We have investigated in 30 patients the metabolic and hormonal responses to middle ear surgery using induced hypotension to a mean arterial pressure of 55 mm Hg. A standardized anaesthetic technique of propranolol, thiopentone-vecuronium-isoflurane was used in all patients and hypotension induced with sodium nitroprusside, trimetaphan camsylate or additional isoflurane. All patients showed a classic stress response with an increase in circulating blood glucose, cortisol and growth hormone concentrations. Blood lactate and plasma uric acid concentrations changed little during operation, suggesting that tissue oxygenation was adequate. However, the former declined after operation, possibly as a result of the concomitant use of propranolol. There were no significant differences between the three hypotensive techniques in their effects on the hormonal and metabolic response, although the increase in blood glucose concentration in the trimetaphan group was obtunded. We conclude that induced hypotension for middle ear surgery induced an endocrine and metabolic response of small magnitude and short duration.

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SummaryNineteen patients with subarachnoid haemorrhage who had cerebral angiography with the new contrast medium iohexol, were randomly allocated to receive either local anaesthesia plus sedation, or general anaesthesia. Arterial blood pressure,

The aim of this study was to compare patterns of mortality in Australia and New Zealand, using routinely collected data. Life expectancy at birth is greater in Australia than in New Zealand (in 1996 the gap was 1.5 years for women and 1.1 years for men). Prior to 1970, mortality was lower in New Zealand than Australia. Possible reasons for the divergence in life expectancies include slower economic growth in New Zealand, more marked increases in economic inequalities which have affected Maöri in particular and, to a modest extent, differentials in health care.

Infection remains a significant problem for patients with cardiac‐implantable electronic devices (CIEDs) but can be difficult to diagnose. We describe an unusual presentation of CIED infection in a patient with abandoned pacemaker leads. A 27‐year‐old male presented with facial flushing on upper but not lower limb exertion due to superior vena cava (SVC) obstruction, as well as pleuritic chest pain due to septic emboli. This was successfully treated with antibiotics and complete endovascular extraction of the pacemaker leads. Upper limb exertional facial flushing may be a useful clinical sign for the diagnosis of SVC obstruction. This case report also describes a rare presentation of CIED infection.