The principles of ganglionic block / by W.D.M. Paton.

  • William Paton
Date:
1954
Catalogue details

Licence: In copyright

Credit: The principles of ganglionic block / by W.D.M. Paton. Source: Wellcome Collection.

    4/28 page 140
    But both of these methods have considerable disadvantages, and it has proved possible to achieve the same end by giving a dose of hexamethonium and then tilting the patient so the blood may accumulate in the lower part of his body. When this technique is successful, very dry fields of operation can be obtained, which make plastic surgery much easier and quicker, and neuro¬ surgery a great deal simpler; sometimes, in fact, the use of con¬ trolled hypotension may make possible operations otherwise almost too hazardous to undertake. But each of these uses has raised problems. In hypertension we have the difficulties that oral dosage is relatively inefficient, that patients vary enormously in their response, and that patients on hexamethonium for a relatively prolonged period develop an increasing resistance to its hypotensive action. Similarly in the use of hexamethonium in gastro-intestinal disease, where it has been used to depress the motility of the small intestine, it has been found to cause distension of the gut, partly simply by delaying its emptying but partly, it appears, by doing something else, such as interfering with absorption of fluid. Finally, the use to diminish bleeding at operation raises the question of why it is that a patient may have his pressure lowered so far without suffering any ill-effects, and the additional practical question of how to make it possible to achieve these reductions of blood pressure more uniformly. These are the sort of problems which arise, and others will no doubt appear in the future; and it is with such questions in mind that we must turn to consider the sort of knowledge needed to be able to handle ganglion blocking agents with some hope of success. This may be summarized briefly as knowledge about (1) the properties of the transmission process in autonomic ganglia; (2) the properties inherent in quaternary salts; (3) normal autonomic background tone and reflex activity; (4) the reactions of the body to autonomic paralysis. 1. The Mechanisms of Ganglionic Transmission and Block The autonomic ganglia receive from the central nervous system preganglionic trunks which enter the ganglia, and there synapse with the cells from which the postganglionic trunks take origin.
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