A manual of surgery : for students and practitioners / by William Rose and Albert Carless.

  • William Rose
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A manual of surgery : for students and practitioners / by William Rose and Albert Carless. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    1171/1194 (page 1171)
    tions gradually become co^UrutsTo'heTe Som asphyxiated^ .SstheUc and the administrator must always be on the look- whatever the anesthetic ^ turning the head so that the tongue falls out and .^e'^^YnfocciS spite of this position being adopted the administra- to one side. If it °cciirs in sp tongue must at all hazards be drawn for- tion is in thi early stages by pulling on the beard wards. This may De accon P , . fQj.^aj.ds by the fingers placed behind or chin or later stages the mouth should be forcibly opened theangleofthejaxw In the^^^^^^^ by forceps and pulled well forwards or a by a gag. and the tongue grasp ^ ^ ^ the root and epiglottis finger may be passed entrance to the glottis is free from^obs’truction Artificial respiration should be undertaken if the breathing has actually stopped. Death should never result from this cause, and if it has actua y ] p ttributed to the carelessness of the anaesthetist. ^'^Obstruction to^the respiration may occasionally arise from the entrance of vomhed material into the air-passages or lungs. during an attack of vomiting, and passing rapidly into a state of asphyxia. In such a case the finger must be swept around the pharynx, if the mouth can be opened, to see that the glottis is clear, whilst tracheotomy or larymgo- tomy may be necessary should the teeth be firmly clenched, or if the obstruc- tion^is below the entrance to the glottis. Fortunately, this accident is of rare ''''^Complete Cessation of Respiration is the usual primary phenomenon from an overdose of chloroform ; it is also stated to happen occpionally during ether narcosis. The pulse continues to beat distinctly for a few seconds, althoug respiratory movements have ceased. Treatment consists in at once stopping the administration, whilst the tongue is drawn forwards, and the muces cleared by the finger. The head should be lowered over the end of the table, and young children may even be completely inverted, so as to induce a flow of blood to the head. Artificial respiration is commenced without delay, whilst the thoracic parietes may be flicked with a cold wet towel, or alternately douched with hot and cold water. Strychnine or ether should also be injected hypodermically, and if the condition persists and the heart s action ceases, a Faradic current may be passed from the second or third intercostal space in front to an electrode placed over the spine. Attempts at resuscitation should be continued for half to three-quarters of an hour. At the same time, these measures must be undertaken with discretion, as otherwise it is quite possible to extinguish the feeble spark of life by the very means which, used wisely, would have restored it. ,.1. 3. Death occasionally results from primary Cardiac Failure, which may arise (a) from fright during the administration of the anaesthetic; ip) from shock with cardiac inhibition, by commencing the operation before com- plete anaesthesia has been obtained; and [c) from an overdose of chloroform or ether acting directly on the nerve centres or on the muscular substance of the heart. On post-mortem examination in such cases, the heart muscle is found to be thin and flabby, and perhaps infiltrated with fat; the ventricular walls are especially affected. Unfortunately, this condition cannot be recognised with certainty by the stethoscope. Patients with simple valvular lesions, where the defect has been more or less compensated, do not generally run any extra risk. The treatment to be adopted in cases of cardiac failure during anaesthesia is the same as for stoppage of the respiration. The Choice of an Ansesthetic in any particular case depends mainly on the condition of the circulatory and respiratory apparatus of the patient. Ether is perhaps, on the whole, the safest drug to employ, especially in adults, although it is less pleasant to take ; it may cause a good deal of bronchial irritation and congestion, and is more likely to give rise to troublesome after-vomiting, 74—2