Every operator of experience has observed the difference in reaction between those patients who have been carefully anesthetized and those who have been improperly anesthetized. In a serious case attended by unavoidable shock the superadded depression of ether-poisoning may be enough to cause a fatal result.
The operator should have nothing to do with the anesthesia, and it should not be necessary for him to watch it. The anesthetizer should make a careful examination of the heart, and should be provided with a hypodermic syringe and the necessary stimulants, which he should use at his own discretion.
He should, of course, use the minimum amount of ether. He should be familiar with the steps of the operation, and he should so regulate the anesthesia that the operator will not be impeded by the straining or struggles of the patient at critical moments.
Preparation of the Patient.—It is always desirable, when possible, to have the patient under observation for several days before operation. As I have already said, a more accurate diagnosis may be made by repeated examinations, and opportunity is afforded for the administration of medicines to improve the general condition. A weak woman about to submit to a serious operation is benefited by the administration of 1/20 grain of strychnine three times a day, for several days before the operation.
During this period the patient should receive a daily bath, a laxative when necessary to produce a daily movement, and a vaginal douche of one gallon of hot water every morning and evening.
The special preparation of the patient is directed to sterilizing the abdominal surface, the external genitals, and the vagina, and to emptying the gastro-intestinal tract. This preparation should begin twenty-four hours before the operation. During this time it is best to confine the patient to bed.
Thorough evacuation of the intestinal tract is very desirable in abdominal surgery. When the intestines are empty and collapsed, the various intra-abdominal manipulations are most easily performed. If the intestine is injured and it becomes necessary to repair it, or if any other intestinal operation is required, it may be performed most easily and with the greatest cleanliness if the gut is empty.
Though it is impossible to sterilize the intestinal tract, yet we most nearly approach the condition of sterilization by thorough evacuation of the bowels.
Twenty-four hours before the operation purgation should be begun by the administration of 1 dram of Rochelle salts, dissolved in half a tumblerful of water or soda-water, every hour until the bowels begin to move freely. Five or six doses are usually sufficient. The lower bowel should finally be emptied thoroughly by an enema of soap and water administered three or four hours before operation. During the twenty-four hours preceding operation the diet should consist of light, easily digested, concentrated nourishment, such as milk, buttermilk, soft-boiled eggs, rare beef, soups, beef-tea, coffee, tea, and whiskey if necessary.
Unless the patient is very weak, no food should be given on the morning of the operation. If her condition does not warrant such abstinence, she may have a glass of milk, buttermilk, coffee, or milk-punch. Such food is required if the operation is performed late in the day.