Cardiorespiratory function was assessed in 22 mechanically ventilated patients who underwent surgery within an average of 4.8 days following traumatic spinal cord injury at C3-7. A fluid challenge technique was used to derive right and left ventricular function curves and to assist in choice of therapy from four possible outcome responses. Both right and left ventricular stroke work increased but left ventricular stroke work was still lower than normal in six (27%) of 22 patients despite elevation of cardiac filling pressures. Pulmonary vascular resistance fell, but systemic vascular resistance was unchanged following fluid challenge. Respiratory function, including intrapulmonary shunt, lung/thorax compliance, dead space, and arterial pO2 and pCO2, were unchanged by fluid administration averaging 520 ml of plasma protein fraction in 12 minutes. The Bainbridge reflex was inoperative. There was no correlation between anesthetic agent, level or type of neurological deficit, and cardiorespiratory function. Left ventricular function was impaired so the use of peripheral vasoconstrictors that elevate systemic vascular resistance should be avoided in the management of spinal shock. Instead, myocardial depressants should be reduced and fluid replacement used to optimize cardiac function. Elevation of central venous or pulmonary capillary wedge pressures to 18 mm Hg should be used to reverse hypotension, acidosis, low venous pO2, or oliguria before institution of centrally acting inotropic therapy in the management of acute spinal cord injury.

A PATIEN'F with a full stomach who requires anaesthesia for an emergency operation or an obstetrical procedure is frequently managed by a rapid induction (crash) technique. This technique ordinarily includes the use of suxamethonium to provide relaxation of the jaw so that tracheal intubation can be accomplished quickly. There are a number of conditions, however, that contraindicate the use of suxamethonium. These conditions include genetic abnormalities, central nervous system lesions that result in muscle atrophy, and severe burns) Moreover, succinylcholine is not desirable when it is essential to avoid an increase in intraocular pressure or intracranial pressure, z Under these circu instances, it would be preferable to use a non-depolarizing muscle relaxant for the rapid induction technique. The purpose of this study was to determine whether there is a dose ofpancuronium that will produce adequate conditions for intubation fast enough to satisfy the purposes of a rapid intubation technique. METHODSThe study group consisted of 40 patients, 24 to 83 years of age. There were 14 males and 26 females. The total number of patients was divided into four groups often.Premedication varied according to the patient's age, physical status, degree of anxiety, presence or absence of pain and the likelihood of increased secretions or reflex activity. In some instances premedication was omitted, in others it was solely an anticholinergic drug or a tranquillizer.After appropriate premedlcation, the patients were pre-oxygenated and placed in the head-up position. Anaesthesia was induced with thiopentone 3 to 4 rag-kg -t or diazepam 20-40 rag,

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