The use of hypotension in anaesthesia for ear, nose and throat operations.

OPINIONS differ vastly and there has been considerable controversy about the usefulness and the advisability of using hypotensive drugs as an adjunct to surgery. Let us, therefore, at the outset say that, within our very limited experiences (some 370 cases in all), we have formed a very favourable opinion of their use in anaesthesia for ear, nose and throat surgery. Of the papers published so far, few seem to have mentioned their wide field of application in these operations. Scurr and Wyman (1954) record the use of Arfonad in 20 operations upon the mouth, nose and throat, but do not mention the particular advantages obtained. Stirling (1955) described 20 fenestrations using hexamethonium bromide with excellent results. We have found that the use of this technique provides two great advantages. Firstly, during operation a comparatively bloodless field has made it much easier for the surgeon to see exactly what he is doing, and that has almost halved operating times. Secondly, there has been no pre-operative packing of the nose, which saves the patient a great deal of discomfort. Nor has there been any postoperative packing, which again has greatly benefited the patient. Almost all patients are able to breathe nasally on the first postoperac ' 405 tive day and their comparative well-being has to be seen to be believed. We started using hypotension in this series in 1951 with hexamethonium bromide as the drug of choice, and achieved considerable but not very consistent success. Since April 1954, we have used Arfonad with much improved (and very much more controllable) results. The total numbers of each drug and the operations for which they were used are given in table I. The results obtained are given in table II . A grading of " V. Excellent" denoted an almost completely dry field. "Excel lent" , "V . Good", " Poor ", and " Failure " indicated lessening degrees of success. It will be seen that Arfonad gave a very much greater percentage of success than did hexamethonium bromide and for that reason we have now completely abandoned the latter.