Natural killer (NK) cell activity and the endocrine response during and after parietal cell vagotomy were studied in two groups of patients receiving either epidural analgesia extending from S5 to Th4 + general anaesthesia (Group I), or general anaesthesia (Group II). NK cell activity of unseparated mononuclear cells in peripheral blood was measured against K-562 target cells in a 51Cr-release assay. NK cell activity increased in the same way in both groups in relation to premedication, anaesthesia and surgery (P less than 0.01). Postoperatively, the activity fell significantly on the first day (P less than 0.01), but returned to preoperative levels on day 3 (Group I) and day 5 (Group II). The endocrine response measured, except for adrenaline and prolactin, differed between Group I and II. In Group I, plasma noradrenaline and serum cortisol increased insignificantly throughout the observed period--compared to the preoperative level--whereas a significant increase in both hormones was found in Group II during surgery and in the postoperative period. A significant increase in plasma adrenaline and serum prolactin was found in both groups during anaesthesia and surgery. The findings indicate that NK cell activity during upper abdominal surgery is modified in almost the same way during two different anaesthetic techniques, one of which partly seemed to block the endocrine surgical stress response. The fluctuations in NK cell activity were not correlated to the changes measured in hormone concentrations.

Changes in complement reactions are described in two patients exhibiting adverse reactions to Stesolid MR (diazepam with Cremophor as solvent). The recorded frequency of adverse reactions to Althesin, propandid and Stesolid MR suggests that the common solvent Cremophor is responsible for the adverse reactions.

During a 12-month period, infraclavicular subclavian catheterization, using a Seldinger technique, was attempted on 77 occasions in 54 children with a median age of 2 years (range newborn to 10 years). General anaesthesia was used in the majority of cases, and catheterization was successful in 74 cases (96%). The initial catheter tip position was satisfactory in 81% of the cases, and catheters remained in situ for a median period of 7 days (range 1-28 days). There were few complications. Providing extensive experience in subclavian venous cannulation is gained in the adult, there is in our experience no minimal age or size which should limit the use of a subclavian vein catheter.

Local venous reactions during and after the injection i.v. of diazepam in oil (Diazemuls) and the water-soluble benzodiazepine midazolam (Dormicum) were studied in 100 patients undergoing gastroscopy. Observation time was 2 weeks. Of the patients receiving diazepam in oil, 8% experienced pain on injection and 6% subsequently developed clinical evidence of thrombophlebitis. Corresponding figures for midazolam were 6% and 10% respectively. No significant differences were observed between the effects of the two drugs.

A prospective, randomized, single-blind investigation was undertaken into the value of midazolam as an agent for the induction of anaesthesia. Sixty patients undergoing orthopaedic surgery of short duration were allocated randomly to receive either midazolam 0.2 mg kg-1 or thiopentone 3 mg kg-1. The induction time (measured as the time until loss of eyelash reflex) in the thiopentone group was significantly shorter than in the midazolam group. No differences were observed between the two drugs as regards time to onset of apnoea, or changes in heart rate and arterial pressure.

The adrenocortical response to a short tetracosactrin (Synacthen) test was studied in 11 patients receiving either etomidate infusion or thiopentone infusion used to maintain anaesthesia for abdominal hysterectomy. Pethidine was used as the narcotic component. The results showed that etomidate infusion (median 28.5 ug/kg/min) completely blocked the adrenocortical response to corticotropin stimulation for at least 24 h after surgery. No suppression was found in patients receiving thiopentone infusion. It is concluded that etomidate cannot be recommended for routine induction and maintenance of anaesthesia.

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Local venous reactions during and after i.v injections of three different formulations of diazepam were studied in 200 patients undergoing gastroscopy. Of the patients receiving diazepam in propylene glycol (Stesolid) 78% experienced pain on injection and 48% subsequently developed clinical evidence of thrombophlebitis. The figures for Stesolid MR (diazepam in Cremophor EL) were 38% and 9% respectively. A significant decrease was achieved (pain on injection 1%; clinical thrombophlebitis 4%) when using Diazemuls, a new formulation in which diazepam is dissolved in oil and emulsified in water. Since no difference in the therapeutic effect of the different formulations was observed, Diazemuls represents a clear advantage to Stesolid and Stesolid MR.