We have examined the effect of extradual injection of 0.5% bupivacaine or normal saline on the progression of spinal anaesthesia in 28 patients undergoing Caesearean section. Three groups were studied. Subarachnoid anaesthesia was established in all patients. Group A (n = 10), the control, received no extradural injection for 20 min. Group B (n = 9) received extradural bupivacaine 10 ml and group C (n = 9) received extradual saline 10 ml 5 min after the subarachnoid injection. Sensory levels were compared at 5-min intervals and extension of the block was found to be similar in groups B and C and significantly faster than the control (P < 0.05). The quality of anaesthesia and incidence of adverse effects was similar for all three groups. We conclude that the mechanism of extension of spinal anaesthesia by extradural injection of local anaesthesia is largely a volume effect.

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Summary

SummaryA twin-tithe breathing sj>stemfor inhulutional anaesthesia in dental surgery is described. The svstem is a modification ? f a parallel Mapleson ' A ' breuthing systrm and is suitable j b r use with continuous flow anaesthetic machines. Resistance to airflow has been evitluated and is bvithin /he rcw~tnmi~rrdi~il ronges ut all,flows likely to be experienced in normal clinical conditions. The sjgsttw is sititahle,for c*hikdwn und urlults, eusy t o use and eficient. The e.rpirutor)* valvc is located remote from the .face and the .sj.stem is suitable tor .scavcwging by octive, assisted or passive sj'stems.

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