Deaths under stovaine: a criticism.

I N the British Medical Journal, April 22, 1950, two deaths immediately following the injection of 2 ml. of Stovaine were reported (Walker and Mathews, 1950) from the department of Obstetrics and Gynaecology, University College, Ibadan, Nigeria, West Africa. It is quite obvious that the deaths were directly due to the anaesthetic. In both cases death followed immediately on the administration of 2 ml. of amylocaine hydrochloride and before the operation had begun. Various measures for resuscitation were carried out but unsuccessfully. In the order given they were: (1) ephedrine grain £ (50 mg.); (2) adrenaline, 8 min.; (3) an intra-cardiac injection of 1 ml. of nikethamide, and also anal stimulation. " Despite these measures and artificial respiration there was no response." If that was the order in which these measures were carried out, of course there would be no response. A spinal anaesthetic has no direct effect on the heart so why stimulate it? It does paralyse respiration if it goes too high, and it is quite obvious that the Stovaine did go too high. Nothing is said about the position of the table, but if the patient were in the Trendelenburg position and if the Stovaine solution were of the hyperbaric variety these two factors would account for the extreme rapidity of the deaths.