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the injury, and the plasma volume 121 hours after was about 2.8% of body weight. The haemoglobin was 11.8 g./100 c.cm. There was a temporary improvement after the first transfusion, but the blood pressure subsequently fell to 85/50 mm. Hg, and two bottles of plasma were given, therefore, between 101 and 151 hours after the injury. A second determination of plasma volume 19+ hours after the injury gave a figure of about 3.8% of body weight; the haemoglobin was 11.4 g./ 100 c.cm. Anaesthesia was begun 21 hours after the injury, and the blood pressure rose from 100/55 to 110/65 mm. Hg in the first 4 minutes and then fell steadily to 80/50 mm. Hg in the next 15 minutes. Ether was stopped after the first 7 minutes. The blood pressure was then maintained at 85/50 mm. Hg until the operation ended 49 minutes after the anaesthetic began. During the next 12 hours the systolic pressure rose to 140 mm. Hg, although eventually the patient died with a gangrenous leg. In less severe cases nitrous oxide and oxygen with a minimal amount of ether may cause the blood pressure to rise, as demonstrated by Case 3. This patient sustained a compound fracture of the left tibia and fibula. His blood pressure was 110/60 mm. Hg 40 minutes after the accident, and his plasma volume was 4.3% of body weight and haemoglobin 12.2 g./100 c.cm. two hours after. No transfusion was given. When anaesthesia was begun 5+ hours after the accident his blood pressure was 130/70 mm. Hg. It rose to 170/75 mm. Hg in the first ten minutes and then fell gradually to 140/75 mm. Hg in the next 25 minutes, remaining there till the operation ended 50 minutes later. The best anaesthetic used in our shocked patients was cyclopropane and oxygen. It was employed in Case 4. This patient, who had a crushed foot and lacerated scalp, had a plasma volume of 3.8% of body weight and haemoglobin of 14 g. /100 c.cm. 30 minutes after the accident. The blood pressure was then 100/60 mm. Hg. Anaesthesia was begun three hours after the accident, and the blood pressure rose slightly to 110/80 mm. Hg, where it remained for the next 20 minutes. At this time the cyclopropane was gradually changed to ether for the purpose of comparison, and the blood pressure fell during the next 15 minutes to 80/60 mm. Hg. After withdrawal of ether the blood pressure recovered, and it was maintained at 100/70 mm. Hg during the last five minutes, when cyclopropane was given again. In attempting to assess the depressing effects of anaesthetics on the cardiovascular systems of shocked patients it is necessary .to emphasize that quite severe injuries can occur with little reduction of plasma volume. This may explain why the lowering of blood pressure by an anaesthetic is sometimes less than might be expected. It occurred in Case 5, a man who sustained a compound fracture of the left femur and a right Colles fracture. His plasma volume was within the lower limit of normal -about 4.8% of body weight-his haemoglobin was 8.8 g. /100 c.cm., and his blood pressure was 110/60 mm. Hg three hours after the accident. During the next 11 hours his general condition remained about the same and his blood pressure was 110/70 mm. Hg when intravenous anaesthesia with sodium pentothal was begun. It then fell steadily to 85/55 mm. Hg in the next six minutes, and remained at about this level until the anaesthesia ended 25 minutes later. The chief factors in anaesthetizing shocked patients seem, therefore, to be, first, the use of a minimalamount of anaesthetic-and it is often surprising how little these patients require; secondly, the choice of an anaesthetic which stimulates rather than depresses the cardiovascular system; and, thirdly, an adequate amount of oxygen. It is unfortunate that the two most satisfactory anaesthetics-cyclopropane and oxygen, and nitrous oxide, oxygen, and ether-both require somewhat elaborate apparatus. Fortunately, however, in modern war it is possible for the great majority of patients to be brought back for operations to base hospitals where such apparatus is available.