Anaesthetics and their administration : a text-book for medical and dental practitioners and students.

  • Hewitt, Frederic William, 1857-1916.
Date:
1907
Catalogue details

Licence: In copyright

Credit: Anaesthetics and their administration : a text-book for medical and dental practitioners and students. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    602/674 (page 560)
    SCO ANrESTH]^7nCS ch.u.. to have been very niiiikL-d. When reudiei- iiieUiud« of arlificial respiration became known, liUiulisni grucliuilly coninienced to lull into disuse. At the present time it is rarely if ever employed, principally Ibr the reason just mentioned, but partly also because of the difficulties iu the w.ay of always having at hand an induction apparatus in working order. It is question- able, howevei-, whether I'aradism should be completely di.scarded. When an entry and e.\it of air can be brought about by Silvester's lueihod, any attemi)t to carry on artificial respiration by electrical stimulation, either of the phrenic nerves or of the diaphragm itself, luust be regarded'as out of place. Should the chest be rigidly fixed, however, so that all manual methods of artificial respiration prove fruitless, and should an induction apparatus be at hand, i'aradism of the phrenic nerves should certainly be tried. We have yet to learn whether this immobility of the chest walls one of the most alarming complications of anajsthesia, and one to which reference has already been frequently made—is the result of spasm of the expiratory muscles. If future observation should lead to this conclusion, faradism may yet be destined to save many lives. An interesting ca.se is reported by Dr. David Lamb {Lancet, 16tii May 1903, p. 1367), in which the intermittent application of the constant current restored respiration after a prolonged period of cessation. Should the arrested breathing be associated with a feeble or imperceptible pulse, the artificial resj)iration may with advantage be combined with partial inversion, as recommended in the treatment of respiratory failure due to fall of blood- pressure (p. 562). Experience leads the author to beheve that drugs are of little or no value in the treatment of this form of respiratory arrest. As already mentioned, patients under the influence of opium, morphine, or other sedatives, are more liable to this variety of arrested breathing than other subjects; and as in Illustrative Case, No. 32, p. 506, delay in the re-establishment of respiration may be quite as much dependent upon the action of the sedative as upon the action of the anaesthetic. With regard to prognosis we may say that, if a pulse can be detected at the wrist when res]3iration ceases, and if air can be made to enter and leave the chest, recovery jnay almost certainly be looked for. Even though the pulse cannot be felt, the administrator should by no means despair, but promptly commence and perseveringly continue artificial respiration. It is almost unnecessary to say that artificial respiration must be kept up so long as there is the slightest chance of restoring tlie patient. Recovery has been known to