Other aspects of anaesthetic technique may have added to danger

doi:10.1136/bmj.311.7012.1089c

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P D M Ellis,
B R Wilkey

Consultant ear, nose, and throat surgeon Consultant anaesthetist Addenbrooke's Hospital, Cambridge CB2 2QQ

EDITOR,--We take issue with K E A Nicholson and J E G Rogers's conclusions regarding use of the combination of cocaine paste with adrenaline for preparing the nose before nasal surgery.1 We agree that the recommended doses should not be exceeded, but the case for removing adrenaline from the mixture has not been made.

In cases 1 and 2 both children were given premedication of oral atropine, and the endogenous catecholamine concentration would therefore have been high because of …