TI-~ ~r~vENOUS ADMINISTtLZxTION Of local anaesthet, tc drugs ,n chmcal medmme was mataated by Bmr m 1908 Holmes, 1 an Februat3t 1963, reported ,,tlnrty eases for wll~eh he employed a mo&:fieatmn of Bier s ve~ous anaesthesm The teehtuque has been readily adopted by the Anaesthetm team m the new Teadnng Hospatal an Lagos, where many patmnts appear ]l[or emergency treatment of lesmns of the extrem~tles The 514 patmnts m thJis series wexe anaesthetized dunng the eaght-month permd from April to December, 198a They were unpremedmated and unprepared an that food had poss~b]qy been eaten w~thm a short t-,me of anaval METHODS A sphygmomanometer cuff was apphed to the affdcted extremity of the recumbent pataent and the blood pressure was measure, prior to drainage of the extremity and again one minute after final release of the tourmquet For hand refections the anaesthetist had the choice of applying the cuff above or below the elbow A 20-e e syringe loaded with hgnoeame was attached to a needIe (SWG 22), whmh was introduced into a statable veto distal to the cuff After elevating the extremity for one minute to allow venous dramagej the cuff was inflated above the systohe pressure, the extrematy was returned to the honzontal positron, and the so]utlon of hgnoeame was administered m a single mjeetmn The surgeon then prepared the extremity and performed the necessary operatmn, the dressing was apphed, and the sphygmomanometer cuff was deflated Holmes and Baer preferred the Esmareh bandage for the exsangumatmn ot the extremity, but m the few eases m whmh at was used here, at afforded no pmtmular advantage over the method of grawtatmnal drainageThe eoneentratmn of hgnoeame used vaned between 0 5 and 2 0 per cent, wh~Ie the rejected volume ranged from 10 to 40 c e for the first 150 patmnts Then ~t was demded that a I per cent hgnoeame solutmn was the most satasfaetory and that 20 e e would be adequate for an adult The majority of the patmnts were 20 to 60 years of age and reqmred this chosen hgnoeame dosage of 20(}1 mg Children up to 15 years of age and patmnts over (}0)rears were gwen smaller doses as determined by each mvestagatm for the mdwadual patmntThe surgmal procedure was begun two to five minutes after the mjeetmn of the hgnoeame, and was completed usually m less than five minutes, so that the
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