486

J H Newman

Mr Dormandy replies as follows:

I do not feel that this has by any means been proved to be a useful technique. As the necessary equipment is quite expensive I feel that further properly controlled work needs to be done with this machine before it can be recommended for general use. JOHN A DORMANDY

I completely agree with Mr Newman's comments about the impotance of not assuming that all gas-forming infection is necessarily clostridial; and some of these patients have Charcot joints. However, so far as the controlled environment treatment is concerned, St James's Hospital, Balham

Postoperative analgesia using continuous infusion of papaveretum J M Cundy FFARCS Consultant Anaesthetist, Lewisham Hospital, London

The results of Dr E N S Fry's intravenous treatment of postoperative pain (Annals, September 1979, vol 6i, p 37i) are highly commendable. However, the careful preoperative explanation of the postoperative care could be held to be psychological conditioning likely to minimise the patient's postoperative discomfort'. There is no way that the informed consent necessary for such research could be obtained without such an explanation and therefore a control group cannot be evaluated to eliminate such factors. The problem in most hospitals is in ensuring that analgesics are given when needed since, particularly at night, there can be difficulty in finding nurses qualified to check controlled drugs. The steady I 2-h infusion neatly sidesteps this problem at a lower cost than the Cardiff self-administration system. There is an alternative to the routine uwe of

doxapram in patients with respiratory disease which I have found of considerable value. This is to give 250 mg of aminophylline intravenously slowly after spontaneous respiration has been established and to maintain an infusion of 500 mg aminophylline intravenously over the next I2 h. This combines bronchodilatation with respiratory stimulation at a lower cost than doxapram and has enabled me to avoid many postoperative respiratory problems. By electrocardiographic monitoring one can avoid problems of cardiac arrhythmias due to aminophylline and I have not experienced any difficulties from the use of this drug.

Reference I

Egbert, L D, Baltit, G E, Welch, C E, and Bartlett, M K (I964) New England Journal of Medicine, 270, 825.

Early experience with PTFE femoropopliteal reconstruction J W L Fielding FRCS R A Hurlow FRCS G Slaney chM FRCS F Ashton chM FRCS University Department of Surgery, Queen Elizabeth Hospital Medical Centre, Birmingham

Mr C A C Clyne and his colleagues (Annals, (PTFE) in femoropopliteal reconstruction for July 1979, vol 6i, p 30I) have reported their limb salvage. We have now had experience with PTFE early experience with polytetrafluoroethylene

Postoperative analgesia using continuous infusion of papaveretum.

486 J H Newman Mr Dormandy replies as follows: I do not feel that this has by any means been proved to be a useful technique. As the necessary equi...
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