British Journal of Anaesthesia Volume 43, No. 7 Editor of General Issues: J. E. RIDING July 1971 D o EDITORIAL: Drug Solvents 629 Unilateral pulmonary oedema following aorta w n to right pulmonary artery anastomosis lo ORIGINAL (Waterston's operation) 701 a d Effects of fentanyl, droperidol, and Innovar on M. R. Salem, K. Z. Masud, C. J. Tatooles ed cJa. nDin. eM ciecrheebnrfaell dmere taabnodl isRm. Aa.n dT hbeloyoed flow 630 Apapnlidc aHti.o nO .o Yf aanne send-expiratory pressure in from Respiratory and hypnotic effects of nitrazepam, the management of three cases of pulmonary h diazepam and pentobarbitone and their oedema 705 ttp Esolilzvaebnetst h in Gt.h eB rraabdbshita wa nda ntdh e Bmarobuasrea .J... 637 AdWre.n aJl.i nReu-sisnedlul,c eMd. Mpuolrmgaonn aarnyd Joeeadnem Lau malnedy s://ac Pleuvry a its treatment 709 d Studies of anaesthesia in relation to hyper- Natnik Ersoz and S. C. Finestone em tsepnosniotann. eIolul:s Pvuelmntoilnaatiroyn gas exchange during 644 Perforation of the right innominate vein by ic.o central venous polyethylene catheter 713 u P. Foe'x, R. Meloche and C. Prys-Roberts p The pattern of potassium liberation following M. W. Galbert and J. E. Kay .co a single dose of suxamethonium in normal APPARATUS m and uraemic rats 662 A new dental harness 715 /bja J. N. Powell and M. Golby D. R. Langley /is The effect of temperature on fluoride-resistant PROCEEDINGS OF THE ANAESTHETIC su serum cholinesterase 669 RESEARCH SOCIETY: Belfast Meeting, e/4 J. King, M. J. McQueen and H. G. Morgan March 26, 1971 716 3 /7 CLINICAL BOOK REVIEWS b y Cerebral, oesophageal and nasopharyngeal Elements of Pediatric Anesthesia 661 g temperatures 673 Complications of Anesthesia 668 ue J. D. Whitby and L. J. Dunkin Tharnodm bMoestihs odasn d Bleeding Disorders: Theory 668 st o Suxamethonium muscle pains and pregnancy 677 n 0 J. S. Crawford CORRESPONDENCE 6 A HISTORICAL Repeated anaesthesia in pelvic cancers 704 p Latta—Pioneer in saline infusion 681 J. Stovner, R. Endresen ril 2 Awareness during operative obstetrics under 0 A. H. B. Masson 1 general anaesthesia 723 9 REVIEW J. Wilson; J. S. Crawford Pulmonary oxygen toxicity: a review of the Coronary artery blood flow in the halothane- evidence for acute and chronic oxygen depressed canine heart 724 toxicity in man 687 P. A. Viz Enid R. Kafer Left atrial pressure measurements 729 CASE REPORTS E. A. Shaw, P. Morris; A. D. Clarke, P. W. Jackson Postoperative vocal cord paralysis in paediatric A modification of the Kleinsasser laryngoscope 730 patients: reports of cases and a review of possible aetiological factors 696 S. L. Sellars, M. A. Gordon M. R. Salem, A. Y. Wong, V. C. Barangan, Lingual nerve injury: a complication of R. F. Canalis, M. H. Shaker and A. M. intubation 730 Lotter B. C. Jones Published monthly by JOIH1W SIHIEKRATT & SOW LTD., ALTRflWCHAftfl, EMO1LAIM1P Annual subscription (post free): Inland £6.50; Overseas £7.00; U.S. and South Americas $20.00; Canada (all copies sent by air) £8.50 U.S. mailing agent: Air and Sea Freight Inc., P.O. Box 1305, L.I.C., N.Y. 11101. 2nd class postage paid at New York, N.Y. Printed in England NON-DDA FORTRAI (pentazocine) frees the patient from pain D o w n lo a d e d fro m h ttp s ://a c a d e m ic .o u p .c o m /b ja 60 mg. Ampoule 2 x 50 mg. Capsules 50 mg. Capsule /iss u e for severest pain \ for severe pain for less severe pain /4 3 /7 b y g u "The safety of Fortral, its compatibility with so many e s commonly employed drugs, its lack of deleterious effects t o n on many diseases causing pain or existing in patients with pain, 0 6 A its potency, its effectiveness and its wide p range of application make it a superior analgesic." ril 2 0 Med. Sci., (1967), 18:59 19 Fortral is also available in 30mg. ampoules and 25mg. tablets Fortral is a registered trade mark Full information is available from your Chief Pharmacist or Winthrop Laboratories, Surbiton-upon-Thames, Surrey. WIN^HROP D o w n lo a d e d fro m h ttp s ://a c a d e m ic .o u p .c o m /b ja /is s u e /4 3 /7 Anaesthetic emergency. b y During anaesthesia, g u e s Inderal protects the heart t o n 0 6 against arrhythmias caused by A p ril 2 0 adrenergic stimulation. 