Two Cases of Death from Post-Anaesthetic Acid Intoxication.

IT lhas long been known that acetone is present in the urine of patients who have been anaesthetized. Becker, for instance, states' that acetone follows anaesthesia in at least two-thirds of the cases, irrespective of the nature of the anaesthetic or the daration of the anaesthesia, "and that if it be already present it is increased thereby." This has been confirmed by Abram2 in. a series of cases at the Royal Infirmary, Liverpool. The importance of this fact has been recognized by all, though some, like Wallace and Gillespie of the Prince of Wales's Hospital, London,8 fully appreciate the dangers and take suitable prophylactic measures. The two :cases I have to record both occurred at the Children's Infirmary, Liverpool, within a few weeks of one another. CASE I. The patient was a boy aged 6 years, suffering from a chronic intussuception which had been present for six days. On August 10th, 1910, at 11.30 a.m. he was given ethyl chloride, followed by ether by the [open method. A right rectus incision was then made, and a large chronic intussusception found and reduced easily; there were no adhesions and practically no congestion. The abdomen was sutured in three layers. The anaesthesia lasted about twenty-five minutes, and 3& oz. of ether were used. After-progress. At 8 p.m. the respirations were very rapid (40)' though there were no riles in the chest. He was given atropine gr. B fourhourly. At 1.30 a.m. he was worse, expiration being prolonged at both bases. At 2.30 a.m. he vomited, so was given sod. bicarb. 'j in tiij of water; this was retained, and no more vomiting took place. At 10.0 a.m. he was much worse; pulse 160, but hardly perceptible. Cyanosed; dilated pupils; he was given oxygen and brandy. Retained salines well. At 1.30 the same day the child was just conscious, but obviously dyiing; the breath smelled of acetone. Respirations 72; air hunger; pulse hardly perceptible. Cyanosis not present as oxygen was given continuously.