Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Strength of Solutions.+ In the eye, it is customary to employ a 4 per
cent. solution. For work in the nose, 2 per cent. is generally
considered sufficient. In the latter connection, it is often combined
with adrenalin solution in small amounts to mitigate its depressing
effects as well as to control bleeding. The latter effect is but
transient and is omitted by many as unsatisfactory because of the more
profuse subsequent hemorrhage. In this respect cocaine and adrenalin
are similar. They both cause constriction of the minute superficial
vessels and immediate blanching of the membrane; work in the nose is
hence greatly facilitated, the field of operation being clear and
enlarged by the shrinkage of the encroaching membrane, but it is
incumbent upon the operator to keep his patient under observation at
least an hour after the completion of the operation that he may be
certain of the degree of hemorrhage after the effects of the drugs
have passed away. For the above reason many operators prefer a general
anesthetic or one of the local anesthetic drugs which exert no
constrictor action so that they may know, _ab initio_, the exact
degree of bleeding.
Whatever drug is used, strong solutions are seldom necessary for
application to the mucous membranes but the necessary time for its
absorption is a prime requisite. To secure anesthesia of the
conjunctiva and cornea, the solution is dropped into the eye at the
outer canthus and as it flows off with the tears, it must be
replenished three or four times until anesthesia is accomplished. In
the nose, a spray over the site of incision or a pledget of cotton
saturated with the anesthetic solution and allowed to rest in contact
with that locality, will suffice. The flow of mucus from the nasal
mucosa is stimulated by the presence of the cotton pledget and it soon
becomes entirely coated with a thick mucus which no longer is able to
impart to the membrane its anesthetic solution and must therefore be
renewed several times before complete insensibility of the part is
assured. The topical application of a strong solution on a cotton
wound applicator to a limited area or spot is also efficient.
+Application by Injection.+ In order to bring the anesthetic in contact
with the nerves, it is necessary, where a skin surface is to be
incised, to inject the solution as already described. The technic,
previously detailed, applies here, and any of the methods may be
employed for the injection of solutions of cocaine, some preferring a
single method to the exclusion of all others. The locality to be
treated will also influence the operator as to method.
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