+------------------------+-----------------------------------------------------+ | ANÆSTHETIC. | REMARKS. | +------------------------+-----------------------------------------------------+ |Nitrous oxide |Apparatus simple: short administration can be | | | mastered easily. A little more practice required | | | for cases prolonged by admitting air. Muscles | | | not relaxed, and patient may move when cut. | | | | |Nitrous oxide and |Apparatus more complicated, but short administrations| | oxygen | present no great difficulty to the beginner. | | | Muscles not completely relaxed unless a little | | | ether added. | | | | |Gas and ether |Quick and safe anæsthetic. Deep anæsthesia | | | may be obtained if ether is “pushed.” | | | | |Ethyl chloride and ether|The same. More portable than above. | +------------------------+-----------------------------------------------------+ In this group of short operations, special reference must be made to the _reduction of dislocations_. Here two important features require notice. The whole object of the proceeding is to relax muscles, and therefore nitrous oxide or gas-oxygen are unsuitable. Secondly, the tendency to reflex syncope just at the moment of reduction is very great. For this reason, chloroform has here a painfully high mortality rate; closed-ether, preceded by gas or ethyl chloride, is undoubtedly the method of choice. The Extremes of Age. Children up to the age of ten years take ether badly, salivation and bronchial secretion being sometimes very troublesome. Atropine mitigates this nuisance to a limited degree only. Chloroform is the best drug up to five or six years; from five to ten, mixture; after that, open ether. In children of any age, suffering from acute sepsis, the immediate annoyances and possible respiratory sequelæ of ether must be faced (_see_ page 156), owing to the probability of acidosis. As regards short anæsthetics in children, nitrous oxide, if given at all, should be freely diluted with oxygen, otherwise most undesirable cyanosis will occur. To children under three or four, even gas-oxygen is of doubtful safety. Short anæsthesias in such cases may be induced by open ethyl chloride, with a few drops of ether added.