Nitrogen Mustard in Palliation of Malignant Effusions
Authors: V. B. Levison
Journal: BMJ (1961)

MwICAu.JOURNAL which was possible after about four minutes of the inhalation of 3% halothane.Induction of anaesthesia to a depth sufficient for skin incision required about eight minutes.This time could no doubt be reduced by using 4% halothane, but it appeared a useful safe- guard for the apparatus to be unable to deliver a concentration in excess of 3%.Recovery of reflexes at the end of operation was considerably slower than with nitrous oxide, but much depended upon the ability of the anaesthetist to anti- cipate the termination of the operation and discontinue the halothane.There was, in general, no difficulty in obtaining sufficient relaxation for laparotomy.Many surgeons have now come to expect total paralysis for all surgical intervention in the abdomen, but, nevertheless, there would seem to be little doubt that 3 % halothane would provide sufficient relaxation for appendicectomy or the suture of a perforated peptic ulcer.On an expedition a long induction and long recovery would be of less moment than in a general hospital with a busy operating schedule.The most disquieting feature of halothane anaesthesia is the hypotension which is often seen, particularly in the deeper planes of anaesthesia.Systolic pressures down to 75 mm.Hg were encountered in the present study.Sequelae of hypotension due to halothane were not observed in this study nor when those participating have used halothane on other occasions.There is little experience of the use of halothane in the presence of surgical shock, but there is, as yet, no evidence to suggest that it is any more harmful than any other general anaesthetic agents.Wyman (1953) and Johnstone (1958) consider that vasodilatation is, in fact, beneficiala view shared by many anaesthetists.On a number of occasions the oxygen cylinder was removed during administration of an anaesthetic.The anaesthetist had no difficulty in converting the circuit to draw-through without interrupting the conduct of the anaesthetic, the use of air as carrier gas causing no visible change in the condition of the patient.A small number of patients were successfully ventilated artificially by manual compression of the reservoir bag.However, it is stressed that mouth-to-mouth respiration is preferable to this technique.Not only is the former technique difficult for the inexperienced, but, with the present apparatus, the fresh gas flow is interrupted during inspiration and thereby reduced to some 4-5 litres per minute.At the present time medical officers appointed to the Falkland Islands Dependencies attend the Research Department of Anaesthetics of the Royal College of Surgeons for instruction in the maintenance of the apparatus.Thereafter they receive clinical instruction in its use at Hammersmith Hospital.ADDENDUM.-Sincethis work was completed the author has made some use of the azeotropic mixture of halothane and ether as a general anaesthetic (Hudon, Jaques, and Boivin, 1958).Full evaluation of the mix- ture is not yet complete, but first impressions suggest that it might be more suitable than pure halothane under the conditions of an expedition.An equal depth of narcosis is obtained with a lower absolute concen- tration of halothane, and therefore the likelihood of hypotension is probably diminished.A calibrated and compensated vaporizer is available from Messrs. Cyprane for use with the azeotropic mixture.