'He's fat, and scant of breath'Hamlet, Act V, Sc. I1 In spite of the aesthetic appeal and physical advantages of slimness, obesity remains the commonest nutritional disorder in civilised countries today. Although the Registrar General's statistical review of England and Wales, for 1971, listed obesity as the cause of death in only 170 patients,' the risks imposed on health and life by this disorder are not readily measured. The gross dangers, revealed by the Society of Actuaries' data, show that people who are 20% overweight increase their chances of dying from heart disease by 40% and from cerebro-vascular disease by 50%.' It has been suggested that being 10 Ib (4.5 kg) overweight carries a greater risk to health than smoking 25 cigarettes a day.3 Yet, in spite of an increasing indictment against obesity, the full implications of its adverse physiological effects are still incompletely investigated ; not least of all the response of obese people to anaesthesia and surgery.Obesity means excessive adiposity being derived from the Latin 'obesus' meaning 'fattened by eating'. The implication of the word 'obesity' itself is that 'the flesh has

(Am J Obstet Gynecol. 2019;220:494.e1–494.e7) Open maternal-fetal surgery (OMFS) for fetal myelomeningocele (fMMC) is associated with a significant reduction in morbidity related to spina bifida. OMFS for fMMC may be associated with adverse outcomes in subsequent pregnancies, but there are limited data available. There is a uterine rupture risk of 4% to 9% associated with a classical hysterotomy, but its unclear whether this risk is similar in hysterotomy for OMFS for fMMC. In 2012, the Fetal Myelomeningocele Consortium, now consisting of 25 institutions, was created to establish a registry of patients undergoing fMMC closure. This study aimed to investigate the maternal and neonatal outcomes in subsequent pregnancies following OMFS for fMMC closure.

Haemodynamic measurements and estimates of pulmonary gas exchange have been made in 15 patients during varying degrees of deliberate arterial hypotension induced by IPPV with varying concentrations of halothane in oxygen. Used in this way, halothane caused a dose-dependent arterial hypotension, which was directly related to a reduction in stroke volume and cardiac output, raised right atrial pressures, but insignificant changes in either heart rate or systemic vascular resistance. The findings are not compatible with the concept that the hypotensive effects of halothane are due to "vasodilatation", but are compatible with the results of animal studies which indicate a dosedependent impairment of the contractile function of the myocardium.

1. This study compared serum concentrations of morphine after administration of a buccal tablet (25mg) with those after intramuscular injection (10mg). 2. Buccal morphine was administered to eleven healthy volunteers and intramuscular morphine was given to five preoperative surgical patients. Serum morphine concentrations were assayed by high performance liquid chromatography (h.p.l.c.) in samples taken up to 8 h after drug administration. 3. Mean maximum morphine concentrations were eight times lower after buccal administration than after intramuscular injection and occurred at a mean of 4 h later. Individual morphine concentration‐time profiles showed marked interindividual variability after administration of the buccal tablet, consistent with considerable variation in tablet persistence time on the buccal mucosa.