The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
2. The theatre should be maintained at a temperature between 65 and 75
degrees Fahrenheit. The table should be suitably warmed.
3. The patient’s body should be covered with warm blankets, and, in the
more serious cases, the lower extremities may be bandaged, from below
upwards.
It has been recommended that the brain, if exposed, should be protected
from the cooling effects of the atmosphere by irrigation with saline
solution at a temperature between 110 and 115 degrees Fahrenheit.
Personally I prefer to keep the operative field as dry as possible.
An assistant should be told off, whose duty lies in keeping a record
both of blood-pressure and pulse-rate. The lowering of blood-pressure is
the surest guide to the surgeon of approaching danger.
It is often considered that rapidity of operation is essential. There
can be no greater error. To ensure success the utmost care must be taken
to control the loss of blood, for which it is essential that each step
of the operation should be carried out deliberately and carefully.
=The anæsthetic.= Needless to say, it is essential that the surgeon
should have at his disposal an anæsthetist of great experience in head
operations.
Ether is regarded with favour in the United States, and in other
countries, but we prefer chloroform on the ground that, by its lowering
effect on the blood-pressure, there is less venous oozing, and added to
this there is probably less tendency to post-operative vomiting. I have
recently had the opportunity of seeing the open ether method as carried
out in the States, on one occasion for an operation lasting four hours,
and in this and in other cases the patient left the operation table in
excellent condition, recovering also rapidly from the effects of the
anæsthetic.
The lowering of blood-pressure as produced by chloroform might be
advanced as an argument against the use of that drug, shock being the
greatest danger to be feared in these operations. Still, I must say that
I prefer chloroform so long as it is administered by a skilled
anæsthetist.
In any case, it is advisable to have oxygen ready to hand.
=The position of the patient.= Special tables have been invented and
special positions advised. Thus, the dental-chair position is
recommended for operations on the Gasserian ganglion, and, in cerebellar
operations, it is urged that the patient should be turned on his face,
the forehead resting on a tripod, the shoulders on supports fastened to
the head of the table. Personally, I do not consider that any special
arrangements are required in the majority of cases. Much can be done
with sand-bags and firm pillows. Even in the exposure of one cerebellar
hemisphere I prefer to utilize the semi-prone position.
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