Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
Begin by pouring about thirty drops upon the inhaler, gradually bringing
it nearer from a distance of six inches to the mouth and nostrils of the
patient; then continue by letting one drop fall upon the apparatus every
five or ten seconds until the patient is thoroughly anesthetized; then
use one drop about every ten seconds, although it might be necessary
to push this quantity at certain moments of the operation. To obtain
complete anesthesia by this method takes about ten minutes. The vapor
should be thoroughly mixed with air in the proportion of ninety-five
per cent of air to five per cent of the vapor. The amount administered
during operation can rarely be determined, because of the uneven
respiration of the patient, who takes more during frequent inspiration
than during ordinary breathing. By all means do not let the chloroform
trickle upon the skin or into the eyes, as it causes considerable
irritation.
The respirations are at first full and deep, soon becoming shallow and
rapid. At first the pulse is slightly stronger and fuller than the
normal, but it soon loses its strength and volume and becomes more rapid.
The pupils are at first dilated, and as narcosis is induced, contract.
Should they contract after this, during operation, it is a danger signal
not to be neglected. Death may come on suddenly.
If the patient struggles violently under early anesthesia, as is often
seen in alcoholics and athletes, it is not advisable to push the
chloroform nor should total muscular relaxation be effected. The arrest
of reflex movement is all that is required.
As the reflex action of the cornea disappears last of all, the
anesthetizer can use this as a guide during further administration to
avoid all danger. This is accomplished by gently touching the cornea with
the index finger, raising the eyelid with the third finger.
Chloroform lowers the body temperature, due undoubtedly to its aiding
in the dissipation of heat and by reason of its effect on the nervous
mechanism of heat production. It is rapidly eliminated by both the lungs
and the kidneys, because of its high volatility, and as little is given,
the irritation to these organs is not as great, volume for volume, as
with ether.
In case of asphyxia the lower jaw must be pushed far forward, the tongue
be drawn forward with forceps, and the head extended and lowered, by
raising the feet off the table. Cold water should be dashed over the face
and chest. Slapping the chest with a wet towel and vigorously rubbing
with hot cloths or brushing the palms and soles. Brandy and water, one
to two parts, can be introduced into the rectum, or faradization of the
nasal mucous membrane can be tried. These means failing, artificial
respiration (Sylvester’s method) must be resorted to. This being of no
avail, tracheotomy must be done.
Public-domain text, read in full here on John Shaqi.
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