A prospective, randomized, controlled trial was conducted in 200 consecutive patients undergoing endoscopy of the upper alimentary tract. One hundred patients received supplementary oxygen at 4 liters/minute through nasal cannulae, while 100 patients received no additional oxygen. Within each of these two groups, 50 patients were sedated with midazolam and 50 patients with diazepam suspension ("Diazemuls"). The patients' weights were recorded and correlated with their height to assess whether they were over or under their ideal weight. Oxygen saturation was recorded at baseline and throughout the endoscopic procedure. The principal finding of this study was that hypoxia (oxygen saturation less than 93%) was prevented in all cases by the administration of 4 liters/minute of oxygen, whereas 48 of the 100 patients who did not receive oxygen exhibited falls in oxygen saturation to less than 93% (p < 0.0001). Those with the highest risk were the obese patients (p < 0.01). There was no significant difference between the two sedative drug groups in either frequency or severity of associated hypoxia (p = 0.77, patients not given oxygen; p = 0.31, patients receiving oxygen). The cost of administering oxygen during upper gastrointestinal endoscopy would be an average of 95 pence ($1.60) per patient. In conclusion, the administration of oxygen during endoscopy is a worthwhile prophylactic measure to prevent hypoxia and its potential adverse effects.

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SummaryA 24-year-old female presented in hospital following self-poisoning with a dose of greater than 30 g of paracetamol (acetaminophen), taken both as co-proxamol (dextropropoxyphene and paracetamol) Key wordsToxicity; paracetamol. Complications; hepatic. Hypothermia.As many as 200 deaths per year in the UK are caused by paracetamol ingestion [I], and paracetamol poisoning is the most frequent cause of fulminant hepatic failure in the UK [2]. Patients who ingest large amounts of paracetamol and present at hospital late, beyond the time for effective protection by intravenous n-acetylcysteine [3], remain a difficult management problem and represent a large proportion of the patients who require intensive care for the management of fulminant hepatic failure and liver transplantation.The present patient's clinical course may point to a potential advance in the care of patients suffering from paracetamol poisoning. Case historyA 24-year-old female presented to the accident and emergency department in deep coma. The brief history obtained from a relative revealed a manic-depressive illness, previous episodes of self-poisoning and a disagreement, involving physical violence, 24 h before, which could have precipitated the attempted self-poisoning.On examination, the patient was found to be profoundly hypothermic with a rectal temperature of 19°C. Although severely hypothermic, she still maintained a heart rate of 30-40 beat.min-l and her electrocardiogram showed an irregular broad-complex bradycardia with 'J' waves. She was hypotensive with blood pressure of 50/30 mmHg. She was still breathing spontaneously but was hypoventilating and cyanosed. Neurological examination revealed fixed dilated pupils, a Glasgow Coma Scale of 5 and generally increased muscle tone. No gag reflex was elicited. Blood gases revealed a respiratory acidosis. There was mild hyperkalaemia (5.9 mm.1-') and mild hyperphosphataemia (2.63 mmo1.-'), consistent with hypothermia. Haematological and coagulation studies were normal. The serum paracetamol level was 943 pmol.l-'. N o salicylate was detected.