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MUN)3ELEER AND DECASTRO reduced an analgesic a~d sedatwe state for surgmal procedures, without using balblturates or volatile a~aesthetm agents, whmh they called neuroleptanalgesla They employed a comb!#atlon of drugs developed by Janssen m Belgmm to* aecomphsh this state and many anaesthetists are now usmg thas techmque m Europe 1-~ Of the numerous new analgesm and sedatwe ~lrugs recently developed by Janssen, the combination of droperldol (R4749, dehydrobenzpendol, Inapsine| and fentanyl (R4263, phentanyl, Subhmase| an a 50 lk mxxture has been found ' I to provide the most satisfactory anaesthetm eondatmns an both ammals and m man, without causing sermus pl~ysmlogmal disturbances that cannot be controlled effectwely 7 s The pharmaeologma| propertms of these two drugs are summarized m Table I

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ONE OF THE COMMONEST COMPLICATIONS Of anaesthesia and surgery is the occurrence of nausea, retching, and vomiting. The action of anaesthetic and associated drugs directly upon the digestive tract and its central and peripheral innervation probably play a prominent role on its incidence (see Table I). 1,2 Many nonspecific prophylactic and therapeutic measures have been employed to prevent or reduce its occurrence with but variable success (see Table I1). 3.4 Numerous drugs have been shown to have a depressant effect on the vomiting induced by chemical agents in dogs and other animals? Unfortunately, it is not as easy to reproduce the usual clinical factors which appear to initiate vomiting in man, so that it is practically useless to attempt to prove the eflqcacy of an anti-emetic drug by animal experiments alone?-7 Several other factors must be considered before it is decided to use an antiemetic agent in man in order to be sure that it is indeed useful following anaesthesia. First, the anti-emetic drug should be free of an appreciable depressant effect on the circulation and on respiration in the dose which might suppress postanaesthetic vomiting. The agent should be non-toxic to vital organs, and it should not prolong the hypnotic effect of anaesthetics or itself cause marked drowsiness. Very few of the drugs currently available as anti-emetics have such a limited action. Furthermore, the brief duration of the anti-emetic effect of these drugs substantially limits the optimum time for their administration, s-x~ Metoclopramide (MK 745) was developed in France in 1963, where it is known as Primp6ran. Its anti-emetic action was said to be powerhfl whether vomiting is of central or peripheral origin in a variety of clinical conditions in man. The formula is shown in Figure 1. 0 II CI-.~C-NHCH2CH2N(C2Hs)2 9 HCI H~N~OCH3 Metoclopramide hydrochloride 4-amino.5-chloro-N-[2-(diethylamino) ethyl]-o-anisamide hydrochloride CI,~H22CIN302 .HCI FIctrl~ 1. Structural formula of metoclopramide.