Arterial blood levels of lactate and pyruvate and the production of excess lactate were studied in two groups of patients. One group of ten patients was anaesthetized with <1 per cent halothane, nitrous oxide and oxygen and allowed to breathe spontaneously. The second group of twelve patients was anaesthetized with nitrous oxide and oxygen, and additional trichloroethylene or papaveretum, and deliberately hyperventilated. No significant changes were found in lactate or pyruvate during anaesthesia in the first group, but there was a significant increase in the lactate: pyruvate ratio half an hour after recovery from the anaesthetic. Significant excess lactate production occurred during anaesthesia in the second group after hyperventilation had been in progress for half an hour. The excess lactate increased after 1 hour of hyperventilation and further increases were found half an hour after recovery from the anaesthetic. These findings are discussed in relation to the observed changes in blood-gas levels and acid-base balance and to the current knowledge of carbohydrate metabolism. BRITISH JOURNAL OF ANAESTHESIA TABLE I Age, sex and diagnosis of patients studied.

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Arterial blood levels of lactate and pyruvate and the production of excess lactate were studied in two groups of patients. One group of ten patients was anaesthetized with <1 per cent halothane, nitrous oxide and oxygen and allowed to breathe spontaneously. The second group of twelve patients was anaesthetized with nitrous oxide and oxygen, and additional trichloroethylene or papaveretum, and deliberately hyperventilated. No significant changes were found in lactate or pyruvate during anaesthesia in the first group, but there was a significant increase in the lactate: pyruvate ratio half an hour after recovery from the anaesthetic. Significant excess lactate production occurred during anaesthesia in the second group after hyperventilation had been in progress for half an hour. The excess lactate increased after 1 hour of hyperventilation and further increases were found half an hour after recovery from the anaesthetic. These findings are discussed in relation to the observed changes in blood-gas levels and acid-base balance and to the current knowledge of carbohydrate metabolism. BRITISH JOURNAL OF ANAESTHESIA TABLE I Age, sex and diagnosis of patients studied.

Disclosures: F. Chiou-Tan, Elsevier, Receipt of royalties Objective: Spasticity can cause torsion of the upper limb after injury to the brain from stroke or trauma. This may be treated with botulinum toxin, phenol, or alcohol injections. Existing anatomic references do not provide the location of muscle targets in this hemispastic position. This article reviews the anatomy of the proximal arm in the position of upper extremity hemispastic flexion synergy and its relationship to procedures in the clinical setting. Objective: To provide anatomically accurate schematics of proximal arm anatomy in the position of hemispastic flexion synergy relevant to needle procedures. Design: Musculoskeletal ultrasound images were obtained in a healthy subject in anatomic neutral and hemispastic position. Anatomic illustrations were derived from these images. Setting: Academic PMR Department. Participants: Healthy human subjects. Interventions: Musculoskeletal ultrasound images of the arm in the position of hemispastic flexion synergy as compared to anatomic neutral. Main Outcome Measures: not applicable Results or Clinical Course: Cross sectional schematics for the arm were drawn as they appear in imaging projections. The level of cross section was selected to highlight important anatomic landmarks for injection. Color coding was used to emphasize needle procedure targets (blue) and structures to be avoided (red). Change in position of key muscles commonly injected for upper extremity spasticity are illustrated. Conclusions: It is hoped the schematics created in this paper allow for safer and more accurate needle procedures in the arm for the treatment of spasticity.