Our technique is essentially one of pharmacological blockade achieved for the most part by a combination of ganglion blocking drug, halothane and β-adrenergic blocker. To these are added the effects of posture and controlled respiration to reduce systolic blood pressure to 60-80 mmHg at heart level. Initially this is seldom difficult, but the maintenance of a steady hypotension often needs an increasing amount of halothane together with a rising end-tidal positive pressure. This paper is restricted to technique, but it would be a mistake not to draw attention to the physiological limitations which this technique imposes. These are the circulatory changes in the brain caused by the steep head-up position and a low systolic pressure, and the altered ventilation: perfusion ratio within the alveoli of the lungs. These are the parameters of physiological trespass within which the technique must be practised if success is to be achieved with safety.
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