Practical Points in Anesthesia

by Frederick-Emil Neef

Cocainization of the pharynx is an unnecessary procedure.

For operations on the mastoid or brain the pharynx need not be tamponed about the tubes. This is done only when blood is apt to flow down into the air passages, as in resecting the upper jaw, in Kocher’s excision of the tongue and various intrabuccal operations.

In such cases, the Roser mouth gag is inserted and the tongue drawn gently forward out of the way, while, aided by the index finger of the right or left hand, a piece of gauze tampon is placed snugly about the naso-pharyngeal tube or tubes. If a stream of expiratory air issues from the tube it is certain that the pharyngeal openings in the tube have not been plugged by the tampon or tenacious secretions. In certain operations on the nose where both nostrils are involved it becomes necessary to introduce the tubes through the mouth—oro-pharyngeal intubation.

The Surgical Plane

The anesthetist need not be at sea, although he is at a considerable distance from the face and eyes, which he is accustomed to watch with such care during narcosis. In any case, the pupil is no longer a very useful guide because the patient has received morphine. There is access to the pulse at the wrist or the dorsal artery of the foot and its regularity and |Pulse| quality can be noted. A diffuse and weakening pulse wave is at once appreciated as a danger sign—too much chloroform—and the tube should be disconnected from the funnel to admit pure air, until the pulse has recovered its quality.

Color and Breathing

The color of the face can be observed; also the breathing movement of the chest and abdomen, and the respirations are readily heard through the tube. Any change in the character of the breathing or any hindrance in inspiration or expiration is readily detected. From time to time the funnel is disconnected and fluid which may have accumulated in the tube, as for instance condensed anesthetic, is allowed to flow out.

Clogging of the Tube

Secretions clogging the pharyngeal end of the tube are expelled by “milking” the tube, that is, forcing an occluded column of air through it by stroking it between the finger and thumb in a direction towards the patient, or allowing a gentle stream of oxygen to flow into its lumen.

As long as the breathing remains unembarrassed and regular, the pulse is of good quality and a general, passive condition maintained, the patient is in the normal plane of surgical anesthesia and any interference would be meddling.