Pt_ECENTLY, rather enthusiastic reports (1, 2, 8,4) concerning Fluothane (CFa CHC1 Br) appeared in the literature The pubhshed reports (1, 2) indicated that this was an exceedingly "potent, non-lmtating, non-explosive agent, reqmxmg careful control of concentration and easy recogmtaon of anaesthetie depth if over-dose and resulting serious cardiovascular depression were to be avoided. Since few anaesthetists have available at pr, esent the facilities for constant accurate control of concentration, it seemed necessary to find dependable easily recogmsed clinical signs, and to correlate these with the accurate electroencephalographm levels. In fins way a satisfactory safe pattern of anaesthesia would be available. M~a'ttoDTwenty-two unselected pataents were ,studied The type of operation, age range and duralaon of anaesthesia were as follows.
ENDO~CI-maL intubataon is today an accepted part of anaesthesia. Most complicalaons following mtubation are, m general, amenable to simple forms of treatment. For the more severe problems~ amongst which is subglottic membrane, aclave &agnostic and therapeutic measures are required.Aetlologlcal factors responsible for comphcalaons of endotraeheal intubation include mfect~on, constatutaonal defects, tassue anoxia, local laryngo-traeheal abnormalilaes, shape, sine and form of endol~:acheal tube, movement of tube in trachea, neck position, inflammation following cluodenal catheter pressure with secondary involvement of trachea (1), trauma from the laryngoscope and the sty]:et, chemical /rritants, followmg theLr use for sterfllzattoa of tubes (8), undue sensitivity of palaent's trachea to endotracheal tubes, and allergic re~ctlons (8).It is an axiom that for the optamum treatment the exact chagnosis is necessary. To exemplify thas and to indicate the necessity for a constant bagh suspicion of a subglottac membrane, the events leachng up to such a case and a description of this case are here given.During the middle of February, 1955, there ,was an unusual spate of postoperattve respiratory comphcalaons m two of tJa~ hospitals in th~ area. These comphcattons occurred at a ttme when there was a minor ende~xac of upper respiratory m_feclaons One of the pal:tents at the Umverslty Hosp:~tal, a wbate female, required an emergency tracheotomy following a cholecystectomy with a very taght fitting endotracheal tube. In retrospect this is considered ~o have been a case of subglothc membrane. The descnplaon of the mvestagated case follows.M.S., a 68-year-old white woman, was admitted to the University Hospital for cholecystectomy on February 22, 1955. Cholelithiasls had been d~ rachologlcally two years previously, elsewhere. Since age 15 the patient had suffered from intermittent charrhoea. In 199.2 her only child was born. In 1927 hospitahzation was necessary for several weeks for a nervous breakdown. In 1929 an uterine prolapse was repaired by an abdominal operation. A dilatation, curettage and msertton of radmm for menopausal bleeding in 1938 was successful. All of these procedures were wathout comphcations. Since 1985 treatment for hypertension had been continuous.Physical examinalaon revealed a thin, poorly developed female, with a moist, pale skin. The pulse was 108, blood pressure 170/90, and respirataons 22. The apical impulse was m the anterior a~xl/ary line. The abdomen was protuberant, with a mldhne infra-umbflical scar The spree showed a mild kyphosis. The urinalysis, haematology, and blood chemistry were all within normal limits, except the serum amylase which was 820 So, mogyl units (normal 50--200).On February 24, 1955, a cholecystectomy was performed. Premedication conslsted of demerol| 75 mgm. and atropine sulphate ~o0 gr. Anaesthesia was
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