Minor Anesthesia with Ethyl
Chloride.
Office Anesthesia
In surgical office work, there is occasionally the need of a rapid and fleeting anesthesia which does not necessitate the use of a cumbersome apparatus for its induction. In these cases, in place of chloroform, anaesthol or ether, the ethyl chloride spray can be used on the Schimmelbusch mask already described. It produces a prompt anesthesia during which an abscess can be opened, washed and dressed without causing the patient the slightest pain.
Intubation Anesthesia.
In intubation anesthesia, or tube anesthesia, as it might be called, the patient does not receive the anesthetic directly from a cone or mask. It is inhaled through a soft rubber tube which is introduced into the pharynx through the nostril or mouth. It is most successful in cases that do not require a very profound narcosis. It is indicated in operations on the head, enabling the anesthetist to be at a distance from the field of operation and out of the surgeon’s province.
An important preliminary is to give the patient morphine sulphate, gr. ¼, hypodermatically one half hour before anesthesia is begun, as much less of the anesthetic is then required.
Intubation Narcosis
The method is simple. The anesthesia is carried to the surgical degree in the ordinary way with anaesthol or chloroform. A soft rubber catheter with an opening at the end and side, and varying in diameter between ¼ and ⅜ inch, is made smooth with sterile vaseline and then passed through the nostril down into the naso-pharynx for a distance of about 7¼ inches in the adult, to the vicinity of the larynx. If the respiratory air streams freely through the tube it is assumed to be at the proper level and the tube is anchored and held in place by making a single turn of zinc oxide adhesive plaster about it, near the nostril, and fastening the ends to the cheek. It is important that these straps adhere firmly and the skin should therefore be cleaned with a little ether or chloroform before they are attached. This naso-pharyngeal tube must now be connected with a second tube, the conducting tube, to which a perforated funnel covered with gauze is attached, or which is dipped into a tumbler containing loosely packed gauze; the conducting tube should lie by the side of the patient, beneath the sterile sheets and it should be so long that the anesthetist can sit at the foot of the operating table to administer the anesthetic.
Catheters, a piece of rubber tubing, some zinc oxide plaster, and a tumbler containing some gauze, are, therefore, all that one needs in order to improvise, in a few minutes, an adequate intubation apparatus. In practice, simplicity is frequently important.
Cocainization of the Pharynx