The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum].
- Duncum, Barbara M.
- Date:
- 1947
Licence: In copyright
Credit: The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum]. Source: Wellcome Collection.
628/664 page 608
![are thus placed, all blood must, of necessity, drain backwards, and turning the head to one side does not permit the blood to escape as it would if the patient were flat.' ' The entry of blood into the larynx and trachea during these operations ', Hewitt stated, ' may be easily avoided by attention to the following simple rules :—(a) when practicable, the posture should be such that blood can easily flow out of the mouth ; (b) the head should be kept, as far as possible, in a line with the body, so that coughing and swallowing movements may effectu- ally take place ; (c) the anaesthesia should not be too profound, otherwise the pharyngeal and laryngeal reflexes will be abolished ; and (d) the anaesthetist should have at hand several small, round, coarse sponges unattached to holders, so that, in the event of it being impracticable to adopt a posture favourable for the escape of blood, this fluid may be repeatedly removed by sponging. ' The cases in which asphyxial complications from blood are most to be feared are those in which the larynx has become, during the course of chronic throat or nose disease, comparatively insensitive. In such cases coughing and swallowing may not take place even during a comparatively light anaesthesia, and if the posture be faulty a moist expiratory rale will become audible, indicating that blood is present in the larynx. . . . ' In connection with . . . operations [upon the tongue] it may be well to say a few words as to the advisability of trache- otomy, for the anaesthetist may be consulted upon this point. Generally speaking, this measure is unnecessary if the lateral posture is adopted. But should the patient display any con- siderable embarrassment in breathing when the mouth is first opened to the requisite extent by the gag, it is, as a rule, advisable to open the trachea at this juncture, for such embarrassment to breathing will be liable to increase during the course of the case.' Hewitt stated, however, that : ' For such operations as partial or complete excision of the larynx, thyrotomy for the removal of laryngeal growths, etc., the surgeon usually first performs tracheotomy, employing a Hahn's or Trendelenburg's tube with the object of preventing blood passing from the larynx to the trachea. In my experience Trendelenburg's plan of cutting off communication with the trachea by the distension of a small air-ball round the tracheotomy tube has given the best results. In one or two cases I have known the sponge surrounding the Hahn's tube to allow the passage of blood from above down- wards. But whichever plan be chosen, it is certainly a mistake to adapt to the tracheotomy tube the long flexible tube and funnel generally supplied for maintaining anaesthesia ; for the](https://iiif.wellcomecollection.org/image/b20457200_0640.jp2/full/800%2C/0/default.jpg)
