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The competence of the laryngeal-closure reflex was assessed in a group of patients having ketamine anaesthesia and found to be depressed. All patients in a control group of conscious volunteers had a competent reflex. The possible dangers of ketamine anaesthesia without endotracheal intubation are discussed.

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A patient with a permanent pacemaker underwent radical neck dissection. After induction of anaesthesia, a magnetic surgical instrument mat was placed over the patient's chest. This caused the pacemaker to go into a threshold test which included a 2.5-s period of asystole. Surgery had to be abandoned temporarily. We suggest that magnetic instrument mats should not be used with pacemaker patients; not all pacemakers are converted to a fixed magnetic rate by application of a magnet. The anaesthetist should check to see if the patient has a pacemaker with a threshold test and, if possible, this should be rendered inactive.

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