A trial was undertaken in children to compare the use of halothane and isoflurane in outpatient dental anaesthesia. A wholly inhalation technique was chosen and nitrous oxide in oxygen was delivered from a Boyle's machine via a coaxial (Bain) breathing system and was supplemented with either halothane or isoflurane. Isoflurane produced significantly fewer arrhythmias than halothane but the induction of anaesthesia took longer and proved more difficult.

Summary

Twenty patients who underwent elective Caesarean section received ranitidine 150 mg by mouth 8-14 h, and 50 mg i.m. 90 min, before surgery. Intraoperative gastric aspiration resulted in contents with a pH greater than 2.5 and volume less than 25 ml in all patients (mean pH 6.5 (SD 0.8); mean volume 9.0 (SD 7.2) ml). Sixty patients in labour, who received ranitidine 50 mg i.m. 6-hourly, underwent emergency surgery. Half of this group received, in addition, a single preinduction dose of either 15 or 30 ml of sodium citrate 0.3 mol litre-1. A further 30 patients who remained unmedicated during labour and required emergency surgery received a preinduction dose of 15 or 30 ml of sodium citrate 0.3 mol litre-1 alone. Ranitidine medication resulted in a mean aspirated gastric volume of 31.4 (26.6) ml and pH of 5.3 (2.1); five of 30 patients had a pH less than 2.5. The addition of sodium citrate 0.3 mol litre-1 resulted in gastric pH greater than 2.5 in all patients and a mean gastric volume of 43.2 (38.3) ml. The group who received only sodium citrate 0.3 mol litre-1 had a mean pH of 5.3 (1.1) and a mean volume 122.7 (98.2) ml.

Changes in arterial oxygen tensions in nine anaesthetized patients during controlled ventilation with either 79% nitrous oxide in oxygen or air only, were measured continuously using an intra-arterial oxygen electrode. When the patients were ventilated with the mixture, there was a significant increase in PaO2 of 2.74 +/- 1.08 kPa (P less than 0.002) over control values obtained while the subjects were awake and breathing air spontaneously. Changing the inspired gas from nitrous oxide in oxygen to air while ventilation was held constant resulted in a significant decrease in PaO2 of 2.22 +/- 0.94 kPa (P less than 0.001). However, these PaO2 values were not statistically significantly different from control values. We conclude that continuous accurate measurement of arterial oxygen tension is feasible provided that corrections are made in the electrode system for anaesthetic gases. We also found that the increase in PaO2 when 79% nitrous oxide in 21% oxygen was used, when compared with air, was lower than values proposed by previous investigators. The decrease in PaO2 when the inspired gas was changed back to room air was less than that found by others and there was no evidence of hypoxia when patients were ventilated on air alone after inspiring the mixture.

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