This paper describes the results of 500 percutaneous catheterisations of the internal jugular vein. The first 200 of these have been previously reported 1.Several techniques of central venous catheterisation for pressure recording or mixed venous sampling have been developed previously. The complications of infraclavicular subclavian venepuncture have been described by several authors, the commonest being pneumothorax. Damage to the subclavian vein, extravenous placement of the catheter in the tissues or pleural cavity and septicaemia have also occurred*-5. A supraclavicular technique has been described with a low incidence of complications 6 although we have as yet no experience with this method. Percutaneous femoral vein catheterisation has also been described but has a high (46 %) complication rate including four fatalities from septicaemia'. The insertion of a long catheter from the antecubital fossa either by cutdown or venepuncture quite often results in thrombophlebitis and it is frequently difficult to thread the catheter into the central veins. External jugular venous anatomy is inconstant and it is difficult to thread a catheter past the valve commonly present at its termination5.The value of central venous pressure monitoring is unquestioned and as it is frequently necessary in cardiac surgery we have developed two techniques for catheterising the internal jugular vein by percutaneous venepuncture. A N A T O M YThe internal jugular vein emerges from the base of the skull posterior to the internal carotid artery. It terminates at the inner border of the anterior end of the first rib behind the clavicle. During its course through the neck it becomes lateral and then antero-lateral to the carotid arteries and is covered superficially for most of its length by the sternomastoid muscle. The posterior belly of the digastric muscle, the omohyoid muscle and the vessels and nerves to sternomastoid cross the vein superficially. When the head is turned to the opposite side the internal jugular vein in the lower part I

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Lignocaine is widely used as a topical analgesic for the larynx and trachea prior to endotracheal intubation or bronchoscopy 1 ' 2.Prilocaine which was first described in 1959 3 has since been shown to be similar to lignocaine in its analgesic properties41 5 . Toxicity studies in animals have indicated that it is 40 % less toxic than lignocaine6. A drug which is less toxic than lignocaine but equally effective topically would be a considerable advantage, especially as drugs for topical application are usually used in high concentration.Two trials were therefore carried out to compare the effectiveness of lignocaine and prilocaine as topical analgesics. h.1 A T E R I A L SThe following solutions were used : 1 Physiological saline 2 2 % prilocaine 3 4% prilocaine 4 4 % lignocaine.

Lignocaine is widely used as a topical analgesic for the larynx and trachea prior to endotracheal intubation or bronchoscopy 1 ' 2. Prilocaine which was first described in 1959 3 has since been shown to be similar to lignocaine in its analgesic properties41 5. Toxicity studies in animals have indicated that it is 40 % less toxic than ligno-caine6. A drug which is less toxic than lignocaine but equally effective topically would be a considerable advantage, especially as drugs for topical application are usually used in high concentration. Two trials were therefore carried out to compare the effectiveness of lignocaine and prilocaine as topical analgesics. h.1 A T E R I A L S The following solutions were used : 1 Physiological saline 2 2 % prilocaine 3 4% prilocaine 4 4 % lignocaine.

percentage of patients, higher than the incidence of those showing suxamethonium-induced pain, demonstrate also post-operative pain not related to the incision site.