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HYPERVENTILATION AND METABOLIC ACIDOSIS
302
BRITISH JOURNAL OF ANAESTHESIA
Dundee, J. W., and Moore, J. (1961b). The effect of scopolamine on methohexital anaesthesia. Anaesthesia, 16, 194. Barron, D. W.. and King, R. (1960). The effect of methylation on ethyl methyl propyl thiobarbiturate. Brit. J. Anaesth., 32, 566. Moore, J., and Dundee, J. W. (1961a). Promethazine: its influence on the course of thiopentone and methohexital anaesthesia. Anaesthesia, 16, 61.
Moore, J., and Dundee, J. W. (1961b). Alterations in response to somatic pain associated with anaesthesia. V: The effect of promethazine. Brit. J. Anaesth., 33, 3. Stocking, V. K. (1953). Clinical use of newer intravenous barbiturates in anesthesiology. Anesth. and Analg., 32, 370. Graf, J. P. (1954). Preliminary report of five new intravenous barbiturates. Anesthesiology. 15, 61.
CORRESPONDENCE
M. HOBSLEY
Middlesex Hospital, London, W.I J. F. NUNN
Royal College of Surgeons of England REFERENCES
Robinson. J. S. (1961). Some biochemical effects of passive hyperventilation. Brit. J. Anaesth.. 33, 69. Symposium on pH and Blood Gas Measurement (1959), edited by R. F. Woolmer, p. 79. London: Churchill.
This letter was shown to Dr. J. S. Robinson who submitted the following reply: Sir,—This criticism seems a trifle surprising. The discussion at the symposium was obviously intended to reach a wider public. The fact that the proceedings of the symposium were not published
simply for private circulation must imply that it was intended that it should be read by those "not present at the symposium". Presumably the signatories were given the opportunity of eliminating or modifying equivocal material before publication. Certainly, this passage seems to have been misconstrued frequently: it has often been quoted to me as evidence conrraindicating the use of hyperventilation during anaesthesia. JOHN S. ROBINSON
Liverpool A. C. KING LTD
Sir,—May I be allowed to add a postscript to my letter under the above heading printed in your issue of January last (Brit. J. Anaesth., 33, 39). I have been assured by the British Oxygen Company, through the kindness of Mr. F. W. B. Kittel, that the name of A. C. King, which still appears associated with that of the parent company on the facia over the showroom in London, will remain so associated for the immediate future. It is over 20 years since A. C. King Ltd. became part of the British Oxygen Company, and those who are able to visit the showroom will realize that the same friendly welcome and service is extended quite unaffected by these changes, which, I believe, merely indicate that the present company now shows openly that it accepts full responsibility for the maintenance of the services provided for so long under the name of A. C. King. It is most reassuring to know that a large organization can, with us, take pride in an example of individual service and I believe that this happy state of affairs will remain for many long years to come. T. DINSDALE
Manchester
Downloaded from http://bja.oxfordjournals.org/ at National University of Singapore on August 6, 2015
HYPERVENTILATION AND METABOLIC ACIDOSIS
Sir,—In the article by Robinson (1961), we were surprised to find ourselves credited with the suggestion that "respiratory alkalosis produced by hypervenalation during anaesthesia is completely controlled by the production of a metabolic acidosis". The suggestion was derived not from a paper by ourselves but from remarks during discussion at the "Symposium on pH and Blood Gas Measurement" (1959). Reference to the transcript of the discussion will reveal that no such suggestion was made. One of us (M.H.) reported that "in three patients who were under controlled respiration . . . and had Pco2s of about 28 millimetres, the metabolic acidosis was sufficient to entirely compensate the respiratory alkalosis". We feel strongly that the freedom of discussion at a scientific meeting will be greatly curtailed if the reporting of findings in three patients is interpreted by others (not present at the symposium) as a "suggestion" of apparently universal application.
BRITISH JOURNAL OF ANAESTHESIA
Dundee, J. W., and Moore, J. (1961b). The effect of scopolamine on methohexital anaesthesia. Anaesthesia, 16, 194. Barron, D. W.. and King, R. (1960). The effect of methylation on ethyl methyl propyl thiobarbiturate. Brit. J. Anaesth., 32, 566. Moore, J., and Dundee, J. W. (1961a). Promethazine: its influence on the course of thiopentone and methohexital anaesthesia. Anaesthesia, 16, 61.
Moore, J., and Dundee, J. W. (1961b). Alterations in response to somatic pain associated with anaesthesia. V: The effect of promethazine. Brit. J. Anaesth., 33, 3. Stocking, V. K. (1953). Clinical use of newer intravenous barbiturates in anesthesiology. Anesth. and Analg., 32, 370. Graf, J. P. (1954). Preliminary report of five new intravenous barbiturates. Anesthesiology. 15, 61.
CORRESPONDENCE
M. HOBSLEY
Middlesex Hospital, London, W.I J. F. NUNN
Royal College of Surgeons of England REFERENCES
Robinson. J. S. (1961). Some biochemical effects of passive hyperventilation. Brit. J. Anaesth.. 33, 69. Symposium on pH and Blood Gas Measurement (1959), edited by R. F. Woolmer, p. 79. London: Churchill.
This letter was shown to Dr. J. S. Robinson who submitted the following reply: Sir,—This criticism seems a trifle surprising. The discussion at the symposium was obviously intended to reach a wider public. The fact that the proceedings of the symposium were not published
simply for private circulation must imply that it was intended that it should be read by those "not present at the symposium". Presumably the signatories were given the opportunity of eliminating or modifying equivocal material before publication. Certainly, this passage seems to have been misconstrued frequently: it has often been quoted to me as evidence conrraindicating the use of hyperventilation during anaesthesia. JOHN S. ROBINSON
Liverpool A. C. KING LTD
Sir,—May I be allowed to add a postscript to my letter under the above heading printed in your issue of January last (Brit. J. Anaesth., 33, 39). I have been assured by the British Oxygen Company, through the kindness of Mr. F. W. B. Kittel, that the name of A. C. King, which still appears associated with that of the parent company on the facia over the showroom in London, will remain so associated for the immediate future. It is over 20 years since A. C. King Ltd. became part of the British Oxygen Company, and those who are able to visit the showroom will realize that the same friendly welcome and service is extended quite unaffected by these changes, which, I believe, merely indicate that the present company now shows openly that it accepts full responsibility for the maintenance of the services provided for so long under the name of A. C. King. It is most reassuring to know that a large organization can, with us, take pride in an example of individual service and I believe that this happy state of affairs will remain for many long years to come. T. DINSDALE
Manchester
Downloaded from http://bja.oxfordjournals.org/ at National University of Singapore on August 6, 2015
HYPERVENTILATION AND METABOLIC ACIDOSIS
Sir,—In the article by Robinson (1961), we were surprised to find ourselves credited with the suggestion that "respiratory alkalosis produced by hypervenalation during anaesthesia is completely controlled by the production of a metabolic acidosis". The suggestion was derived not from a paper by ourselves but from remarks during discussion at the "Symposium on pH and Blood Gas Measurement" (1959). Reference to the transcript of the discussion will reveal that no such suggestion was made. One of us (M.H.) reported that "in three patients who were under controlled respiration . . . and had Pco2s of about 28 millimetres, the metabolic acidosis was sufficient to entirely compensate the respiratory alkalosis". We feel strongly that the freedom of discussion at a scientific meeting will be greatly curtailed if the reporting of findings in three patients is interpreted by others (not present at the symposium) as a "suggestion" of apparently universal application.