Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Toxicology.+ The repeated use of cocaine in the same patient should be
avoided on account of the danger of establishing the cocaine habit.
The drug should be given with the greatest care, especially in
operations about the head, neck, face, and urethra, as several deaths
and many alarming cases of syncope, delirium and paralysis or tetanic
fixation of the respiratory muscles have followed its use. Because of
its marked depressing effect upon vital organs, it should never be
given unless the patient is in the recumbent position. The
administration of one drop of a one per cent. solution of trinitrin
given at the first onset of the constitutional effects and repeated if
necessary every five minutes, will entirely prevent any unpleasant
effects as it is a true physiologic antidote.
If the surgeon has a case in which he intends to use large amounts of
cocaine, it is best to have at hand and ready for use the following
agents: a hypodermic and a rectal syringe, a battery, cardiac and
respiratory stimulants, oxygen, and a catheter.
If the patient becomes very delirious and is in no way depressed,
chloral or hyoscine should be given. In all cases of cocaine poisoning
the patient should be catheterized to prevent re-absorption and should
then be treated symptomatically.
Strong solutions should never be employed for any purpose except in
cases where, by previous experience with the mild ones, it is known
that no idiosyncrasy exists.
The central nervous system, and next the sensory and motor nerves, are
affected by cocaine. Respiratory paralysis follows the introduction of
appreciable amounts of cocaine into the circulation and respiratory
depression may follow the introduction of smaller quantities. A given
quantity of the drug in great dilution will, under normal conditions,
give no toxic symptoms, whereas the use of the same amount in a more
concentrated form will give rise to pallor, cyanosis and even syncope
and collapse. It is said that a maximum dose of cocaine can never be
fixed; this, however, seems of less importance than knowing the
minimum dose, for while it is true that many bear it well, this drug
so frequently gives rise to toxic symptoms, and the idiosyncrasy for
it is so common, that one can never be certain of an exact dosage.
Various pharmacopias place the maximum dose at 0.05 grm. (about
seven-eights of a grain).
Bearing in mind that a great dilution of a given amount makes for
safety, we are astonished to learn that 7 c. c. (about 2 drams), of a
1 per cent. solution introduced into the urethra has caused death.
(Czerny).
Hertzler cites numerous instances in which a few drops of a more
concentrated solution (2 per cent. to 4 per cent.) have caused death.
It is therefore obvious that the use of this drug must be guarded by a
technic so perfect that but the smallest quantity of a very weak
solution shall be permitted to enter the circulation.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account