Correspondence hyperinsulinism is considered.'S2 Furthermore, many cases have been described from a swgical ~i e w p o i n t .~.~The choice of anaesthetic technique for these patients is of little significance. We have used both halothane and neuroleptanalgesia without difficulty. Provided that blood sugar estimations are frequent and appropriate quantities of dextrose are administered intravenously preoperatively and during surgery, severe hypoglycaemia should neither occur, nor should the effects of anaesthetic agents cause confusion. Stress in operating theatre personnel
Department of Anesthesiology,
R. MILLER
Mount SinaiIn recent years attention has been focussed on the health risk run by operating theatre personnel. Rosenberg and Kirves' in the Finnish survey suggested that excessive work loads rather than anaesthetic gases are the major cause of obstetrical disturbances among nurses working in operating rooms. Smitha pointed out that we should not necessarily seek a single cause for these alleged potential hazards of being an anaesthetist. Contributory causes could include occupational stress arising from the incidence of uncertainty and anticipation exacerbated by irregular routine, fatigue and emotional factors. This study was undertaken to establish whether or not working in an operating theatre environment led to increased stress as evidenced by altered physiological and biochemical responses and to compare some of the findings with those obtained in nurses working in wards.Two series of experiments were undertaken, the first on two separate groups of workers. The first group was composed of nine male and six female volunteers, ranging in age from 24 to 60 years, who normally worked in the operating theatre as doctors, nurses and technicians. The second group consisted of six male and nine female nurses from the wards, their ages ranging from 26 to 57 years.All subjects were in normal health and were not taking any drugs, and were studied between the hours of 9.00 a.m. and 12.00 noon; there was no systematic difference in the time of day during which different groups were investigated. The measurements of pulse rate and blood pressure were taken at 9.00 a.m. and again at 12.00 noon. Blood pressure was taken by auscultatory method. Blood samples for cortisol estimation were also withdrawn at 9.00 a.m. and 12.00 noon. The measurement of plasma cortisol was made by the method of Mattingl~.~ In the second series, the urinary output of adrenaline and noradrenaline was estimated in six healthy male volunteers, ranging in age from 26 to 48 years, comprising of three anaesthetists, two surgeons and one theatre technician. The urine samples were collected in two periods from 9.00a.m.to12.00noonand2.00p.m.to5.00p.m.,on operating days and non-operating days, thus using each subject as his own control. The details in the experimental studies were strictly standardised, including food and fluid intake and urine collections.The volume of urine was measured during each period. Catecholamines were extracted from the a...