The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum].

Duncum, Barbara M.

Date:: 1947

Credit: The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum]. Source: Wellcome Collection.

525/664 page 505

$' The preparation of the patient is the same as for chloroform anaesthesia. Whenever possible the patient should be fasting, but we have anaesthetised a few out-patients, when the operation was urgent, although they had had a meal. Heart and lungs were always carefully examined and the urine tested. Pulse and breathing were kept under observation throughout anaes- thesia.' Lotheissen stressed the advisability of having everything in readiness for the operation before beginning induction because ' the onset of anaesthesia is rapid and it passes with equal rapidity '. He stressed the need for quiet during the induc- tion period because any disturbance delayed the onset of anaesthesia and so entailed a greater expenditure of ethyl chloride. Describing administration Lotheissen wrote : ' From 3 to 5 grams of ethyl chloride are sprayed on to the gauze, the patient is asked to breathe normally and the facepiece is applied to the face and pressed lightly home, so that it fits air- tight. This quantity of ethyl chloride is sufficient for 3 to 4 minutes ; for longer anaesthesia more anaesthetic must be sprayed in just before the end of this period. ' The rapid onset of anaesthesia is characteristic ; about 1 to 1-J minutes after the application of the facepiece (and in children \ to 1 minute after) the operation can be begun. The excitement stage is usually absent or trifling—in only 13 per cent, of our Kelene anaesthesias was the excitement worth recording. Com- plete analgesia is established with the induction of anaesthesia, although corneal and pupillar reflexes are usually completely retained, so that the patient moves his eyeballs and so to speak looks around . As we never needed deep anaesthesia, in the few cases where these reflexes were abolished we immediately raised the facepiece until pupil and cornea again reacted briskly. ' The quality of the pulse does not alter during anaesthesia, although the rate changes slightly, as a rule somewhat decreasing. The number of respirations is generally increased, but without being otherwise disturbed. Cyanosis is almost always absent ; we observed it in only 3 cases. ' Recovery from ethyl chloride anaesthesia, by comparison with that from other anaesthetics, is very swift, but the return to consciousness is not quite so rapid as the onset of anaesthesia. . . . We noticed [vomiting] in a few (18) cases, but it was quickly over. Many patients, indeed, feel so well after anaesthesia that they can eat with appetite. In any case Kelene anaesthesia leaves no unpleasant after effects, such as the nausea following$