Practical Points in AnesthesiaNeef, Frederick-Emil
Science
Practical Points in Anesthesia
Neef, Frederick-Emil
Anesthetics
Post-operative gas pain is often the source of great distress to
patients who have undergone the ordeal of laparotomy. It is due to a
temporary paresis of the gut and consequent distension with gas. When
the trouble is in the lower bowel considerable relief may follow the
insertion of the rectal tube. Irrigation of the colon, when permissible,
may stimulate peristalsis in the higher segments of the bowel. A routine
intended to militate against intestinal paresis in celiotomies, and
worth a fair trial, is to administer with the morphine sulphate a small
dose of eserine sulphate hypodermatically. For the ordinary adult the
dose should be about one-fourth of a grain of morphine sulphate and one
fiftieth of a grain of eserine sulphate given subcutaneously one-half
hour before narcosis.
[Sidenote: Vomiting]
When it is important to avoid post-operative vomiting, gastric lavage
with plain water, made faintly alkaline with lime water or milk of
magnesia, may be done as soon as the narcosis is ended and while the
patient is still on the operating table. During the procedure the head
end of the table is lowered a few degrees.
I have gathered the impression that _crowding_ is one of the prime
causes of excessive vomiting after anesthesia. It has been my experience
that cases in which I could truly say that I had not crowded the
anesthetic and where it was not swallowed to any extent during the
induction, have suffered little or not at all from this disagreeable
after-effect of the narcosis.
[Sidenote: Nausea]
[Sidenote: Thirst]
The attentive nurse will find that there are numerous little things,
seemingly insignificant, that help greatly toward the patient’s comfort.
She may support the wound during a coughing spell or if the patient
vomits. If her charge is tormented with nausea a piece of cotton
saturated with a mixture of alcohol and acetic acid can be dropped into
a tumbler and the patient allowed to inhale the vapor. If the lips and
throat are dry and parched, moisture is grateful and small pieces of
gauze wet with iced water may be laid over the lips and nostrils.
[Sidenote: Pain]
If the patient is suffering after operation, one should be generous with
morphine. It should always be given hypodermatically. To the adult less
than one quarter grain as a dose is of little avail. In such
post-operative use there need be no fear of inculcating the morphine
habit.
MORPHINE-ANAESTHOL SEQUENCE.
For general use in every day practice the morphine-anaesthol sequence
already described is most satisfactory.
As indicated, the adult receives a quarter grain of morphine sulphate
hypodermatically one-half hour before anesthesia.
[Sidenote: Anaesthol]
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