The effective dose of hypobaric ropivacaine combined with sufentanil 5 µg providing 95% success in spinal anesthesia for traumatic femoral neck surgery in the elderly is ED95 = 9 mg (95% confidence interval, 8-14). Using doses exceeding the ED95 may increase the incidence of hypotension. If doses less than the ED95 are chosen, the use of additional analgesia may be necessary.

We report a system for the continuous measurement of oxygen uptake (VO2) and carbon dioxide output (VCO2) during open-circuit anaesthesia. Gas concentrations were measured by a mass-spectrometer, and expired flow by a pneumotachograph. The values measured by the system were compared in vitro to values produced by a nitrogen-dilution technique. Excellent correlations were found. Continuous measurements were performed in 21 patients anaesthetized for abdominal surgery. Compared to pure intravenous anaesthesia (flunitrazepam-fentanyl), anaesthesia including the administration of nitrous oxide or nitrous oxide and halothane led to more pronounced and sustained decreases in VO2 and core temperature, with a better cardiovascular stability. Two hours postoperatively, VO2 was not different from preoperative values. After a transient increase at the onset of anaesthesia, the respiratory exchange ratio (VCO2/VO2) returned to preoperative values, and then remained subsequently unchanged. Based on these observations, the system described provides an accurate approach to noninvasively monitoring the pulmonary gas exchange in the operating room.

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