This paper describes an investigation designed to find out if theatre fires could be started by the antiseptic painted on the patient's skin being ignited by cautery or diathermy. It was found that hot wire cautery or diathermy generated enough heat to ignite all alcohol-based antiseptics even if these contained as little as 20 per cent alcohol. They could also cause iodine to explode in the presence of nitrous oxide, and nobecutane to explode in the presence of nitrous oxide or increased oxygen. The likelihood of these combinations causing fires is discussed, and it is recommended that when diathermy or cautery is to be used near the surface of the body, either an aqueous-based antiseptic is used or if spirit solutions are required they are carefully dried off before proceeding.

The influence of sedative, anaesthetic and neuromuscular blocking drugs on diagnostic urethral pressure profiles and cystometrograms has been investigated. These agents have marked effects on the results obtained; in particular, the urethral pressure profile was raised by opiates and lowered by anaesthetic induction agents. Bladder capacity as measured by the cystometrogram was greatly increased by halothane. These findings indicate that urodynamic studies should be performed only on conscious unsedated patients.

Internal jugular vein cannulation is reputed to be a safe procedure. The only neurological complication reported after it is a Homer's syndrome (Parikh, 1972). We report a case in which lesions of the left cervical sympathetic nerve; the ninth, tenth, eleventh, and twelfth cranial nerves; and the anterior branches of the second, third, and fourth cervical nerves occurred aftter left internal jugular cannulation. Case ReportA 64-year-old man with an anaplastic carcinoma of the bladder was admitted to hospital for cystectomy. Preoperative examination of the patient showed no neurological abnormality.As heavy blood loss was expected during the operation an arterial line was inserted into his left radial artery, an intravenous infusion into his right arm, and a central venous line into his left internal jugular vein. The latter consisted of a 16-gauge Medicut needle placed in the left internal jugular vein by the elective method described by English et al. (1969). This was then attached to a central venous pressure recording line containing 5 % dextrose solution.During the operation severe haemorrhage occurred, and eight litres of a mixture of blood, plasma, and dextran were given through the arm. Also 100 ml of 8-4% sodium bicarbonate and 10 ml of 20 % calcium chloride were given through the jugular vein, which was used for the rest of the operation to monitor central venous pressure (Briscoe, 1973).The transfusion in the neck was continued until the next day when a large swelling was noticed and the cannula was therefore removed. Intravenous tetracycline and 200 ml of 10% mannitol were given during this period but it is not certain through which line.The patient's postoperative progress was marred by an ileus during the first week, and he was not given fluids by mouth for 10 days. He was then found to have some difficulty in swallowing and it was noticed that he had a left Horner's syndrome.More neurological abnormalities appeared during the next week.A barium swallow in the third week showed obstruction at the level of the pyriform fossa and some spill of the barium into the trachea. There was no evidence (that damage had been caused directly by insertion of the needle. It appeared, therefore, that injury had been due to pressure from a haema.toma or extravasated fluid, or ito chemical damage from this fluid and ithe drugs contained in it.Haema'tomata occasionally may produce peripheral nerve palsies, and recovery may be delayed for days or weeks after subsidence of the iswelling (Parkes, 1945), presumably because of reversible structural damage tothe compressed nerve fibres (Fowler et al., 1972). Nevertheless, in -this case the delay in onset of the neurological abnormalities and the absence of iron deposits in the neck suggest that compression by a haematoma was not a major factor.The most importanit contribution to the damage was probably a direct chemical action of 'the drugs and fluids on the nerves. The swelling in the neck suggests ithat the cannula became at least partially dislodged from ithe vein, and t...

The incidence and nature of electrocardiographic changes occurring in subarachnoid haemorrhage was determined by a prospective study of neurosurgical patients. Electrocardiography was performed daily. The patients were grouped according to whether the electrocardiogram was always normal, always abnormal, or changing. A high incidence of electrocardiographic changes occurred not only in patients with subarachnoid haemorrhage (62 per cent) but also in those with space-occupying lesions (68 per cent). The prognosis in patients with changing electrocardiographic abnormalities was worse than in those in whom the electrocardiogram was consistently normal or consistently abnormal. The cause of these electrocardiographic changes was not elucidated but they were noted to occur more frequently in association with deteriorating levels of consciousness, pyrexia, and diastolic hypertension.

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