ANAESTHESIA FOR COMPLETE VAGOTOMY: Postoperative Pulmonary Complications after various types of Gastric Surgery, with special reference to the omission of atropine

An anaesthetic technique is discussed omitting atropine or hyoscinefrom premedi-cation to comply with the requirements of the surgeonperforming complete gastric vagotomy. Experience in sixty casesreveals no evidence of undesirable reflex activity in the cardiovascularsystem, and the increase in secretions in the respiratory tracthas not proved troublesome. The incidence of postoperative pulmonarycomplications is compared with that in a control group usingconventional premedication, and is shown to be lower in thetest group. The relationship of smoking habits, age and sexto postoperative respiratory complications following all formsof gastric surgery is also discussed. ^*Present address: Edinburgh Central Group of Hospitals. Present address: Department of Surgery, University of Aberdeen.     

THE EFFECT OF METHOXYFLURANE ON THE FOETUS

Sixty-four patients received methoxyflurane analgesia and/oranaesthesia for labour and delivery. Analgesia with methoxyflurane-airproduced satisfactory analgesia for labour and delivery in themultigravidae of Group I. Foetal and maternal blood levels didnot increase with increased duration of inhaler use, apparentlydue to the absence of pain-induced hyperventilation. Patientsin Group II required the addition of light methoxyflurane, nitrousoxide and oxygen anaesthesia. This resulted in the highest foetalmemoxyflurane levels of the three groups, and the highest rateof neonatal depression. Group III patients arrived with deliveryimminent, and were given light methoxyflurane, nitrous oxideand oxygen anaesthesia. Despite high maternal levels of methoxyflurane,foetal levels were no higher than in Group I, presumably becauseof the short duration of exposure. Methoxyflurane has littleeffect on the foetus if low concentrations are administeredto the mother, or if the duration of higher concentrations iskept short. ^*Deceased. Supported in part by a grant-in-aid from Abbott Laboratories,North Chicago, Illinois, and by General Research Support Grant5501 FR 5350-5 from the National Institutes of Health, U.S.Public Health Service. Assistance was provided for this research by the Universityof Arkansas Medical Center Research Computation Laboratory,which is supported by Grant FR 00208-05, from the National Institutesof Health, U.S. Public Health Service.