Ninety-nine unselected patients were given a standardized general anaesthetic with fentanyl 1.5 rag' kg -~ every 30 minutes and were randomly divided into three equal Groups: Group 1 patients received naloxone 0. I mg, Group It naloxone 0.2 mg, and Group III naloxone 0.4 rag, at the end of operation and after the reversal of neuromuscular blockade. After administration of naloxone systolic blood pressure increased by 4, 8 and 7 per cent and mean arterial blood pressure increased by 3, 8 and 8 per cent in Groups I, II and III respectively; heart rate increased by 4, I 1 and 8 per cent and rate-pressure product increased by 7, 18 and 15 per cent in Groups 1, II and Ill respectively. Tidal volume increased by 97, 101 and 95 per cent and minute volume increased by 122, 164 and 143 percent in Groups I, II and III respectively after naloxone. Forty-nine percent of patients had a tidal volume of less than 5 ml. kg -~ ora minute volume of less than 50 ml. kg -~ before adminislration of naloxone; after naloxone three patients in Group I (naloxone 0. I rag) had a tidal volume of less than 5 ml. kg-~ and no patient had a respiratory minute volume of less than 50 ml. kg-L It is concluded that under the conditions of this study naloxone 0. I mg is adequate to reverse the respiratory depressant effect of fentanyl in the majority of cases.

A brief description of the change from a normative evaluation to a formal audit of anaesthesia for neurosurgery is described. The criteria to be applied and their significance for clinical practise are listed. It is emphasized that these items are not presented as criteria for the standard of anaesthesia practised but as matters deserving debate among anaesthetists participating in a formal audit, particularly where the case load dues not permit statistical analysis of patient outcome and only discussion of individual patients or small groups is possible. It is suggested, as it has been by others, that formal audit in a department of anaesthesia can be developed as the form of continuing medical education most closely related to the clinical work of the anaesthetists working within it.

An empty British Oxygen Company (B.O.C.) Mk. 4 carbon dioxide absorption cannister was modified for use as a vaporizer by placing a layer of flannelette bandage over the horizontal perforated septu m and adding a base plate with an exit port for anaesthetic vapour. Aliquots of liquid anaesthetic were injected from a syringe through the top of the cannister and vaporised by air drawn through the cannister. Laboratory testing showed that this could be a useful way of administering inhalational anaesthesia in the absence of compressed gas supply.

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