Possible causes of prolonged apnœa / by W.D.M. Paton.

  • William Paton
Date:
[1958]
Catalogue details

Licence: In copyright

Credit: Possible causes of prolonged apnœa / by W.D.M. Paton. Source: Wellcome Collection.

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    VOL 13 NO 3 ANAESTHESIA july 1958 Possible causes of prolonged apncea W. D. M. PATON, DM, FRS Department of Pharmacology Royal College of Surgeons of England The starting point of this paper is the apparently simple question, which I have often discussed with anaesthetic friends, ‘Why was this patient so slow in recovering his normal breathing? Was it because . . .?’ Discussions of this kind have usually focussed on the properties of muscle relaxants; and sometimes ideas are put forward best described by adapting Churchill’s phrase, as hypothesis wrapped in a theory enshrined in a speculation. As one goes into the problems presented it seems possible that it may be wrong to concentrate ex¬ clusively on problems of neuromuscular block, and that there are a number of other causes for failure to breathe deserving more atten¬ tion. In this paper, therefore, I have attempted simply to enumerate some possible mechanisms for prolonged apncea such as occur to an experimental pharmacologist. We shall deal only with apncea due to failure of respiratory muscular movement, and exclude conditions such as bronchial obstruction. These cases appear to be unusual, in relation to the large number of uneventful anaesthesias, although they are none the less important or interesting for that. If this is true, then one is entitled, and indeed ought, to look for reasons which might not habitually operate; that is, one should enquire, necessarily rather speculatively, as to how unusual responses might come about. To justify the speculations in de¬ tail, would be a very lengthy proceeding; accordingly I will only in¬ dicate briefly the nature of the evidence which could be brought to bear on them. MORIBUNDITY In experimental work, if one has had bad luck or been sufficiently in¬ competent, one sometimes brings an animal, through asphyxia or circulatory shock or both, to a state where it is still breathing, but where any further insult, even one which is normally relatively trivial, will suspend respiration. A similar situation may occur clinically, for Read at Silver Jubilee Meeting, Association of Anaesthetists 5 December 1957.
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