Hypotensive reaction after propanidid and atropine.

SIR,-I wish to report reactions during anaesthesia using propanidid. The patients were two children aged 12 and 4 years, each undergoing an operation for the evacuation of pus, one from a submandibular abscess, the other from a pelvic abscess. Both children were ill as a result of these conditions, but not severely toxic or with a high fever. In each case the child received the recommended dose (6-7 mg./kg.) of propanidid intravenously after intravenous atropine, and in each case the child immediately became bright red in colour all over. This marked peripheral vasodilatation was accompanied by acute hypotension, which demanded immediate resuscitation. A headdown tilt, artificial ventilation with oxygen, and a large and rapid infusion with a plasmaexpander were all rapidly instituted. The severe hypotension persisted for a much longer period than expected and constituted a threat to life. The second patient showed some resistance to artificial ventilation, possibly due to bronchospasm, and we wondered whether this was a histamine-release phenomenon. This child had received two similar anaesthetics uneventfully in the preceding six weeks. The first patient had had no previous anaesthetic. The outstanding feature of the reaction was the change in the child's colour from pale to scarlet, rapidly becoming cyanosed as peripheral blood flow ceased, Reported reactions of this type are rare. Beck, reported by Zindler,1 observed one very similar case and Radnay' one with some similarities. A further case has recently been reported byDesai.' I would be interested to receive any reports of similar abnormal reactions attributable to propanidid.-I am, etc., BRIAN KAY. Derbyshire Royal Infirmary, D-rbv REFERENCES I Zindler, M., Acta Anaesthesiologica Scandinavica. 1965, Sup1ementum No. 17, P. 79. 2 Radnay, P. A., Acta Anaesthesiologica Scandinavica, 1965, Supplementum No. 17, p. 79. ' Desai, P. G., personal communication.