314

Correspondence

6 . PESKETT, W.G.H. (1973) Antacids before obstetric anaesthesia. Anaesthesia, 28, 509. 7. BULEY, R.J.R., DOWNING, J.W.W. & BROCK-UTNE,

J.G. (1977) Right versus left lateral tilt for Caesarean section. British Journal of Anaesthesia, 49, 1009.

Neurological complications of spinal analgesia Serious complications of spinal analgesia are fortunately rare, although minor and transient changes in the postoperative period are probably more common than is generally realised. The distinction should be made between complications of the spinal technique itself and those resulting from preexisting disease. Our experience in Athens of spinal analgesia employed in 2018 patients between 1975 and 1977 may be of interest. The method was used in a variety of operations including those of general surgery, gynaecology, urology, orthopaedics and plastic surgery. The patients in this series were aged between 40 and 70 years and the local analgesic agents used were lignocaine 2%, prilocaine 2% or prilocaine 4%. Only two patients developed neurological symptoms and signs in the postoperative period. Both had a history of alcoholism and in both patients complete recovery occurred. The first patient a 45-year-old man, underwent reduction of fractures of the tibia and fibula under spinal analgesia. On the fifth postoperative day he complained of weakness, paraesthesial and loss of sensation in the lower limbs. Neurological examination revealed no sensory deficit but there was diminution of muscle tone and tendon reflexes. Treatment with large doses of Vitamin B complex, thiosulfuric calcium (Versenate)

and cortisone was instituted as well as physiotherapy. The symptoms subsided within 1 week and the electro-myelogram following discharge after 4 weeks in hospital was normal. The second patient, a 64year-old man, underwent prostatectomy under spinal analgesia. On the eighth postoperative day he developed tremor, especially of the lower limbs, with considerable muscle weakness on standing, and sensory changes. On examination there were increased spinal reflexes and hyperaesthesia of the skin of the lower limbs. The patient was treated with the same therapeutic regime as the earlier patient and the symptoms subsided within 18 days. The electromyelogram was normal at the time of discharge from hospital 4 weeks later. It would seem that the symptoms and signs which occurred in these two patients might have resulted from the fact that they suffered from chronic alcoholism. Alcoholic polyneuritis is the likely diagnosis and the spinal analgesia was probably not relevant. The experience of over 2000 spinal blocks gained here suggests that it is a useful and safe technique in experienced hands. Department of Anesthesiology, G. ECONOMACOS Athens General Hospital, Greece.

The prevention of pipe-line accidents

I read Dr Cundy’s letter (Anaesfhesia, 1977, 32, 922) followed by Dr Robinson’s comment concerning pipe-line accidents prevention. I agree with Dr Robinson’s opinion that ‘colour shouldn’t be considered a primary safety factor’. In a country like Greece where foreign manufacture of anaesthetic machines and equipment is a rule and when the origin of this equipment varies even in the same hospital, it seems extremely difficult if not impossible to formulate a pipe-line standard. In our hospital however we have solved this serious anaesthetic problem using central pipe-lines for oxygen supply and cylinders for nitrous oxide. This disad-

vantage of changing cylinders of nitrous oxide occasionally in the middle of major operations is a small price to pay for the safety of our patients. Of course we have to rely on manufacturers’ testing for identity and purity of nitrous oxide cylinders. So far we are quite happy with this not very convenient but safe way of oxygen and nitrous oxide administration. Hellenic Anticancer Institute,

A. FASSOULAKI

St Sauas Hospital,

171 Alexandras Av., Athens 603, Greece.

Sedative premedication? Few would deny that one of the chief aims of a sedative premedication is to reduce the patient’s anxiety and even make him sleepy. So why do we generally receive him in a brightly lit anaesthetic room, wake him up if he has fallen asleep, sit him up to remove his gown, busily chatter away and generally stimulate him? Has not the anaesthetist failed

if a child continues to cry or even scream after he has reached the theatre suite, and is his technique not at fault if a child cries and struggles during induction? Why don’t we leave patients alone in a quiet and darkened room and anaesthetise them in a way that leaves little or no memory of the event? Whilst perfection is unattainable, surely the quiet

Neurological complications of spinal analgesia.

314 Correspondence 6 . PESKETT, W.G.H. (1973) Antacids before obstetric anaesthesia. Anaesthesia, 28, 509. 7. BULEY, R.J.R., DOWNING, J.W.W. & BROCK...
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