Practical Points in Anesthesia

by Frederick-Emil Neef

The Use of the Breathing Tube.

Breathing Tube

The breathing tube is a soft rubber tube 5/16” in calibre and 7¼” in length. The end is smooth and beveled and has an opening, there being a second opening on the side, about a quarter of an inch distant. To introduce it, the tip of the nose is lifted and the rounded end of the catheter directed into the larger nostril perpendicularly to the face. The use of a little white vaseline obviates friction and unnecessary traumatism. The tube is pushed gently back into the pharynx behind the receded base of the tongue until the respiratory air streams freely through it. Very rarely, it is necessary to pull the tongue forward until the tube is in position. At times it is of advantage to support the angle of the jaw lightly, in order to get the full benefit of the tube breathing. Oxygen, it is true, improves the color when the tongue has receded and there is partial asphyxia, but no one will argue that it eliminates the cause of the obstruction, viz., that the base of the tongue has dropped back into the pharynx and occludes the way to the air passages.

Sometimes, when the recession of the tongue is slight, supporting the angle of the jaw helps, because the base of the tongue is carried forward with it. Frequently, this is insufficient. The tongue may be drawn forward by means of forceps or suture, but this method is crude and necessitates also the use of a wedge and mouth gag. The same accessories are imperative, when an attempt is made to introduce a breathing tube through the mouth into the pharynx. It is for these reasons that the nasal route is preferred. The method outlined is uncomplicated—its efficacy is often striking. It seems to be the simplest solution of the problem to re-establish the respiratory air channel, which has been occluded by the recession of the tongue.

Indications for Stimulation During
Narcosis.

Volume of the Pulse

The volume of the pulse diminishes during protracted narcosis. The volume may be expected to decrease about one-third in the course of an hour, and as much as one-half in a two hours’ anesthesia. If, in a chloroform or anaesthol anesthesia, the pulse gives the impression, to the palpating finger, of having lost more than one-half of its original volume, stimulation is indicated. If ether feeding through the Schimmelbusch mask, and |Camphor-Ether| one drachm of 25% camphor-ether hypodermatically do not improve the volume notably, an intravenous infusion of physiological saline at 98°-105° F. should be given without delay. If the anesthesia has been conducted with ether instead of anaesthol or chloroform, |Strychnine| camphor-ether stimulation is not in place; the resort is to strychnine stimulation instead—one twentieth of a grain of strychnine sulphate hypodermatically, which may be repeated in half an hour. If there is no prompt improvement |Venous Infusion| in the condition of the pulse, the intravenous infusion should not be postponed. It must also be borne in mind that, not drugs, but infusion of fluid alone can make good any great loss of blood.

The Influence of Morphine on
Narcosis.

Morphine

During the course of any operation, the surgeon is responsible for a long chain of ingoing impulses, which travel along the sensory paths from the site of operation to the spinal cord and brain. Morphine diminishes the awakening effect of these impulses by benumbing the perceptive centers in the brain. The correct plane of anesthesia for a patient who has had morphine, for example, one quarter of a grain of morphine sulphate hypodermatically half an hour before narcosis, must appear very superficial as compared with a case to which morphine has not been administered. Not only is considerably less of the anesthetic required, but the lid, for instance, may be quite tonic without indicating that more of the anesthetic is necessary. These observations apply cardinally to anesthesias with chloroform, or chloroform combinations, such as anaesthol.