Anaesthesia
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The author's first 300 caudal anaesthetics in children up to the age of 10 years are reviewed. Emphasis is laid upon sedation, both by premedication and by the anaesthetic technique. Nearly all the children were anaesthetised briefly for the sacral injection. ⋯ There was a good correlation between volume of injection per unit of body weight and level of blockade. Dosage can be calculated on this basis for operations on the perineum, lower and groin with 97 to 98% confidence. The volume of solution appeared to be more important than its concentration in determining extent of blockade.
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The Penlon Oxford Ventilator functioned well to 6 atmospheres absolute in an air environment and to 31 atmospheres absolute in an oxyhelium environment, as assessed remotely utilising a lung ventilator performance analyser. It features easily comprehensible controls and functions, and its use in prolonged ventilatory support could be taught to non-anaesthetists with relative ease. In addition to its relative simplicity, it is reliable, readily available, and requires only fitting with a male Schrader valve for use at high pressures. The ventilator is recommended for ventilatory support under extreme hyperbaric conditions.
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This study of the obstetric and anaesthetic circumstances relating to 100 consecutive Caesarean sections under general anaesthesia suggests that the general anaesthesia rate for Caesarean section could be reduced from the present 37 to 27% by making maximum use of epidural block and to 16% by using subarachnoid block in addition. The need for general anaesthesia on account of urgency to deliver can be greatly reduced by the administration of epidural analgesia during labour in patients identified as being more likely than average to require Caesarean section, and by the use of subarachnoid block when the need for section arises unexpectantly. Patients' objections to undergoing Caesarean section while conscious were analysed, and suggestions are made for minimising the number of patients who decline. Technical problems with blocks may sometimes be overcome without resort to general anaesthesia, while patients at risk from haemorrhage or coagulopathy will continue to require general anaesthesia.