One hundred and one patients were randomly allocated to have their peripheral vascular surgery performed under general anaesthesia (51 patients) or spinal anaesthesia (50 patients). Intraoperative haemodynamic changes were markedly different between the two groups with a higher incidence of hypotension in the spinal group (72% vs 31%) and a higher incidence of hypertension in the general anaesthesia group (22% vs 0%). Blood loss was significantly less in the spinal group (560, SD 340, ml vs 792, SD 440, ml). Postoperatively three patients from the general anaesthesia group died from causes unrelated to the anaesthesia, and one had a myocardial infarct. Two patients in the spinal group had myocardial infarcts, both had been treated for bradycardia and hypotension intraoperatively, and one died. There was a significantly higher incidence of postoperative chest infection in the general anaesthesia group (33% vs 16%). There was no significant difference between the groups in the incidence of postoperative confusion, or lower limb amputation rate or need for further surgery prior to hospital discharge.

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The influence on foetal outcome of maternal Peo2 at caesarean section under general anaesthesia was assessed in 27 "clinically acceptable ideal patients" as defined by Crawford. l A standard anaesthetic technique was employed which utilised left lateral tilt and an FI02 of 0.5. A highly significant relationship (p < 0.001) was found between umbilical vein P02 and maternal end-tidal Peo2 in the range 20-40 mmHg, such that hypocarbia was associated with a lowering of umbilical vein P02. In spite of this relationship, only three values of P02 were less than normal (28 mmHg). No relationship was found between clinically measured parameters of foetal outcome and maternal end-tidal Peo2. The relevant literature is reviewed.