Caudal analgesia in children. Five hundred cases for procedures below the diaphragm.

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. Despite high levels of blockade, cardiovascular stability was well maintained, particularly in the younger children. 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.

A technique of anaesthesia in haemorrhagic shock. Illustrative case histories and a discussion.

The anaesthetic management of patients in haemorrhagic shock is described. The principles are those of initial resuscitation with electrolyte solutions and alleviation of metabolic acidosis, combined with early induction of anaesthesia to permit control of bleeding as soon as possible. The anaesthetic technique depends on pre-oxygenation, intravenous anaesthesia, muscular relaxation and ventilation with pure oxygen. Earlier cases were induced with thiopentone and maintained with intermittent suxamethonium, but intravenous ketamine was later employed for induction and intramuscular ketamine for maintenance; this use of ketamine is now the author's method of choice. The use of a central venous pressure line connected to a cannula in the internal jugular vein is recommended.