Handbook of anæstheticsRoss, J. Stuart (John Stuart)
Science
Handbook of anæsthetics
Ross, J. Stuart (John Stuart)
Anesthesia; Anesthetics
_The eyelids_ are usually half open, and the eyeballs at rest looking
forward and slightly downwards. An extreme rotation downward may
usually be taken as a sign of very deep anæsthesia. _The pupil_ is, as
already said, always active to light, but its actual size varies with
the anæsthetic used. With ether, particularly “closed” ether, it may be
large (4–5 millimetres): with open ether, preceded by morphia, about
3–4 millimetres: a good chloroform anæsthesia usually exhibits a pupil
of only 2–3 millimetres, and if morphia has also been given, it may be
pin-point in size. Too much emphasis must not be placed, however, upon
the mere size of the pupil; that may vary within wide limits without
necessarily indicating serious abnormality. The essential point is that
the light reflex shall be brisk. A pupil of 5 millimetres reacting
sharply to light may be of no special moment: one of that size immobile
to light would cause real anxiety.
_The conjunctival reflex_ usually disappears fairly early in the
third stage: if briskly present, the anæsthesia is certainly a light
one, and probably insufficient for an abdominal section. _The corneal
reflex_ if properly taken in the way already described can usually
be elicited throughout the third stage. In an anæsthesia deep enough
for abdominal section it is, of course, not brisk, but we may say
generally that its entire absence is _presumptive_ evidence of a very
deep anæsthesia--probably undesirably deep. It must not be forgotten
that some local causes such as drying of the surface of the cornea
may cause it to disappear, and in case of doubt it is sometimes worth
while to wash out the eye with a little saline solution. If after doing
so the anæsthetist still finds the reflex not present he should be on
his guard. Provided, however, that the light reflex is still present
and colour and respiration satisfactory, he need not consider that the
patient is in any immediate danger.
Broadly speaking, then, the third stage, the stage which is called for
by the requirements of major surgery, is characterised by (1) full
regular respirations; (2) colour not much removed from normal; (3)
moderate sized pupil, larger in the case of ether than chloroform; (4)
conjunctival reflex faint or absent; (5) corneal reflex just present,
or, in a deep third stage, just absent; (6) light reflex present: these
may be regarded _as the signs of fully developed surgical anæsthesia_.
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