Anaesthesia in Gall-Bladder Surgery

Abstract

a few months of comfort rather than years of useful work. If The choice of anaesthetic and the method of administration is dictated by the condition of the patient, the time the operation will take and one's own personal prejudice. Inhalation anaesthesia held pride of place for many years, and both chloroform and ether have had their protagonists. The necessary muscular relaxation can be obtained in other ways, however, and the modern anaesthetist has a choice of several methods. Intravenous anaesthesia, spinal analgesia, and regional analgesia can each be used to give relaxation, but care must be exercised in employing any one of these methods. The indications and contra-indications for their use are discussed below. The patient's condition, both mental and physical, must be carefully considered. The frightened patient is more difficult to anaesthetise than the placid one, and requires more anaesthetic. The "Falstaffs" are also difficult, largely owing to their build. On the other hand these portly patients who habitually do themselves well seldom suffer with post-anaesthetic vomiting! The anaesthetist should know the condition of the patient's cardiovascular system (myocardium, blood pressure, arterio-sclerosis, etc.). The liver and renal function, too, should be known, for the blood urea is a very good guide of a patient's general condition. It is obvious that a fat, jaundiced patient with a flabby heart and poor excretory system will need more care than will a young, thin, wiry patient. Not only has the anaesthetist several separate methods of approach, but he may use a combination of methods.Inhalation anaesthesia for gall bladder surgery calls for third plane anaesthesia, that is to say, full muscular relaxation. The surgeon is completely in the hands of his anaesthetist when inhalation anaesthesia alone is used, for if the patient be not sufficiently relaxed, the operation may be well nigh impossible. Chloroform alone can be used, but is not recommended, and