Practical Points in AnesthesiaNeef, Frederick-Emil
Science
Practical Points in Anesthesia
Neef, Frederick-Emil
Anesthetics
The volume of the pulse diminishes during protracted narcosis. The
volume may be expected to decrease about one-third in the course of an
hour, and as much as one-half in a two hours’ anesthesia. If, in _a
chloroform or anaesthol anesthesia_, the pulse gives the impression, to
the palpating finger, of having lost more than one-half of its original
volume, stimulation is indicated. If ether feeding through the
Schimmelbusch mask, and one drachm of 25% camphor-ether hypodermatically
do not improve the volume notably, an intravenous infusion of
physiological saline at 98°-105° F. should be given without delay.
_If the anesthesia has been conducted with ether instead_ of anaesthol
or chloroform, camphor-ether stimulation is not in place; the resort is
to strychnine stimulation instead—one twentieth of a grain of strychnine
sulphate hypodermatically, which may be repeated in half an hour. If
there is no prompt improvement in the condition of the pulse, the
intravenous infusion should not be postponed. It must also be borne in
mind that, not drugs, but infusion of fluid alone can make good any
_great_ loss of blood.
THE INFLUENCE OF MORPHINE ON
NARCOSIS.
[Sidenote: Morphine]
During the course of any operation, the surgeon is responsible for a
long chain of ingoing impulses, which travel along the sensory paths
from the site of operation to the spinal cord and brain. Morphine
diminishes the awakening effect of these impulses by benumbing the
perceptive centers in the brain. The correct plane of anesthesia for a
patient who has had morphine, for example, one quarter of a grain of
morphine sulphate hypodermatically half an hour before narcosis, must
appear very superficial as compared with a case to which morphine has
not been administered. Not only is considerably less of the anesthetic
required, but the lid, for instance, may be quite tonic without
indicating that more of the anesthetic is necessary. These observations
apply cardinally to anesthesias with chloroform, or chloroform
combinations, such as anaesthol.
GENERAL COURSE OF THE ANESTHESIA.
[Sidenote: Tranquil Narcosis]
The ideal narcosis is tranquil. It resembles a natural sleep. The
breathing is unimpeded and easy. Any change in the character of the
breathing sound, or the rhythm, demands attention. If, for the moment,
the anesthetic has been given too hurriedly, a few breaths of air will
restore the calm. If, on the other hand, signs of awakening are
discovered—the lid becomes more tonic, the corneal reflex more active, a
tear appears in the eye, the patient begins to sweat, saliva collects in
the throat, the pulse becomes more rapid—a few drops of the anesthetic
should be administered until the desired free and unembarrassed
respiration returns.
AWAKENING.
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