In order to investigate the analgesic effect of timing of administration of ketorolac 10 mg i.v., we recorded patient-controlled use of diamorphine at 2, 4 and 12 h after abdominal hysterectomy. In a randomized, double-blind trial, 30 patients received ketorolac before skin incision and 28 after skin closure. A control group of 32 patients did not receive ketorolac. We measured operative blood loss and assessed nausea, vomiting and pruritus. After 2 h of patient-controlled analgesia, the median cumulative diamorphine dose in the group given ketorolac before operation was less than that of the control group (95% confidence interval 8-66 micrograms kg-1; P = 0.01). There were no other statistically significant differences in diamorphine consumption between the groups. The frequency of nausea and vomiting was similar in all groups Median blood loss in the group given ketorolac before operation exceeded that of the patients who did not receive ketorolac before operation (95% confidence interval 20-149 ml; P = 0.01). We conclude that the diamorphine-sparing effect of ketorolac attributable to timing of administration was small, conferred no clinical benefit and was accompanied by increased bleeding. No patient given ketorolac complained of pruritus.

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In this technique22966~93.94 the pH of the blood is measured before and after equilibration with two gas mixtures of different but known Pc02. The pH of the two equilibrated blood samples is plotted against the log Pcoz of the equilibrating gases and the points joined by a straight line. This is the buffer line of the blood. The pH of the blood as drawn from the patient is then interpolated in this line and the Pcoz read from the ordinate. Since the equilibration technique ultimately depends on only three blood pH determinations it is important to make these measurements as precisely as possible (see section on pH measurement). Astrup et a166 and Siggaard-Andersen et a122 have described a micro-equilibration unit,* comprising two H-shaped thermostatted glass chambers, which allows two samples of the blood to be equilibrated with each gas simultaneously. The whole unit is shaken mechanically at about 2,500 reciprocations per minute.The gases used for equilibration of the blood are usually 4 % and 8 % C02 in oxygent, but unless a certificate of analysis has been supplied by the manufacturers the user must check the composition by analysis. For this purpose the Haldane apparatus is commonly used; for accurate work the calibration of the analysis burette should be checked by mercury displacement.For clinical work the Campbell-Haldane analyser 123 is adequate. When the Haldane type of apparatus i s used the first few analyses will yield a

The frequency and severity of hypoxaemia during induction of anaesthesia in neonates and small infants at the Norfolk and Norwich Hospital, a district general hospital, was compared, using pulse oximetry, with that of the nearest specialist hospital, the Queen Elizabeth Hospital for Sick Children in London. There were differences in stafing and the choice of anaesthetic techniques between the hospitals. One third of the patients in both hospitals experienced desaturation of more than 5% (moderate or severe hypoxaemia) at one or more recordings during induction. The highest incidence of hypoxaemia was associated with awake intubation. There was no statistical diyerence in the incidence or severity of hypoxaemia between the hospitals. In the district general hospital, moderate or severe hypoxaemia of greater than 30 s duration was more likely if an anaesthetist with a regular paediatric operating list was not present at induction ( p < 0.01).