Alfentanil requirements were compared in thirty-six Asian and forty-three European patients during general anaesthesia with muscle relaxants. Alfentanil infusion at 5 jlg/kg/min was started immediately after induction with thiopentone and alcuronium. The infusion rate was reduced to 0.5 jlg/kg/min after ten minutes. An incremental dose of5 jlg/kg/minfor five minutes was given on each occasion when anaesthesia was clinically judged to be inadequate. Recovery parameters were recorded. Pharmacokinetics were also studied in five Europeans, four Chinese and four Nepalese. The dosage of alfentanil required was comparable in both Asian and European patients, but recovery was slower in the Asian patients. The elimination ha(f-/ife in the Chinese and the Nepalese were both significantly shorter than that of the Europeans (P < 0.05), but at the time of recovery of spontaneous ventilation, the mean plasma concentrations were not significantly different.

An anaesthetic technique for laryngeal microsurgery is described and evaluated using intravenous propofol infusion and topical lignocaine with the patient breathing spontaneously without an endotracheal tube. Eighty adult patients divided into two groups according to their ASA status (Group A; 58 ASA I and Il; Group B; 22 ASA III and IV) were analysed. Operating conditions were good in all but one case. Good anaesthesia was achieved in about 70% of patients. The requirement for propofol was less in Group B. Blood pressures decreased signifcantly following induction (P < 0.001) but returned towards the preoperative values after ten minutes in Group A patients whereas the recovery was slower in Group B. Apnoea occurred on induction in about 40% of patients overall. P aeo2 showed a similar small increase in both groups. Oxygenation was adequate. The results show that propofol as an infusion in this simple tubeless technique is satisfactory. As the technique was considered potentially hazardous in those patients with upper airway obstruction, such patients were not included in this study.

Although anaesthesia was discovered in 1846, pain relief had been used for many years previously. Opium, mandragora, and Indian hemp amongst others have been used since the earliest times as alluded to by many of the classical writers. The use of refrigeration anaesthesia is known to have been recommended a millennium ago although it never had much usage. Very soon after the introduction of ether anaesthesia, it was recommended for military use and the first use by the American forces was in Buena Vista early in 1847 and then again at Vera Cruz. Pirogoff taught and used ether anaesthesia on active service with the Russian forces in the Caucasus in the summer of 1847. Meanwhile Spencer Wells, who was serving with the Royal Navy in Malta, was the first British service medical officer recorded to have used anaesthesia. He went on to write up a series of 106 anaesthetics. The Danes were probably next to use anaesthesia in battle using chloroform in 1848. However, it was not until the Crimean War that anaesthesia began to play an important part in battle surgery with many anaesthetics being given with varying results. The War of the Rebellion was the next war in which anaesthesia was important and the first one in which proper statistics were kept allowing useful analysis. Anaesthesia had irrevocably found its place in battlefield surgery. The Discovery of Anaesthesia The history of military anaesthesia is closely inter woven with that of anaesthesia in general and it is somewhat arbitrary to attempt to separate the This paper was based was based on a lecture delivered at the National Scientific Congress of the Australian Society of Anaesthetists, Sydney, September 2004.

Experience gained by two anaesthetists using the Triservice hatothane. trichtoroethylene air and oxygen draw-over apparatus in thejield and in a sophisticated hospital is described and discussed.