Bradycardia, hypotension and cerebral dysfunction after spinal anaesthesia

A reply EDITOR: I was delighted to read Professor Payne's comments on my case report [1] and to be reminded of the challenges of bloodless field surgery in the 1940s. I would not dispute any of his statements regarding the prime cause of the events of my case. My hypothesis was that an intact RAS system may have some protective effects in this situation and that ACE inhibitors may augment (both in magnitude and duration) the ensuing depression of cardiovascular function. In current practice, deliberate or accidental hypotension is often viewed with some concern, and awareness of exacerbating factors may be of import. With regard to the other points raised, I would agree that the fluid input was perhaps overcautious, and would apologise for the dosage error for bendrofluazide (which should have read 2.5 mg daily). However, the anaesthetic description was a resume of detailed recordings and I would contend that preoperative blood transfusion for elective surgery when the Hb is 10 g dL−1 is not indicated. N.