SummaryHaemodynamic changes and plasma catecholamine concentrations were measured in 12 patients aged 24 to 87 years after performance of a j e l d block for elective repair of inguinal or femoral hernia. The local anaesthetic used comprised a mixture of lignocaine 0.5% with adrenaline 1:200 000; the dose of lignocaine administered varied from 3.8 mglkg to 4.9 mglkg. Plasma adrenaline increased by 326% and plasma noradrenaline by 75% at I0 minutes after completion of the block. Mean heart rate increased from 75 to 94 beatslminute after 20 minutes, whilst there were no obvious changes in systolic and diastolic arterial pressures. Potentially serious arrhythmias developed in two patients, thought to be related to the peak plasma concentrations of adrenaline produced. It is recommended that the dose of adrenaline used as described for this block should be reduced.

Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 unitslhr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95 % confidence interval (Cl) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.

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