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1.1. Two hundred cases of continuous caudal anesthesia are presented and discussed mainly from the viewpoint of the obstetrician. 2.2. Pontocaine-suprarenin-saline solution has proved a safe agent for this method providing 3 to 5 hours of relief from the first dose, and 1 or more hours of relief from subsequent injections. 3.3. Certain precautions are outlined, but the detailed technique is reserved for another publication. Adherence to a strict regime is advised. 4.4. Tables are given quoting figures on duration of labor under caudal anesthesia and time required to complete cervical dilatation. We find that cervical dilatation is not accelerated in this series. 5.5. The incidence of operative deliveries is increased. 6.6. Several disadvantages of caudal anesthesia are discussed. 7.7. The results and complications are classified, including 1½ per cent total failures, and 13 per cent additional not completely satisfactory. One hundred seventy-one of 200 cases were completely satisfactory. One prolonged neurological complication is reported. 8.8. There was no maternal mortality. Fetal mortality was 3.0 per cent. ∗ ∗See Discussion on Symposium on Obstetrical Anesthesia, page 85.

The purpose of this paper is to help eliminate a certain fear which we feel exists in the minds of many obstetricians in regard to the use of Pentothal Sodium. In our minds, we were doubtful, too, but because of personal experience in the use of Pentothal Sodium in minor battle casualties during the last war, welt that its trial in obstetrical deliveries was justified. The largest series of cases (1,415) was reported in 1944 by Hellman and associates. 1 Previous to this time, others (LaBrecque, 3 Rucker 10 ) and since this time still others (Mazzola, 5 Dippel 7 ) have reported smaller series of cases. Their results were favorable and justify the continued use of Pentothal Sodium. However, its employment is not as widespread as it might be. It is not the purpose of this paper to review the literature exhaustively, but merely to add to it our experiences with a series of 294 cases since October, 1946. The results with our technique, we feel, have been excellent both for mother and child and indicate to us that Pentothal Sodium properly used has a place in obstetrical anesthesia.

Hypnosis for obstetrical anesthesia is becoming a more popular procedure. One of us (L. B. W.) 1 has recently published results with hypnoanesthesia in a series of routine deliveries. There is no question but that this type of anesthetic is best and safest for both mother and child. Similarly, hypnoanesthesia has been used for delivery by cesarean section. 2 As far as can be determined, the surgical procedure was employed more for demonstration than because of absolute medical necessity. It is the purpose of this paper to report a case of severe, fulminating, pre-eclamptic toxemia, in which the patient was delivered by cesarean section and in which hypnosis, resulting in complete absence of pain, was not only the anesthetic of choice, but, for all practical purposes, was the only safe procedure for both mother and child.

Trilene is a potent analgesic drug. Its margin of safety and ease of administration will ultimately make it a standard agent on all delivery floors. Trilene's wide variety of uses will probably allow almost every obstetrician to find a place for it in his obstetrical practice.

A series of 63 consecutive obstetrical patients managed with the Hingson Reserve Midget machine is presented. The study is too small to arrive at any definitive conclusion. It appears, however, that this compact unit may merit a place in the field of obstetrical anesthesia. The machine is easy to handle and explosion hazards are markedly reduced. Despite these advantages the dangers inherent in the administration of any and every anesthetic agent remain.

Summary 1. A detailed analysis of 108 uterosacral nerve blocks for pain relief in labor and delivery is presented. 2. Seventy-eight per cent of our patients had excellent and good results. Except for pudendal block, no other anesthsia was required for delivery. 3. There were no adverse fetal effects resulting from this technique of nerve block. 4. One definite maternal complication was observed. This generalized clonic onvulsion was probably due to intravenous absorption of 1 per cent hexylcaine from the site of pudendal block. There was no serious sequela.

