Convulsion during ether anaesthesia; a case report.

A five-year-old girl was admitted to Hammer-smith Hospital with a diagnosis of a perforated appendix. Her mother stated that she had complained of pain in the R.I.F. for 12 hours prior to admission, that during that time she had vomited periodically and was "breathing very fast." The pain had become severe in the evening and she was brought up to the Casualty Department. Physical examination revealed a well developed child in slight distress and looking very toxic. Her temperature was 102.6,°F pulse rate 140 min, respiration rate 30 min. There was no history of previous illness or fits. It was decided to operate and premedication of atropine (0.6 mg) was given 40 minutes before operation. The temperature in the operating theatre was 86° F and outside there was a thunderstorm. Anaesthesia was induced with N 3 O and O 2 at 2 a.m., ether being added slowly in a semiclosed circuit. On establishing second plane anaesthesia an intravenous drip of 5 per cent Dextrose was set up and the skin incision made 15 minutes later. At 2.30 ajn. the peritoneum was opened and free pus found. At the time the peritoneum was lifted to open, very mild twitching of the eyelids and facial muscles was noted; these rapidly spread to the trunk and limbs, followed by generalized convulsions. The ether was turned off at once, the surgeon stopped his manipulations, the bag on the anaesthetic machine was emptied and pure oxygen was administered. At the same time 3 mg of d-tubocurarine were put into the drip and within three minutes all convulsive movements ceased. The respiratory movements became slightly depressed , and so respiration was assisted. Anaesthesia was maintained on a 5:2 N 2 O-O, mixture and assisted respiration continued while the surgeon removed the perforated appendix and closed the abdomen 25 minutes later. Respiratory exchange was adequate by this time. Pharyngeal toilet was carried out and much thick mucus was removed. It was considered advisable to keep the child under further observation and she was kept in the operating theatre. At 3.10 a.m. (15 minutes after completion of surgery) she was about to be returned to the ward when slight clonk movements of the arms and legs were noted: these gradually became more pronounced ; the reflexes were hypertonic, opistho-tonos was present to such an extent that a closed fist could be placed easily under the arched back. At …