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The glycemic threshold for hormonal responses to hypoglycemia falls in individuals with intensively treated diabetes or insulinomas, but these patients are more likely to develop EEG abnormalities during hypoglycemia. This disparity helps explain the increased vulnerability of intensively treated patients to severe hypoglycemia.

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arterial line in selected cases, but in our opinion it is neither necessary nor justifiable to insert routinely intra-arterial lines in all patients admitted to a general medical intensive care unit.Flexibility is the essence of modular monitoring apparatus. It allows the clinician to decide which physiological variables he wishes to monitor, and he should never regard such a system as a "panindicator" unit. Therefore each separate system must be reliable in its own right, and reliability in the clinical environment can be assessed only by intensive study in a clinical situation. The technique we used seems to give a useful indication of whether a particular system is suitable for routine clinical use. Moreover, we would suggest that to be of value in hospital conditions an automatic monitor needs to be at least 90% reliable.We would like to acknowledge the unstinted co-operation of the nursing staff of Starling Ward; Mr. A.

We studied EEG and brainstem auditory evoked potentials (BAEP) during routine surgery at various concentrations of isoflurane (12 patients) or halothane (11 patients) or during prolonged (mean 2.5 h, range 1.9-3.5 h) administration of 1% isoflurane (five patients). Recording and analysis was performed with the cerebral function analysing monitor (CFAM). At equivalent MAC, the two agents exhibited distinctive neurophysiological profiles. Increasing concentrations of isoflurane produced a clear sequence of EEG changes (decreasing fast and increasing slow components) then burst suppression activity suggesting cortical depression. With halothane, changes in EEG amplitude were less pronounced and those in frequency content less systematic, with no periods of suppression. Simultaneous BAEP showed greater latency increase with halothane than with isoflurane. Prolonged administration of 1% isoflurane was associated with a stable EEG (no periods of suppression) and BAEP.

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