Handbook of anæstheticsRoss, J. Stuart (John Stuart)
Science
Handbook of anæsthetics
Ross, J. Stuart (John Stuart)
Anesthesia; Anesthetics
Experience gained during the war has thrown a certain amount of light
upon this subject. Post-anæsthetic bronchitis and pneumonia was
very prevalent among the wounded, far more so than among civilian
patients. It is, the author believes, reasonable to attribute this
fact to several causes. In the first place, the soldier’s life,
alternating between stuffy billets and wet trenches, predisposed him
to naso-pharyngeal catarrh of a fairly high degree of infectivity.
Enthusiastic press representatives might state that you could not take
cold so long as your feet and legs were always buried in half frozen
mud, but experience hardly bore out their golden promises. Again, the
soldier did not improve his catarrh by inveterate cigarette smoking.
Lastly, military hospitals were large institutions, some under canvas,
some in huts, some in buildings constructed for other purposes, and
rapidly altered to the urgent needs of the army. Of whatever type,
nearly all had one feature in common--many of the surgical wards were a
long (and draughty) way from the operating theatre.
For the prevention of post-anæsthetic pneumonia, the author offers the
following tentative suggestions:--
(1) See that the skin is kept covered up as much as possible
during the operation and that the patient is not exposed to
draughts during or after it. Rooms can, and should be, well
ventilated without cold draughts.
(2) If a patient has an acute or sub-acute naso-pharyngeal
catarrh, treat it as fully as possible before operation by
sprays and gargles.
(3) Do not use ether to patients who suffer or recently have
suffered from such conditions.
(4) Give a hypodermic of morphia and atropine before operation
as a routine.
(5) In so far as possible, let the patient’s shoulders and head
be raised by pillows during the early hours of convalescence.
(6) Lastly, remember that while no care will absolutely banish
these dangerous sequelæ from our practice, the greater care
and skill shown by the anæsthetist, the less bronchitis and
pneumonia will appear among his patients. As regards ether, the
author believes that it is the strength of vapour used, more
than the duration of the anæsthesia, which counts. It is for
that, among other reasons, that he has for the induction period,
no hesitation in recommending a method whereby a small part of
the requisite ether strength is replaced by chloroform.
Vomiting.
After an anæsthesia lasting more than a few minutes, it may almost be
regarded as normal for the patient to vomit once or twice. Usually this
occurs a few minutes after the administration has ceased. In the case
of nitrous oxide and oxygen, even this slight disturbance may not occur.
Public-domain text, read in full here on John Shaqi.
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