A handbook of local therapeutics / edited by Harrison Allen.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of local therapeutics / edited by Harrison Allen. Source: Wellcome Collection.

    83/554 (page 71)
    air passages become accustomed to the slightly irritant effect of the ether, and then the cone may be held down close over the nose and mouth, the ether being administered in as concentrated a form as possible. In this way a person may be completely anaesthetized with scarcely a struggle. When the conjunctiva is insensible to the touch of the finger, when muscular relaxation is complete and the breathing tends to become ster- torous, the stage of complete anaesthesia has been reached. At this point the quantity of ether poured in the cone should be reduced, or none should be added for a few minutes, subsequent additions being made only at times and in quantities necessary to keep the patient unconscious for the desired length of time. The first effect of inhalation of ether is an acceleration of the pulse and' respiration, increase of the activity of the salivary glands, with a disposition to muscular movements, which frequently require restraint; the brain, too, is excited, and the patient may cry out. These symptoms demand continuance of the administration of the ether, and not its withdrawal. If the patient has taken solid food before the ether- ization, vomiting is now likely to occur. If this should happen, the cone should be withdrawn from the face and the patient's head and body be turned well over to one side, while the mouth and throat are freed as quickly as possible of all vomited matters by means of a sponge fastened to the end of a stick, or held in the blades of a pair of forceps. In the absence of these, the finger covered with a fold of tow^el or napkin will suffice. The second stage of ether narcosis may be considered to begin with complete loss of consciousness, and the patient soon passes into perfect relaxation, with a slow, regular respiration. The stertorous breathing that is noticed if the drug is forced a little further is due to paresis of the muscles of the palate, and, as a rule, is a warning to give less ether. The face during etherization is somewhat congested ; marked pallor and lividity are always indications of failure of the heart's action or of the respi- ration, and when these signs appear the administration of the ether should be suspended. It is the habit among some anaesthetizers to cover the entire face and cone with an additional towel, to prevent loss by evaporation. This is a reprehensible practice, as it removes from view one of the best guides to the patient's condition. It is not an uncommon occurrence when a patient is anaesthetized, for muscular relaxation to be so complete that the tongue falls backward, the glottis closes, the face becomes cyan- osed, and the pulse frequent and irregular. Death may be threatened from asphyxia. In this event the head should be extended and the jaw pressed forward from behind with the thumb on the angles. It is rarely necessary to drag the tongue forward by means of a volsella forceps or tenacula, as is often done in clinics. Should so unfortunate an accident as apparent asphyxia occur, artificial