Pulmonary Disability in Coal Workers'

scopy (12 February, p. 411). During the past 12 months I have anaesthetized 75 patients for either laparoscopy or laparoscopic sterilization, during which carbon dioxide has been used to inflate the peritoneal cavity. Continuous electrocardiographic monitoring has been carried out throughout each procedure and no cardiac arrythmias have been observed. All patients are premedicated 12 hours prior to operation with Pamergan SP. 100 (pethidine 100 mg, promethazine 50 mg, and hyoscine 0 43 mg) and anaesthesia is induced with methohexitone in a dose of 2 mg/kg body weight to which D-tubocurarine in a dose of 25-30 mg has been added. Intubation using a cuffed Oxford tube is then performed and anaesthesia maintained with nitrous oxide and oxygen 8: 5 litres per minute in a semi-closed system with an absorber using intermittent positive pressure respiration with a Commonwealth Industrial Gases auto-hand respirator. Atrophine and neostigmine in doses of 12mg and 2-5 mg respectively are administered routinely to all patients at the conclusion of the operation. Under the conditions which exist when laparoscopy is performed-that is, gross distention of the peritoneal cavity and considerable degree of tilting of the table-one is not surprised that some arrythmias will occur if the patient is subjected to the added trauma of spontaneous respiration without intubation, and I would suggest that cardiac arrythmias observed are not due to the laparoscopy but are iatrogenic.-I am, etc.,