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Tardive dyskinesia (TD), a condition induced by the long-term use of neuroleptic (antipsychotic) drugs, results in impaired and involuntary body movements which persist long after withdrawal of the neuroleptic. To measure TD outcome, monthly multiple assessments were carried out among 49 chronic psychiatric outpatients (15 males and 34 females) who were followed-up for an average of 40 weeks after discontinuation of neuroleptics. The average age of the patients was 54 years, and average neuroleptic exposure was about nine years. Ten of the patients were schizophrenic, and the remainder had an assortment of diagnoses including bipolar (manic depressive) and schizoaffective disorders. Only two percent of the patients demonstrated a total reversal of TD symptoms. Patients who were able to stay off neuroleptic medication for 24 weeks showed about a 50 percent reduction in TD symptoms. However, many of the improved patients became psychotic and had to be placed on neuroleptics again. Employed patients demonstrated significantly more improvement than unemployed patients. Two puzzling findings were that patients with the longest illness duration demonstrated significantly more improvement than younger patients with shorter illness duration, and that higher neuroleptic doses before discontinuation were predictive of greater improvement. Nonschizophrenic patients were 3.3 times more likely to improve than schizophrenic patients or patients with other diagnoses, suggesting that both type and longevity of psychiatric illness affect TD outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

• Twenty-one nonschizophrenic and 12 schizophrenic outpatients with tardive dyskinesia (TD) were followed up for a mean of 12.0 and 8.6 months, respectively, following discontinuation of neuroleptic therapy. Of the 33 patients, only one demonstrated complete reversal of TD. Cumulative survival curves of the length of time to first improvement (reduction in movement ratings by 50% of baseline) did not differ between the two groups. The median time to first improvement was seven months. If a patient can be kept off of a neuroleptic regimen for 18 months, the estimated probability of showing a 50% reduction in movement is 87.2%. In the nonschizophrenic group, depressed mood was negatively correlated with severity of abnormal movements.

One of the most useful yet most neglected anesthetic procedures is the combination of sciatic and femoral nerve block. The physician who treats a large number of diabetics or patients with minor or major accidental injuries of the legs will find this block most useful. The technique of a satisfactory sciatic-femoral nerve block is simple to master, and the procedure is almost free of complications, which makes it useful to the general practitioner as well as to the specialist. Sciatic-femoral nerve block has been neglected by most physicians for the following reasons: 1. Spinal (subarachnoid) analgesia is regarded as easier to master and less time consuming to perform, and the results are believed more predictable. 2. Poor results often occur from solely blocking the sciatic nerve for work on the foot. This is because the foot is partly supplied by the femoral nerve (see figure 10, variation). 3. In many

In November, 1951, we presented a paper in which it was stated that intramuscularly administered dimenhydrinate (Dramamine) seemed to reduce postoperative vomiting by approximately 50%. At that time it was stated, "It is hoped that further interest in this subject will be stimulated so that an extensive evaluation of the drug may be made."1 Certain objections have been raised regarding the validity of the conclusions of our preliminary report and those of others describing the efficacy of dimenhydrinate for control of postoperative vomiting.2 The main objections that have been raised were that (1) if the study method described in this article is to be significant, many thousands of cases must be reported, and (2) no "placebo" control series appeared. Other minor objections included the facts that ( 1) there was no note made of the amount of vomiting past 50 cc., which was set as criterion for vomiting; (2)

Many physicians avoid the admittedly useful technique of intercostal nerve -block because of the supposedly high incidence of pneumothorax. The purpose of this study was to determine whether or not silent forms of pneumothorax follow intercostal nerve block and to evaluate the over-all incidence of pneumothorax after this procedure. In the present study roentgenograms of 200 consecutive patients revealed one silent pneumothorax. In a previous study of 4,333 patients there had been 4 cases of symptomatic pneumothorax. The conclusions from this study were (1) that with direct personal supervision physicians can learn to perform intercostal block satisfactorily, (2) that it should be taught in teaching programs, and (3) that the possibility of pneumothorax after intercostal nerve block is not a substantial argument against its general routine use.

