Practical Points in AnesthesiaNeef, Frederick-Emil
Science
Practical Points in Anesthesia
Neef, Frederick-Emil
Anesthetics
If the narcosis has been conducted correctly the patient should become
conscious promptly after operation. The premonitors of awakening are
readily recognized, the corneal reflex becomes more active, the tonicity
of the eyelid approaches the normal, a tear may appear in the eye, beads
of perspiration are seen on the forehead, the patient may begin to
mutter incoherently, the pulse becomes faster, the breathing loses its
snoring character, and the patient begins to move his head.
[Sidenote: Termination of Narcosis]
If the operation is a laparotomy and the patient is under the influence
of morphine-anaesthol, the narcosis is terminated by giving a drop
occasionally when the surgeon puts his first sutures into the abdominal
wall; after the fascial repair, the anesthetic is stopped entirely. The
narcosis may be so timed that the patient becomes conscious and responds
to questions promptly after the last stitch has been placed.
If the morphine-anaesthol narcosis has been continued with _ether_ by
the drop method, as is frequently indicated, and if considerable ether
has been used, the patient will be a little tardier in arousing, and the
administration of the narcotic should be stopped at an earlier period.
To be less abstract, in the case of a laparotomy the anesthetist desists
at once from giving ether when the surgeon has applied the _peritoneal
suture_ for the closure of the abdominal wound.
RECESSION OF THE TONGUE AFTER
NARCOSIS.
[Sidenote: Post-operative Asphyxia]
Sometimes, especially in individuals who show this tendency during
narcosis, a marked obstruction in breathing is met with, attended by
increasing cyanosis, a condition due to dropping back or recession of
the base of the tongue into the laryngo-pharyngeal space. Changing the
position of the head does not improve the breathing, the jaw cannot be
pushed forward because the masseter is rigidly contracted and the teeth
are clenched tightly. To draw forward the tongue would require a rough
procedure, with wedge, gag, and forceps. If a soft rubber catheter or
the breathing tube be passed through the nostril into the pharynx the
respiratory air streams freely through the tube.
POST-OPERATIVE DISTRESS.
[Sidenote: Gas-Pain]
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