Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
If the patient is induced to vomit, he should immediately be turned on
his side to prevent the indrawing of the ejected matter into the lungs.
After it has ceased, thoroughly wipe out the mouth with a long-handled
sponge. The anesthetic must now be crowded slightly to overcome the
irritation of the mucous membrane of the stomach. Often during the early
stage of anesthesia the patient stops breathing, which must be overcome
by slapping the chest or by two or three forceful downward movements on
the epigastrium.
If the face of the patient takes on a sudden change of color or breathes
heavily the anesthetic should be withdrawn for a few moments, until the
symptoms abate. If the mucus collects about the glottis it is liable to
cause respiratory difficulty and must be swabbed out. If the inversion of
the patient does not relieve syncope and the methods already mentioned
fail to relieve, injections of normal salt solution into the median
basilic vein must be employed as a last means.
ETHER
(_Jackson, Morton._) Sulphuric ether is used in the pure form, free from
alcohol and water. It should be a colorless, volatile, mobile, and highly
inflammable liquid, having a peculiar penetrating odor. As its vapor is
much heavier than air, and owing to its combustible nature, lights about
the room should always be placed above the patient. Often its vapor is
ignited by the careless use of the electro-cautery.
Ether for anesthesia should not affect blue litmus. It should not give
a blue color to ignited copper sulphate—the test for the presence of
water. Alcohol is indicated when it turns red by adding fuchsin.
Ether is less toxic than chloroform, therefore it requires a greater
quantity to induce narcosis.
If properly administered it is by far safer than chloroform, Ollier,
of Lyons, reporting only one fatality directly due to its employment
in four thousand patients. If the anesthetic is crowded cyanosis with
jugular pulsation is noted—the signs of inefficient oxygen and cardiac
distention. In most recorded cases of death there were complications
of a nephritic pulmonary nature. Ether should not be used where there
is bronchitis, gastritis, or peritonitis, owing to its irritant effect
on mucous membranes, nor in nephritis, aneurysm, or advanced atheroma.
The movements of the diaphragm must be constantly watched as it is the
first to become paralyzed when anesthesia is carried too far. The same
care must be observed with the pupil for cerebral and the pulse for
cardiac signs. Before giving this anesthetic the same preparations as for
chloroform narcosis should be observed. The stomach should be empty, the
nose and mouth smeared with vaselin, and the eyes protected with a towel.
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