Anesthesia ; Anesthetics - adverse effects ; Ethnicity ; Humans ; Papua New Guinea

World-wide more than 4 million people are at present suffering from cancer pain, and many more from other kinds of pain. Pain remains an under-treated and neglected public health problem. Lately technological advances and greater understanding of the physiology and anatomy of pain have helped further progress in pain management but much is still empirical without a scientific basis. Since the fundamental component of the practice of anaesthesiology in the treatment of pain, the anaesthetist is the best person to understand pain and organize pain clinics.

Over a nine-month period in Goroka Base Hospital 310 patients with chronic pain were treated in the pain clinic. Disabling lower backache was the most common complaint, followed by myofascial disorders and cancer pain. Best results for the management of pain was observed in patients receiving intralesional steroids, followed by intercostal block and lumbar sympathetic block for abdominal malignancies.

Techniques of total intravenous anaesthesia with ketamine and continuous epidural block are compared with the conventional method of using halothane, nitrous oxide and relaxant. Both ketamine and epidural techniques were associated with minimal cardiovascular disturbances, low blood loss and better quality of anaesthesia and recovery scores. The usual psychomimetic effect associated with ketamine administration was observed in only one patient. Further experience of total intravenous ketamine anaesthesia with adjunctive use of fentanyl to attenuate cardiovascular effects and midazolam for the pyschomimetic effect can further refine the technique. Cerebral function monitoring, if possible, will allow correlation of depth of anaesthesia with drug dosage and can ensure appropriate anaesthetic depth and recovery.
Adult ; Anesthesia - standards ; Anesthesia, Intravenous ; Humans ; Ketamine - administration & ; dosage ; Papua New Guinea

Either tacrine (THA) with succinylcholine or alcuronium was used on a randomized basis for laparoscopic procedures in twenty young females. The technique using THA with succinylcholine was found to be more suitable and predictable for this procedure and gave a smoother anaesthetic course, brighter recovery and minimal postoperative complications.
Alcuronium - adverse effects ; Aminoacridines - adverse effects ; Anesthesia Recovery Period ; Laparoscopy - methods ; Postoperative Complications - prevention & ; control

An episode of hypoxia following the use of propranolol and sodium nitroprusside to induce hypotension in a 50-year-old male patient undergoing craniotomy for frontal meningioma is described. The importance of proper preoperative screening of lung function and intraoperative monitoring of blood gases is highlighted.