Practical Points in AnesthesiaNeef, Frederick-Emil
Science
Practical Points in Anesthesia
Neef, Frederick-Emil
Anesthetics
The Schimmelbusch mask is used; this fits the face and is large enough
to include the bridge of the nose and prominence of the chin. It is
covered with a piece of thin flannel, and, over this, impermeable cloth
in the center of which a lozenge-shaped fenestra (1½”×1”) has been cut.
In the upper half of this little window with the flannel pane, on the
inside of the mask, a small wad of gauze is fastened. The mask is then
complete and _can be used for administering any anesthetic by the drop
method—chloroform, anaesthol or ether._ In giving ether one makes use of
the upper half of the fenestra with its separate ether pad; while
chloroform and anaesthol are given to advantage through the lower
portion. The chin, cheek and bridge of the nose are anointed with a
little white vaseline at the line of contact with the mask, and then the
latter is allowed to rest lightly on the face of the patient for a few
moments, until he can reconcile himself to the strange procedure, and
resumes his normal breathing. There must be absolute quiet. The
anesthetist alone may speak when he deems fit.
[Sidenote: The Induction]
[Sidenote: Primary Anesthesia]
The beginning is made with anaesthol or chloroform drop by drop. The
slightest objection on the part of the patient that the vapors are too
strong must be considered; irritation of the throat, slight coughing,
all merely emphasize that the introduction must be very gradual. If the
patient is solicitous about the efficacy of the anesthetic he should be
assured that there is no hurry, and he should be enjoined to take deeper
breaths, if he breathes too lightly. As long as the patient is conscious
he will respond to the injunction to take a deep breath; if he does not
respond to this request he has reached the _stage of unconsciousness—the
state of primary anesthesia_.
Sometimes a remarkable calm, a period of relative apnea, _precedes_ the
stage of excitement. At other times, this stage ushers the patient
_directly_ into the state of complete anesthesia. There need be no stage
of excitement at all. This is especially true if morphine has been
administered hypodermatically before narcosis, and if the induction of
the anesthetic is cautious and gradual.
[Sidenote: Surgical Degree]
_The surgical degree, the state of complete anesthesia_, is announced by
the respiration when it assumes the more or less well marked snoring
character of one who is fast asleep.
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