In the year I665 Sigismund Elsholtz first attempted intravenous anaesthesia by injecting a solution of opiate to obtain insensibility. It was not until I872 that Ore, Myer, and Witzel experimented with chloral hydrate on animals, but this method was soon abandoned. The real work on intravenous anaesthesia started about I905, when Fedorow, St. Petersburg, reported his results on 530 cases in which he used 0*75 per cent of Hedonal (CH3 CH2 CH2 CO (CH3) OCH NH2) in a normal saline solution, and claimed that he had no fatalities.Burkhart, after many experiments on dogs, published the results of his first forty-six cases of general anaesthesia using ether and chloroform. He injected a solution of 5 per cent to 7 per cent warmed to 280 C. through a cannula into the vein in the arm, and found that very variable quantities, even up to several litres, were required. Some of the patients showed syncope, cyanosis, and pulmonary oedema. The difficulties of administration were so great that Isopral (CCL3CH (OH) CH3) was used by his successors. Burkhart, trying out a solution of a mixture of ether and isopral, reported excellent results in seventy cases.It was during this time that Bier studied regional intravenous anaesthesia of the limbs. A variable amount of o * 5 per cent novocaine was injected into the veins near the site of the operation. -The blood supply at each end of the limb was occluded to keep the novocaine in the veins. In five to ten minutes anaesthesia was complete. From 25 to 200 c.c. of novocaine without adrenalin were required, according to the size of the limb. This method was most successful for operations on the arm, particularly the forearm.The technique used by Gwathmey of America, when he injected 5 per cent to 7 -5 per cent solution of ether in Ringer's solution was as follows:Thirty minutes before the operation a hypodermic injection of morphine sulphate gr. "th, atropine sulphate gr. 1*oth, scopolamine gr. Thth was given. The solution of ether with filtered sterile Ringer's solution at a temperature of 850 F. was thoroughly mixed in a reservoir placed eight feet above the floor.. A superficial vein which was away from the operator had to be used, for the infusion, and if the elbow was selected, a padded splint was passed beneath the patient and the wrist bound to it. The skin over the chosen vein was sterilised and, under local anaesthesia, a small incision was made and the vein lifted out. The vein was then cut and the cannula inserted and tied in place. The fluid was allowed to flow through an indicator drip chamber down through rubber tubing into a blunt cannula until the usual signs of anaesthesia appeared. WVhen the desired degree of narcosis was obtained, the flow, which had to be continuous, was reduced by means of the control cock below the indicator. Great care was necessary to maintain an unobstructed airway. The dressings were-applied before the flow was actually stopped, as the return to consciousness was often rapid. About I,OOO c.c. of the solution were used per hour, and at the end of...
Anaesthesia has changed considerably during the last ten years. It is often said, and rightly so, that this branch of medicine has advanced more than any other. Nevertheless the main factor, that is, the patient, remains the same since the days of Simpson. The patient's comfort is considered before everything else, and this point of view is always held before the eyes of the research worker. The patient has the right to expect the anesthetic which is considered the safest and the best, and also the one likely to give him the least trouble before, during and after the operation. In this he is guided by his own private doctor, or by the surgeon in whom he has placed his trust. The anaesthetist is consulted and makes his decision on the general aspect of the patient, both clinical and psychological. (3) Those who desire to remain conscious whilst the operation is being performed.It is with this picture of the patient of to-day that the anaesthetist is faced and his work is not made easier by the publicity given to modern methods in the lay press, or the fact that every patient reacts differently to any anesthetic that may be given him. Therefore ultra-modern methods cannot be said to suit every type of patient; and yet with the recent advances in pre-medication, it is very nearly possible to satisfy the demand of the most difficult.Premedication. This is probably as good a name as any other for this branch of anaesthetics. lt implies the administration of a mild drug so as to produce a form of sleep before operation. This renders the patient quiet and peaceful, with his mind at rest.Opium. The first recognised drugs used for premedication were morphia and atropine given hypodermically. Then various compounds were made containing morphia, atropine and hyoscine. Later omnopon was produced, and this was followed by the combination of omnopon and scopolamine which produced the condition known as "Twilight Sleep." The dosage of morphia has been widely discussed in the past few years and it has been suggested that morphia alone is a drug that should be treated with great respect, but larger doses of its alkaloids may be given. There are three alkaloids of scopolamine, a dextro-rotary, a laevo-rotary, and a combination of the two, the dextro-rotary being exciting and the laevo-rotary depressant. It is advisable to give the laevo-rotary alkaloids of scopolamine with omnopon.
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