In the last several years the Phencyclidin derivative Ketamin has been used more andmore clinically in obstetrics as in other fields. Especially in obstetrics some pharmacological qualities of Ketamin led to the assumption that this substance caused fewer anesthesia-induced sideefFects on mother and child. In the field of obstetrics the range of effects and side-effects of an anesthetic influences the process of birth (specifically active labor, and blood flow to the placenta) as well as the condition of the fetus in the Uterus and the condition of the newborn infant immediately after birth and illnesses specific to pregnancy, especially toxemia. The first extensive clinical experiences with Ketamin in obstetrical anesthesia resulted in widely diversified reports about the effects of Ketamin on active labor [2, 3, 15, 16]. The heart-frequency of the fetus was not affected by these use of Ketamin [15, 16, 21]. The condition of the neonate immediately after birth was judged to be better than after the use of other anesthetic agents [15, 16, 21]. The positive chronotropic effect of Ketamin and its property of increasing the blood pressure proved useful for inducing anesthesia in hypotonic patients or patients in hemorrhagic shock [18]However, caution in the use of Ketamin seemed indicated with pre-eclamptic or manif estly eclamptic patients [l, 7, 22]. The following reports of experiments with Ketamin deal with: 1. Motility of the Uterus during birth. 2. The effect of Ketamin on placental bloodflow in animal experiments. 3. The clinical comparison of two series of caesarean sections with different methods of inducing anesthesia, and was Curriculum vitae

To our knowledge, no case of pregnancy complicated by complete heart block and old myocardial infarction has been reported. In this communication, we shall describe the obstetrical course and anesthetic management of a pregnant patient with these unusual complications. Report of a Case A 35-year-old woman was admitted to Metropolitan Hospital in December 1960 with an acute myocardial infarction of the anterior wall, complete heart block, and syphilitic aortitis. Before this admission, she had delivered four children uneventfully, the last child having been born in May 1960. After treatment of the acute episode, she was followed up by the Home Care Service as a class 3-C cardiac (as defined by the New York Heart Association). She received pentaerythritol tetranitrate, 10 mg four times a day, and her physical activities were restricted because of easy fatiguability and angina pectoris. At age 40, the patient again became pregnant. Her expected date of

Until the eighteenth century, pregnancy, labor, and delivery were largely free from the influence of medications administered by the physician or midwife (Hingson & Hellman 1956, pp. 57-70). The birth process was acknowledged to be a painful, traumatic experience much like the valley of the shadow of death, through which a woman must pass largely unaided except by curious and extraordinary manipulations to aid the birth process. As the untrained midwife was gradually replaced by the physician and as agents for the relief of pain became available, the customary neglect of the "woman in travail" gave way to the administration of an increasing number of therapeutic agents to relieve pain. James Simpson, who held the Chair of Midwifery at the University of Edinburgh, was the first to administer chloroform to a woman in labor and became a champion of obstetrical anesthesia. His delightful account of the first pregnant patient to whom he administered chloroform tells of the birth of a perfectly healthy, vigorous infant delivered 25 minutes after the inhalation began (Simpson 1959). The mother, whose previous pregnancy had been complicated by a 3-day labor terminating in the traumatic delivery of a stillborn infant, was understandably apprehensive about her second labor. Upon her awakening from the anesthetic it was difficult to convince her that the labor was over and

Dr. Flowers, an obstetrician, has written this book for physicians practicing in his specialty. The author is no stranger to the field of obstetrical anesthesia, having pioneered the use of continuous peridural anesthesia in 1949. The book contains 11 chapters, each devoted to a different phase of obstetrical anesthesia. Early in the book the author deals with changes in maternal physiology associated with pregnancy that may influence the action of anesthetic agents. An excellent chapter deals with psychological preparation of the pregnant woman. His recommendation on the use of analgetic drugs and their effect on labor is well done. Other notable sections deal with the effects of anesthetic agents on the fetus, and with newborn resuscitation. Dr. Flowers admirably emphasizes moderation in obstetrical anesthesia. He recommends the judicious use of analgetic drugs and pudendal or paracervical block whenever possible. Several chapters deal largely with the technique of administration of spinal

A technique for producing complete obstetrical anesthesia by means of lumbar sympathetic paravertebral block is described. Seventy-one cases are reported with complete success in 61, partial success in 6, and failure to obtain perineal anesthesia in 4. It is felt that this method could be added to the armamentarium of obstetrical anesthesia.