Plastic and cosmetic surgery

by Frederick Strange Kolle

Ether

(Jackson, Morton.) Sulphuric ether is used in the pure form, free from alcohol and water. It should be a colorless, volatile, mobile, and highly inflammable liquid, having a peculiar penetrating odor. As its vapor is much heavier than air, and owing to its combustible nature, lights about the room should always be placed above the patient. Often its vapor is ignited by the careless use of the electro-cautery.

Ether for anesthesia should not affect blue litmus. It should not give a blue color to ignited copper sulphate—the test for the presence of water. Alcohol is indicated when it turns red by adding fuchsin.

Ether is less toxic than chloroform, therefore it requires a greater quantity to induce narcosis.

If properly administered it is by far safer than chloroform, Ollier, of Lyons, reporting only one fatality directly due to its employment in four thousand patients. If the anesthetic is crowded cyanosis with jugular pulsation is noted—the signs of inefficient oxygen and cardiac distention. In most recorded cases of death there were complications of a nephritic pulmonary nature. Ether should not be used where there is bronchitis, gastritis, or peritonitis, owing to its irritant effect on mucous membranes, nor in nephritis, aneurysm, or advanced atheroma. The movements of the diaphragm must be constantly watched as it is the first to become paralyzed when anesthesia is carried too far. The same care must be observed with the pupil for cerebral and the pulse for cardiac signs. Before giving this anesthetic the same preparations as for chloroform narcosis should be observed. The stomach should be empty, the nose and mouth smeared with vaselin, and the eyes protected with a towel.

At first the patient is given the ether with a considerable mixture of air, which should be lessened gradually. Coughing comes on quite often, which is overcome by increasing the ether. Soon there comes a state of respiratory forgetfulness. This is caused by the irritation of the trigeminal and vagal nerves (Hare). This is corrected by dashing ether upon the epigastrium or by sudden and repeated pressure at this point. There is also choking and struggling, the face becoming suffused and red and there is an injection of the conjunctiva. As the ether is pushed the patient becomes quiet, followed by a second seizure of struggling, so intense, that force must often be employed to hold him on the table. With this there are the various attacks of laughing, crying, singing, or yelling—a semiconscious exhibition of the state of the mind of the individual.

As anesthesia progresses relaxation takes place and the time for operation is at hand. Often the throat fills with mucus, owing to the irritant effect of the vapor on the mucous membranes. This must be wiped out with the sponges.

If vomiting occurs the head of the patient is turned to one side until relieved. The mouth should be cleansed thoroughly thereafter to prevent the contents getting into the lungs and causing bronchial irritation and often broncho-pneumonia. If the patient gets too little air, shown by laryngeal stertor, frequent and feeble pulse, livid face or pallor, tonic spasm, thoracic breathing with fixed diaphragm, and drawing in of the abdominal walls with inspiration, the ether should be let up and the jaw pushed forward by placing the fingers under the rami. The tongue should be drawn forward, as already described, and such methods be used as have been mentioned in connection with asphyxia in chloroform narcosis. The pupils fixed in dilatation is indicative of immediate danger.

Strychnin and digitalis should be given hypodermically or the intravenous use of ammonia may be employed. If the stertorous breathing is due to mechanical causes, not to too much ether, the hypodermic use of ether will bring about reflex respiratory movement by reason of the local pain and irritation thus produced.