A RETURN TO SIMPLICITY? *

I HAVE been asked to speak today on the theme “ A Return to Simplicity ”. But what do we mean by Simplicity ? To what should we Return ? As I see it, the question of simplicity presents a complex problem. First of all, a technique which is “ simple ” to one anasthetist may be “ difficult” to another, and vice versa ; it seems reasonable, however, that the problems presented by a particular patient or operative procedure, or the straightforwardness of a given undertaking, should by and large be reflected in the conduct of the anaesthesia. Again, one must not divorce the desire for simplicity from the ultimate good of the innocent party; yet some have an uneasy feeling that anzsthesia today is often made unnecessarily complicated, and that intricate techniques as oft satisfy some whim of the amsthetist as they yield intrinsic benefit to the patient. Further, the pharmacological effects of different drugs and the repercussions of their use upon normal physiology must certainly serve as yardsticks when sizing up a situation ; nevertheless, theoretical considerations should not entirely outweigh, or blind us to, practical experience and results because, after all, the proof of the pudding is in the eating. On so large a canvas I can do no more than rough in the general outline, sketching in a feature here and there. I shall, thereforein a sort of sequel to my R.S.M. address1 of last year-first of all try to justify much that is done today and then exemplify certain points where 1 think the train of Anasthesia is going off the rails.