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A case of post-operative cerebral infarction is presented in a 53-year-old man, in whom a clinical diagnosis of Takayasu's disease was made retrospectively. The cerebral infarction occurred in the absence of any identifiable surgical or anaesthetic cause. The possible role of sodium nitroprusside in preventing cerebrovascular accidents in this condition is discussed and the literature reviewed.

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Transient nephrotic syndrome, haematuria, and cryofibrinogenuria in a child after anaesthesia were found in association with a plasma cryofibrinogen that precipitated at 35 degrees C. Investigation of the family showed this to be a familial trait probably with dominant inheritance.

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A random postal survey of 1528 anaesthetists in the UK was performed to assess their use of carbon dioxide in anaesthesia and opinion on its safety. Of 1100 replies (72% response rate), 60.9% used it daily and 77.1% would object to its exclusion from future anaesthetic machines. There was no consistent age-related trend with regard to its use or opinion on its removal. 62.9% of anaesthetists did not regard its presence on the anaesthetic machine as hazardous, but 81.8% agreed that a limit to the maximum flow of carbon dioxide delivered to one litre/minute would improve safety.

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A case of acquired C1 esterase inhibitor deficiency and its anaesthetic implications is presented. Prophylaxis against angioneurotic oedema using danazol and tranexamic acid is described and the resultant complication of mesenteric venous thrombosis reported.

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The action of nifedipine given first intravenously and then orally was studied in nine patients undergoing investigation for angina pectoris who were already receiving atenolol (100-200 mg/daily) and who had been shown to be fully beta blocked (reduction in maximal heart rate by greater than 25%). Intravenous nifedipine 7.5 micrograms/kg reduced both systolic blood pressure and left ventricular pressure (dP/dt) transiently; both values were significantly lower five and 10 minutes after the infusion of nifedipine but were not significantly different from control values at 20 minutes. There was minimal but pronounced depression of atrioventricular nodal function after giving intravenous nifedipine, though this was detected only when sensitive tests of atrioventricular nodal function were used. These effects were also transient, showing no significant change from control values at 20 minutes. Atrioventricular nodal conduction time and sinus rate were unchanged. Radionuclide angiography of patients taking the oral combination of atenolol and nifedipine for chronic angina showed no change in ejection fraction compared with those taking atenolol alone, but there was a small increase in peak ejection rate. Resting blood pressure and heart rate were unchanged and the PR interval did not lengthen. Peak heart rate and systolic blood pressure showed no alteration on exercise testing when the drugs were combined compared with the response with atenolol alone. Despite the negative inotropic influence when nifedipine was given intravenously, the absence of haemodynamic deterioration when oral nifedipine is combined with atenolol has confirmed that this combination can be used safely in patients with normal left ventricular function. The minimal changes in atrioventricular nodal function cannot be detected on the surface electrocardiogram and are not of clinical importance in patients with normal conduction.

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