An improvised ethyl chloride attachment.

THE sequence nitrous oxide-oxygen-ethyl chloride is one which has been successfully used by a number of anaesthetists for many years, especially when a pleasant induction followed by brief but deep anaesthesia and rapid recovery, is desired—e.g. for guillotine tonsillectomy in children. The accompanying photograph illustrates an improvisation to a standard Boyle machine with a Magill attachment which facilitates this technique. A detailed discussion of the technique will be found elsewhere (Campbell and Smith, 1955). The tap of the reservoir-bag is placed in the vertical position and unscrewed. Through the hole thus exposed some 12 to 15 inches of suitably fine rubber tubing are threaded, and so introduced into the adjacent part of the breathingtube. Into the end of the tubing which now remains protruding from the hole is inserted the nozzle of an ethyl chloride spray. This is in turn fixed vertically above the hole by means of an arrangement of clamps of the type used with a laboratory burette-stand. The jaws of the clamp which holds the spray can be padded with adhe sive sponge rubber to minimize the risk of breakage.