1 9 In the absence of underlying cardiac genously released catecholamines and and contraindications. We shall be glad disease, most of the arrhythmias oc- restoring normal sinus rhythm. to send you further Information. curring during anaesthesia can be traced 'Inderal' is particularly effective in to excessive adrenergic stimulation. the treatment of multiple ventricular Inderal 'Inderal' shields the heart through ectopic beats. Its action on cardiac beta-adrenergic 'Inderal' depends for its effect on a receptors. It slows the heart rate and specific pharmacological action. Before reduces the oxygen needs of the myo- using 'Inderal' it is important that cardium, thus protecting the heart doctors read the detailed literature for against the effects of injected or endo- information on dosage, precautions IMPERIAL CHEMICAL INDUSTRIES LIMITED. PHARMACEUTICALS DIVISION. ALDERLEY PARK. MACCLESFIELD. CHESHIRE rnntl* D.A. F.F.A.R.C.S. Our courses for these examinations cover the new syllabus. Multiple Choice questions included in the Primary course. D o Write for further details and instalment w n lo a plan: de d fro m h MEDICAL CORRESPONDENCE COLLEGE ttp s 19 Welbeck Street, London, W.I ://a c a Telephone: 01-935 8626 d e m ic .o u p .c o m /b ja /is s u e INDEX TO ADVERTISERS /43 /7 b y PAGE PAGE g u Anaesthesist, Der 20 Devices Instruments Ltd . 3 e s Appointments East, H. G., & Co. Ltd 4 t on 0 Dalhousie University, Halifax, Nova Scotia 18 Excerpta Medica 24 6 A Hospital for Sick Children, Toronto 23 Imperial Chemical Industries Ltd 1 pril 2 Bailliere Tindall 19 Kabi Pharmaceuticals Ltd 26 0 1 9 Bard, C. R., Internationa] Ltd inside back cover Medical Correspondence College 2 Blease Medical Equipment Ltd 25 Medical & Industrial Equipment Ltd ... back cover British Oxygen Co. Ltd 13-16 Minivent 17 Calmic Ltd 6 Organon Laboratories Ltd 22 Cape Engineering Co. Ltd 8-9 Philips Medical Systems Ltd 11 CIBA 5 Scons Electrical 7 Courses Society for the Advancement of Anaesthesia in Edinburgh Postgraduate Board for Medicine ... 10 Dentistry 21 Glasgow Postgraduate Medical Board 10 Springer-Verlag 20 Cyprane Ltd 12 Winthrop Laboratories inside front cover D o w n lo a d e d fro m h ttp s ://a c a d e m ic .o u p .c o m /b • The Devices Cardiac Output Computer has been • Injection and detection sites are close together ja designed in the Departments of Clinical Physiology and produce satisfactory results when conventional /is s and Electronics at St. Thomas' Hospital, London, methods are inadequate because of low cardiac out- ue where it has undergone extensive tests in over 1500 put and large central blood volume. /4 3 measurements of cardiac output. It is a unique instru- /7 ment which applies refined electronic developments • Complete curves are inscribed within ten seconds b y to simplify the practical application of the thermal di- for patients with normal circulation and in less than g lution technique for obtaining direct reading of car- sixty seconds under abnormal conditions. ue diac output in litres per minute. st o • Computer calculated values of cardiac output are n • The instrument is a self-contained unit consisting instantly available when integration is completed. 06 of two thermistor bridge networks capable of pro- A p tveidminpge radtiurerecst . rDeuadriinngg sa doef tebromthin aintijoenct athtee saanmd eb tlhoeord- • There is no significant recirculation in man. ril 2 0 mistors are used for electronically inscribing the tem- • Thermal exchange within the lungs and the 1 9 perature curve in relation to time, enabling the area effects of pulmonary edema are avoided by placing under the curve to be found by integration, followed the sensor in the pulmonary artery instead of the by computation of the cardiac output from an ana- systemic vessels. logue computer. • Pressure measurements facilitate location of the • Detection is intravascular and blood sampling is catheter tip and provide continuous pressure indica- not required. tion. • The indicator is inexpensive and non-toxic and repeated determinations at very short intervals are Devices Instruments Limited possible. 26-28 Hyde Way • Thermal diffusion achieves more satisfactory mix- Welwyn Garden City, Hertfordshire ing than with conventional indicators. Tel: Welwyn Garden 28511 THE EAST-FREEMAN 'PATIENT TRIGGERED' VENTILATOR MK II, and EAST 'VENTILARM' PRESSURE MONITOR are now in full production Specification includes:- VENTILATOR 1. Controlled or Assisted/Controlled (Patient triggered) ventilation D 2. Pressure or volume limited inflation o w n 3. Infinitely variable Inspiratory/Expiratory ratios lo a d e 4. Positive or Positive/Negative pressure d fro 5. Fresh gas/air reservoir to meet any extra demands m required by the patient h ttp 6. Interchangeable 'Plug-in' electronic control panel s ://a 7. Extremely quiet rotary compressor ca d e 8. Paediatric Circuit (available shortly) m ic 9. 