Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
For accomplishing the best results, the needles must also be selected
for the work at hand. For the initial puncture in sensitive or
inflamed tissue, it is proper to use a needle of the finest lumen so
as to cause the least possible amount of pain. The ordinary needle,
which comes with the usual hypodermic outfit, is about the proper
length for the ordinary work already mentioned, but could be improved
upon for anesthesia by being made a little finer in calibre. This
length (three-quarters of an inch) will be frequently found
insufficient to reach the deeper tissues and in the removal of a more
or less rounded growth, a longer needle must be selected at the start.
Curved or angular ones are only needed in dentistry, where strength is
also a consideration. Strength is afforded in those of short length by
means of a reinforcement at the hub. Needles so augmented may also be
of use in operations upon bone or dense structures in general; the
curve, however, is not essential.
The surgeon should be fully conversant with the details of the
operation which he is about to perform. His work should be definitely
in his mind, for in operations under local anesthesia, there is no
justification for a change of procedure after the beginning of the
work. Account should be taken of the nature of the tissues to be
anesthetized, for it is known that cicatricial tissues and
inflammatory areas do not lend themselves to the action of these
drugs. In a cicatrix, the diffusibility of the solution is impeded,
and in an inflammatory or necrotic tissue, the changes in the quantity
and quality of the fluids present, alter the action of the anesthetic.
In considering the personal element of the patient one meets a
difficulty which is by no means minor, and full explanation for the
selection of the local anesthetic with many assurances of the
painlessness of the operation are frequently necessary. This is
especially true with one of highly emotional temperament, and, to
allay fear in such a patient is not always easy.
Whatever may be said regarding the mental state of the patient who is
to receive an anesthetic, whether general or local, the surgeon must
remember that to be calm does not always lie within the control of his
subject, and it will be found that a hypodermic injection of morphine
(gr. one-eighth to one-quarter) an hour before the start of the
anesthetic, will often render possible the use of the injection method
in a patient with whom it would otherwise have been impossible.
Morphine injections, as suggested, are of advantage in patients on
whom a major operation is contemplated; they loosen the musculature
and diminish the sensations of parts not anesthetized.
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