Modern Anæsthesia

Abstract

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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