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APRIL 5, 1947 d-TUBOCURARINE IN CAESAREAN SECTION MEDIBCALJOURNAL 445conditions for the siurgeon and be non-depressing to the baby and the uterine tone. The safest technique to date has probably been local analgesia, but there are few who would care to maintain that this is a pleasant experience. Some of these patients who had undergone previous sections have been most grateful for the intravenous induction and the subsequent freedom from unpleasant sequelae.d-Tubocurarine has passed its experimental stage, and its early promise has been confirmed by further extensive experience. It is debatable whether any potent drug which is delivered into the blood stream can be called safe, but this one seems to be less dangerous than many others in daily use. On the other hand, among these patients were five who were seriously ill: two had eclampsia, having had several fits, two had had extensive haemorrhage from placenta praevia, and one had advanced pulmonary tuberculosis. They all had an uneventful convalescence and with the exception of the last mentioned were fit for discharge within three weeks.Vomiting during the induction of anaesthesia with consequent aspiration pneumonia is acknowledged to be one of the hazards of this procedure. These patients have not had the usual sedative preparatidn. They are often admitted as emergencies " off the district," and are not infrequently stout and short-necked. All these factors tend to make the induction period a rather anxious time. The ill-advised insertion of an airway immediately after the initial injection did precipitate vomiting in one instance. A cuffed endotracheal tube was inserted, and the fact that suction was ready and to hand prevented any untoward result. Whatever the anaesthetic, these patients are very likely to vomit if they have had a recent meal. A rapid intravenous induction makes the emergency less likely, and the administration of d-tubocurarine undoubtedly facilitates the intubation which may be required as either a prophylactic or a therapeutic measure.The freedom from curarization of the baby has not been surprising. Whitacre and Fisher (1945) have reported that " intocostrin " (Squibbs's biologically standardized extract of curare) has no effect on the infant-an observation which has been confirmed in the present series. Substitution of "kemithal " for thiopentone as an inducing agent and ihe small amount of anaesthetic which is required after d-tubocurarine are factors which have contributed to the wide-awake condition of these babies. The good uterine tone that has been so marked a feature was not expected. This has been so striking that on two occasions it caused a temporary embarrassment to the surgeon, who found that his hand was being gripped by the contracting uterus as he extracted the child. This has so far not proved a serious handicap, and the otherwise good operating conditions have been ample compensation. ' Finally, this technique, by avoiding long post-operative cepression, which is especially menacing after this operation, undoubted...

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