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.

    624/674 (page 582)
    ANyt:ST]{ETIOS CHAP. became fully extended over the end of the table. After about 15 seconds, during which the chest pressure was continued, the colour improved and the breathing returned. No further diHicuIty. Illustrative Case, No. 63.—F., about 35. Thin. Good type of subject. Abdominal section. Nitrous oxide-ether-chloroforin sequence for induction : then C.E. Operation begun under C.E. No reflex move- ment. Pulse about 90 to 100. Good breathing. Whilst appendix being manipulated and patient just well under C.E. mixture, the pulse suddenly dropped in rate, respiration being unafl'ccted. In a minute or two re- spiration began to lessen in force. Patient horizontal. Very little anes- thetic required. The pulse remained slow and small, the breathing shallow, and the face pale. The patient now placed in the Trendelenburg posture, with immediate improvement of colour, breathing, and pulse. In Cases 60 and 61 the most interesting point is the deepening of the anaesthesia as the apparent result of the surgical shock. The author would also specially direct atten- tion to the curious batch of deep respirations observed in Case 61. He has seen this phenomenon in other cases im- mediately before cessation of breathing from suspended cerebral circulation. In Case 63 cardiac inhibition was a marked result of the surgical interference, and the beneficial effects of the Trendelenburg posture are well exemplified. Rectal operatious are frequently attended by slight circulatory shock, even though ether be employed. The following case may be regarded as typical. Illustrative Case, No. 64.—M., about 55. Tall. Thin. Has a beard. Said to have a weak heart, but sounds fairly good. Slow action. Operation for hfemoirhoids. Nitrous oxide-ether sequence followed by C.E. mixture. No difficulty. Eectal dilatation begun when patient fairly well under C.E. Slight reflex movement and crowing breathing. After ten minutes the pulse became very slow and the face pale. There was slight corneal reflex present. No reflex movement. Pulse became slower and disappeared at temple. Breathing fair. Ether given on Skinner's mask. Corneal reflex became brisk. No reflex movement. Pulse gradually returned, but never became full. This was a clear case of cardiac inliibition during moderate C.E. an£esthesia. The absence of reflex movement during the period of shoclc, when tlie patient was very lightly inider the anesthetic, is of interest. In the following case the surgical shock was much more severe. It is of interest, because no special remedial measures were employed, and yet the patient made a good recovery.