Nerve block and local infiltration analgesia is often one of the important parts of a doctor's armamentarium. For years procaine hydrochloride (novocain®) has been the standard local anesthetic agent in most hospitals throughout the country. It meets Labat's requirements of a desirable local anesthetic agent:1 (1) ease of sterilization; (2) ready and complete solubility in cold isotonic salt solutions in such concentrations as actually are used for induction of regional analgesia; (3) rapid and complete absorption locally, leaving no traces of its passage at the site of injection; (4) low toxicity, both when used in weak solutions and in such doses as are sufficient to produce surgical anesthesia; (5) ability to produce rapid onset of anesthesia; (6) one that is not decomposed by addition of a vasopressor, and (7) one that is not irritating to the tissue. Deaths have occurred during the use of procaine, but, since the acceptable

For many years barbiturates have been used for prophylaxis and treatment of systemic toxic reactions to local anesthetic drugs. A study of 533 systemic toxic reactions and their treatment in 36,113 regional block procedures showed that: (1) the reactions were a result, not of an allergy but of high concentrations of the drug in the blood; (2) barbiturates used to treat such a reaction may do harm rather than good and may actually hasten the death of a patient; (3) barbiturates given preoperatively did not prevent reaction; (4) correction of oxygen want was the key to successful treatment of such a reaction; and (5) succinylcholine chloride, not a barbiturate, is now the drug of choice to stop convulsions and allow adequate oxygenation of the patient.

Heat sterilization of all local anesthetic drugs and equipment is mandatory but is not being generally practiced. A survey of the techniques observed in using local anesthetic drugs showed that only 33 out of 101 hospitals were autoclaving the solutions before use. The remaining 68 hospitals depended on cold sterilization, the immersion of the ampul, vial, or bottle in a germicidal solution which acts upon the outside but not on the contents. Experience with 17,368 regional block procedures over a 54-month period has led the authors to conclude that a careful technique which includes the autoclaving of the anesthetic in its container is mandatory. The procedure here described is based on the demonstration that the local anesthetics most commonly used can be autoclaved for 30 minutes at 255 to 260 F. and 18 to 20 lb. of pressure (124 to 127 C and 1.22 to 1.36 atmospheres above ambient pressure) without significant loss of potency. This reduces the danger of bacterial contamination and simplifies both the preparation of regional block trays and the execution of regional block anesthesia.

Most otolaryngologists perform their own local anesthesia and engage an anesthetist (doctor or nurse) to administer the general anesthesia. This paper does not attempt to markedly alter the anesthesia methods preferred by the otolaryngologist or by his anesthetist.The sole purpose of this paper is to make whatever anesthetic is administered safer for the patient. Therefore, it will (1) show how the all too frequent incidence of severe or fatal reactions to the topical application of local anesthetic drugs may be reduced; (2) discuss the advantages and the disadvantages of administering chlorpromazine (Thorazine, Largactil) as sedation before regional block anesthesia; (3) accent the importance of endotracheal anesthesia during the operation and in the immediate postoperative period; (4) detail how laryngospasm during thiopental (Pentothal) anesthesia may be rapidly corrected; (5) emphasize our method of using succinylcholine (Anectine) prior to intubation, which has reduced the incidence of laryngeal granuloma following intubation from

IN OPHTHALMOLOGIC and otolaryngologic surgery one encounters some of the most difficult procedures in anesthesia. This is particularly true if the requirements of the patient, the surgeon, and the anesthesiologist are to be satisfied. Regional analgesia may be employed satisfactorily for short superficial procedures, since the patient will usually tolerate an uncomfortable position as well as manipulation discomforts for limited periods. However, during long and/or tedious procedures requiring deep manipulations of the face, nasal pharynx, oral pharynx, pharynx, larynx, or trachea, the constant cooperation of the patient must not be relied on. Restlessness and motion at a crucial point by a patient who was thought to be cooperative may prove disastrous to the patient or to the operative result being sought. Likewise, the administration of an intravenous, rectal, or inhalation anesthetic to a patient in whom regional analgesia was started and whose airway has been made inaccessible by the drapes