Possible correlations between age and certain characteristics of spinal blockade with plain bupivacaine were investigated in 124 patients, ages ranging from 15 to 92 yr. Three millilitre of 0.5% solution (sp. gr. 1.000 at 37 degrees C) was injected at the L3-L4 interspace. There were great individual variations in all age groups, but the maximum spread of analgesia increased with age, although the correlation was poor (P less than 0.05). The spread of analgesia to L2 and L3 segments in the oldest patients (greater than or equal to 70 yr) was about twice as fast as that in the youngest (less than 30 yr). Complete motor blockade of the lower extremities developed most rapidly in the oldest patients (greater than or equal to 80 yr; mean 11 min), while in patients younger than 50 yr the mean time to complete motor block was approximately doubled. The mean sensory recovery of the two uppermost segments and the mean sensory recovery of the S1 segment did not correlate significantly with age. The decrease of systolic arterial pressure was correlated with the height of the sensory block only in the oldest (greater than or equal to 80 yr) patients. Post-spinal headache was encountered in two patients (1.6%).

Aruisth. Wie&rbcleb 2, 120. YOFFA, D. (1965) Supraclavicular subclavian venepuncture and catheterisation. Lancet ii, 614. a5,563.

Six patients undergoing elective femoral osteotomy were subjected to a series of intravenous glucose tolerance tests and plasma insulin determinations in a study of the way in which a standard operation affects carbohydrate metabolism. The glucose tolerance of all patients assumed a diabetic pattern; this was already observable in the test made on admission to the operating theater and was still evident during the last test on the second postoperative day. The changes were most profound during and four hours after the operation. Insulin secretion was suppressed on the day of operation, but exceeded preoperative values in the postoperative period. Urinary excretion of catecholamines was determined in 4 patients; there was no correlation between the degree of insulin suppression and the catecholamine output. The assumption that the hyperglycemic response and insulin suppression are mediated along splanchnic neural pathways was not confirmed in a quadriplegic patient, who responded to an intravenous glucose tolerance test soon after the injury with hyperglycemia, insulin suppression and a low catecholamine output. It is concluded that the hyperglycemia and insulin suppression observed after trauma represent a complex and purposeful metabolic response, in which several causative factors are involved.