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The study revealed no correlation between steroid dosage and postoperative morbidity or mortality. The incidence of wound dehiscence and incisional hernia compared favourably with the reports of other unselected series of similar patients. Contamination did significantly influence results. Septic complications were more frequent when the operative field was contaminated and both delayed wound healing and mortality were related to this sepsis. A 'clean and dirty' technique was effective in controlling contamination during elective bowel division but preoperative bowel perforation and accidental entry into the lumen of the bowel during dissection were potentially avoidable sources of contamination. Primary healing of the perineal wound after proctocolectomy was seldom achieved in contaminated patients where a drain tube was brought out through the main perineal incision. When perineal sinuses or fistulae followed a proctocolectomy, patients with Crohn's disease had a significantly slower rate of healing than did patients with ulcerative colitis. However, there was no difference in the healing of abdominal wounds in relation to the primary pathology. Even abdominal incisions which were used on more than one occasion healed as well as those which were used for the first time. A prophylactic antibiotic regime of either ampicillin or tetracycline offered little protection against postoperative sepsis. The organisms which caused such infections were often insensitive to the two antibiotics.Corticosteroids are employed widely and often successfully to treat acute attacks of ulcerative colitis. They are also effective in improving the symptoms of patients with Crohn's disease of the colon, but in both diseases their use is often considered to be a major disadvantage if surgery becomes necessary, because they may increase the patients' susceptibility to infection (Fuenfer et al., 1973); they may retard healing (Erlich et al., 1973); and they may be the cause of other serious complications such as peptic ulceration (Glenn and Grafe, 1967). This paper reports the incidence and cause of such post-operative complications in a group of 107 patients who had surgery for ulcerative or Crohn's colitis under corticosteroid cover between January 1969 and December 1974.Received for publication 2 March 1978 Mlethods SUBJECTS A retrospective study of the case notes of colitic patients who were treated surgically in Oxford during this time was undertaken. If the following criteria were met:1. The prinary diagnosis was ulcerative colitis or Crohn's colitis.2. Prednisolone in a dose of 20 mg or more per day was administered during the operation and had been continued for at least five days postoperatively.3. All patients had undergone a singlestageproctocolectomy, or split ileostomy.4. A standard technique had been employed for each operation and the preoperative preparation and postoperative management had been standardised. Some of the patients had undergone more than one operation, and subsequicnt abdominal operations in 729 on 10 ...

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In a prospective, randomized study of 87 patients, we have compared the incidence of hypoxaemia during induction of anaesthesia with subsequent Laryngeal Mask Airway (LMA) insertion in healthy adults when four different techniques were used: one without supplementary oxygen, and three with supplementary oxygen. Twelve patients did not receive supplementary oxygen before LMA placement, 25 underwent partial denitrogenation by breathing oxygen from the start of injection of the induction agent, 25 underwent formal denitrogenation by breathing oxygen for 3 min, and 25 received five tidal volume breaths of oxygen by face mask using positive pressure immediately after induction of anaesthesia. Anaesthesia was induced with propofol 2.0 mg kg-1 and fentanyl 1 microgram kg-1. Additional propofol was given if required. Arterial oxygen saturation was measured by pulse oximetry. Desaturation occurred in 11 of 12 patients who did not receive supplementary oxygen, and in 19 of 25 patients who received manual ventilation with 100% oxygen after induction of anaesthesia before LMA insertion. Full denitrogenation and partial denitrogenation were equally successful in preventing desaturation. Failure to position the LMA successfully occurred in 3% of patients, and some difficulty was encountered in another 18%.

Analgesia provided by either 5 mg diamorphine, or 5 mg methadone administered by the epidural route during elective caesarean section was compared in 40 women. The median time to further analgesia in the methadone group was 395 min, and 720 min in the diamorphine group, P = 0.0003. Linear analogue scores to assess pain were measured 2-hourly for 12 h, then again at 24 h postoperatively. Pain scores were significantly lower in the diamorphine group at 8 and 10 h. The median cumulative i.m. morphine dose administered during the first 24 h was 20 mg in the methadone group and 0 mg in the diamorphine group (P = 0.0005). Nausea and pruritus were common side effects in both groups. Continuous pulse oximetry data were available for 12 h post-operatively in 15 patients receiving methadone, and in 17 patients receiving diamorphine. One or more episodes of significant desaturation (< 90% for 30 s), occurred in three patients receiving methadone, and in nine patients receiving diamorphine. Desaturation to 90-92% occurred in a further three patients given epidural diamorphine, and in one further patient given epidural methadone.