'Built-on' Anaesthetic Table (available shortly) .ou p 10. Hand Inflation attachment (optional extra) .co m 11. East-Radcliffe Humidifier (optional extra) /b ja /is s u e /4 3 VENTILARM /7 b y For use with the East-Freeman g u Ventilator OR ANY OTHER MAKE es OF VENTILATOR. The 'Ventilarm' t o n indicates any change from pre-set; 06 ventilating conditions at the patient A p with high, low and sustained ril 2 pressure alarms. It automatically 01 9 vents the patient to atmosphere if inspiration is held for an excess period. Indicates mains failure. CATALOGUE OF FULL RANGE OF EQUIPMENT SENT UPON REQUEST H. G. EAST & COMPANY LTD. •AST OF SANDY LANE WEST — LITTLEMORE — OXFORD OXFORD Tel: Oxford 79)61/78279 Cables: 'EASTOY OXFORD' I prevent or control arrhythmias during D o w n lo a d e anaesthesia d fro m h ttp s with ://a c a d e m ic .o u Trasicor p .c o m /b ja /is s u e oxprenolol hydtochloride /4 3 /7 b y g Trasicor controls arrhythmias occurring Added safety factor ue s during the anaesthetic procedure. Exces- With Trasicor it may be possible to derive t o n sive adrenergic stress can be effectively the benefit of complete beta-blockade, 0 6 modified. Evidence shows that Trasicor with a comparatively lower risk of precipi- Ap (2mg i v) reduces the mean sinus rate, in tating or aggravating heart failure. (Brit. ril 2 atropinised anaesthetised patients with J. Anaesth. Nov. 1970). 01 9 sinus tachycardia, from 138 to 96 beats a Full information on the use of Trasicor in anaesthesia is minute. available on request. Trasicor is supplied as 20mg and 40mg tablets of oxprenolol Trasicor may be useful for post-operative hydrochloride and, for intravenous or intramuscular use in arrhythmias and in maintaining adequate ampoules containing 2mg freeze-dried oxprenolol hydrochloride. haemostasis at the operative site. C I B A T/27 D o w n lo a d e d fro m h ttp s ://a c a d e m ic .o u p .c o m /b ja /is s u e /4 3 /7 b y g u e s t o n 0 A long time or a short time. A proven product for each need. 6 A p ril 2 TUBARINE'brand 'ANECTINE'brand 0 1 9 Preparations of Injection of Tubocurarine Chloride Suxamethonium Chloride Full information is available on request from the sole U.K. distributors: CALMIC LTD. CREWE HALL. CREWE. CHESHIRE Don't ask an anaesthetist how he decontaminates his equipment, f D o w n lo a d e d He may well be impatiently waiting fro for it to be washed by hand, or "aired" m after gas sterilising. He may even be http waiting for new equipment to replace s that ruined by too frequent auto- ://a c claving. ad e m The only effective solu- ic tion to these problems is .ou p the Scott's "One-Step" .c o Machine. Specially m designed for the /bja purpose, this /is s machine will u e effectively re- /4 3 move or kill the /7 b majority of non- y g spore bearing u e bacteria that may st o be found in the n 0 respiratory tract. 6 A Fully automatic, the p washing cycle lasts ril 2 for only 19 minutes, 01 9 saving valuable time and labour. For full details and a copy of the Test Report published in the World Congress issue of "Anaesthesia", please write to: SCOTTS ELECTRICAL Scotts Electrical, Seamoor Lane, Bournemouth, BH4 9BR. Tel: Bournemouth 66066. Constant Cape-Waine Anaesthetic Ventilator Mark IIA Rebreathing or non-rebreath- Volume ing mechanical circuits. Rebreathing manual circuit. Flowmeters for 2,3 or 4 gases. Fitted Cardiff Swivel anDd oxygen failure alarm. ow n VentUation loa d e Cape Ventilator Mark IId Non-rebreathing circuit for from afr or air/oxygen mixture. Fit hted ofthe humidifier. ttps ://a c a d Cape-Waine e m Multi-Purpose Ventilatoicr Lungs For use with existing ana.oues- p thetic machines. Circuits .cas o Cape-Waine anaesthemtic ventilator. Fitted humidifier /bfor ja post-operative or I.T.U. use/is. s u e /4 Universal Attachment 3 /7 The CAPE range of volume-set ventilators for Babies and Children b y is characterised by extreme operational When connected to and driv gen u and mechanical simplicity. These by an adult ventilator, reducees s ventilators are easy to understand, easy the volume output tt oo n to use and easy to maintain. paediatric requirements. 0 6 A p Cape Minor Ventilator ril 2 0 1 For full details send for twelve page illustration brochure The ultimate in simplic9ity. Fixed respiratory frequency. Variable volume. All parts In contact with patient are auto- clavable. ENGINEERING COMPANY LIMITED The Cape, Warwick Telephone Warwick (STD 0926) 41321 (6 lines)