HE diagnostic procedure of pneumoen-T cephalography (PEG) in a conscious patient may be attended by severe headache, nausea, hypotension, or hypertension. Factors that complicate the administration of general anesthesia include the initial sitting position plus numerous subsequent positional changes; the proximity of x-ray apparatus; and the possible effects of anesthetic procedures on intracranial pressure. It is common, therefore, to attempt to alleviate the patient's discomfort without producing unconsciousness, so that he can maintain his own airway and cooperate when being positioned for x-ray films.Although PEG is a fairly common procedure, there is a paucity of described analgesic technics. Neuroleptanalgesial or diazepam administration,z although satisfactory, is attended by some problems, mainly hypotension with the former and loss of consciousness with the latter. A general anes-thetic technic involving the use of long-acting nondepolarizing muscle relaxants and controlled ventilation has recently been described; although reported to be satisfactory, it may be attended by increased cerebrospinal fluid pressure and hypotension.3In the present investigation, the use of ketamine was contemplated because of its high analgesic potency and lack of hypotensive effects. To reduce the incidence of hallucinations associated with this drug, it was planned to "sandwich" the ketamine between doses of diazepam. For comparison in a second group of patients, alphaprodine was substituted for ketamine.
METHODAll patients were premedicated with diphenhydramine (50 to 75 mg.) and atropine (0.4 to 0.6 mg.) . After establishment of an intravenous infusion, the patient was placed in the PEG chair and the blood pressure
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