Sodium Soneryl as a Pre-Anæsthetic Basal Narcotic

SODIUM soneryl, the sodium salt of butyl ethyl barbituric acid, is-olle of the least toxic of the barbiturates. In the series of cases under considleration, consisting of routine general surgical cases, it has, on the whole, given excellent results. Larger doses are tolerated than in the case of most of the other barbiturates, and the ratio between the medicinal and the lethal dose is high. After a certain amount of experimental vork with smaller doses on a number of cases, the results not being entirely satisfactory, it was deci(led to adlopt the dosage recommended by Birdsell (B.M.J., 26th May, 1933) for this series. The routine adopted was as follows:-The patient was given one capsule (.15 grm.) by mouth the night before operation. This ensured a good night's sleep. One hour before the operation the drug was again administered by mouth in capsule form, the amount being proportionate to the bodyweight. Children received .3 grm. (two-capsules), followed by .15 grm-. (one capsule) if not asleep within half an hour. Adults under ten stone received-.6 grm. (four capsules). Adults of ten to twelve stone received .75 grm. (five capsules). Adults of over twelve stone received .9 grmi. (six capsules). A hypodermic injection of atropine sulphate-was given in all cases twenty minutes before operation. Anaesthesia was induced by chloroform and ether mixture, followed by open ether. It was found that the age factor-had an important bearing on the dosage of sodium soneryl. Elderly patients, and particularly elderly patients of frail physique, required a smaller dose than that indicated for their bodyweight. One case in the series is an excellent illustration of this point. The patient was a man of 66 years about to have a cystostomy performed for a large urinary calculus. He was only given two capsules (.3 grm.) on the morning of the operation, but came to the theatre sound asleep. In the afternoon he felt perfectly comfortable, and inquired when his operation was to be performed. He was an ideal case with complete amnesia, no post-operative vomiting or restlessness, and obviously had received the correct dose. In contra-distinction, another case is instructive. A young girl of 18, with tuberculous adenitis of the neck, through an error of the nursing staff was given only .3 grm. (two capsules) on the morning of the operation, and she came to the table somewhat drowsy but aware of her surroundings. After the operation she …