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1.Seventy-six mothers received 200 to 300 mg. secobarbital intravenously at varying times before delivery. All mothers and infants were classified according to degree of depression noted at delivery. In 51 mothers and infants simultaneous blood secobarbital levels were determined at birth.2.Seventy-nine per cent of infants born to the group of mothers under the heaviest sedation (Grade V) were not grossly depressed.3.Secobarbital rapidly crossed the placenta with virtual equilibration between maternal venous and newborn cord blood within 3 minutes.4.The maternal blood secobarbital concentration dropped at least 80 per cent within 3 minutes.5.The fetus was rarely exposed to more than 20 per cent as much as the initial maternal secobarbital level.6.This difference in peak secobarbital concentration may account for the clinical differences noted in mothers and infants. Fetal circulation contains other mechanisms which may further decrease the exposure of the fetal brain to depressant drugs.7.Seven of the 8 depressed babies were born within 25 minutes of secobarbital administration. Their cord blood secobarbital concentration showed no correlation with the degree of depression.8.Postpartum studies of secobarbital blood levels indicated that full-term infants eliminated secobarbital from their blood streams as readily as did their mothers.

To the Editor:—In the article on "Spinal Anesthesia for Hip Pinning Given With the Patient Supine" by Alon P. Winnie, MD (207:1663, 1969), I am impressed by the ingenuity of the technique of administering a spinal anesthesia from under the operating room table through the opening in the fracture table and am willing to accept that the incidence of hypotension due to spinal anesthesia is reduced by avoiding moving the patient after administration of the anesthesia. However, I strongly disagree with the statement that "this simple change in technique has been shown to reduce... the mortality by more than one half."The author has not demonstrated, to my satisfaction, either that hypotension after spinal anesthesia is likely to be related to the subsequent mortality in hip surgery for the elderly patient, or that, as he states, "The two groups of patients studied were similar in every respect" except

TO THE EDITOR:— In the article entitled "Arterial Thrombosis with Gangrene After Use of Promazine (Sparine) Hydrochloride" by Opinsky, Serbin, and Rosenfeld (J. A. M. A.168:1224-1225 [Nov. 1] 1958) the authors concluded that intravenous injection or perivascular infiltration of a moderately irritating drug such as promazine can lead to arterial spasm and thrombosis and so produce gangrene of the hand and fingers as in the two cases reported. They suggest the avoidance of the intravenous route for the administration of promazine for this reason. Since the proved and potential value of intravenously given promazine is great, it is especially important to evaluate this report. My contention is that both cases of gangrene were due to injection of the drug directly into an artery. The following facts support this conclusion.Inadvertent arterial injection, especially in the region of the antecubital fossa, has been reported during administration of pentothal-sodium. Forrest