COOLING

succinylcholine chloride 3Omg and inflated through a cuffed endotracheal tube with nitrous oxideoxygen until spontaneous respiration returned. Her blood pressure at this time was 120/80 and her pulse rate 80, and she did not gag when halothane 0.5 per cent was added to the mixture via a Fluotec attachment. The halothane percentage was gradually raised to 1 per cent and over the next few minutes 6Omg of gallamine was given intravenously in divided doses each of 2Omg. Relaxation at this time appeared adequate, and the blood pressure had fallen to 100/70, pulse 120, but as the patient moved slightly as the incision was made, the halothane concentration was not lowered from its present level of 1 per cent. A few minutes later when the abdomen was open, the respirations had become very rapid and the blood pressure was found to be 80/60, pulse 140. The halothane was turned off, but her condition quickly deteriorated and she became pale, shocked and apnceic. Her blood pressure was unreadable and her pulse rate about 160 as a dextran drip was set up and lOmg methyl amphetamine was given whilst the halothane was washed out by inflation with a high flow of oxygen. Her condition remained stationary for several minutes and it was noticed that the exhaled oxygen continued to smell strongly of halothane for a long time. In about ten minutes her colour and pulse gradually returned, followed by a return of spontaneous respirations and the operation was completed with light cyclopropane anresthesia. At the end of the operation, her blood pressure was 14/90 and her pulse rate was down to 90 and she made a quick uninterrupted recovery. There appeared to be no reason for the collapse apart from halothane overdosage, and as the drug had only been used for a period of fifteen to twenty minutes and at no time at a higher concentration than 1 per cent this seemed extraordinary. It was noted however, that the temperature close to the wall of the theatre was 86" F. and was therefore probably above 90" under the lamps. I feel that at this temperature the Fluotec attachment was giving a much higher halothane percentage than was expected. The makers do state that the percentages are accurate 'up to 90" F.' but I feel that great care must be used when employing halothane in temperatures in this region. Yours faithfully, J. E. Norman