Alcohol-Chloroform-Ether (A. C. E. Mixture, English Formula, 1:2:3).—This induces rapid anesthesia without the danger of syncope or the other objections to chloroform or ether when used alone.
Chloroform-Ether-Alcohol, in the proportion of 3:1:1, and known as Billroth’s mixture, is extensively used in the same way.
Chloroform-Ether.—This mixture, in equal proportions, is known as Tillman’s mixture, and has been employed by many well-known surgeons.
Nitrous Oxid
Nitrous oxid, as advocated by Sir Humphrey Davy, is a safe product, but the anesthesia produced thereby is of too short duration to be of practical value in plastic surgery. Its employment is resorted to only for such operations as the opening of abscesses or the removal of small cysts, etc.
Ethyl Bromid
While ethyl bromid is a product that cannot be said to be absolutely safe, Terrier, of Paris, has used it largely to induce anesthesia, following it up with chloroform. It should be given freely with deep inspiration, the sixth inhalation producing total loss of consciousness. A moment after complete muscular relaxation is attained, with congestion of the face and dilated pupil. The average time necessary to accomplish this is about one minute, in which about three to five grams are used. In this way the stage of excitement is overcome and immediate narcosis is obtained. As the chloroform is substituted it must be given fairly strong, reducing it gradually. The facial congestion slowly diminishes and the pupillary dilation gives way to contraction. About sixteen grams of chloroform are required to keep up anesthesia for fifteen minutes. The after-effects of chloroform are entirely overcome by the above method.
Ethyl Chlorid
Hawley, in reviewing the use of ethyl chlorid as a general anesthetic in minor operations, states that after several years of more or less constant use of ethyl chlorid, both in clinical and private practice, he has still to see the first case in which it has caused him the slightest uneasiness. The following precautions in its administration should be observed: (1) The patient should be prepared as for chloroform or ether; (2) whatever mask is used, it should fit the face snugly; (3) a graduated tube with a large aperture should be used; (4) the anesthetic should be well supplied with air and as little given as possible; (5) care should be taken not to present it at first in too large a quantity; frequently a dram is quite sufficient for short operations; (6) the patient should rest a while after its administration, as faintness sometimes supervenes; (7) a mask should be used which does not receive the drug close to the patient’s face, otherwise one is liable to either freeze the face of the patient or to cause asphyxia by the moisture from the expired air freezing on the gauze in the mask, and thus preventing the free passage of air to the patient.
The use of ethyl chlorid has the following advantages: (1) Safety in administering; (2) ease of administration; (3) it rapidly produces surgical anesthesia; (4) it can be used where chloroform or ether would be contra-indicated; (5) the patient can be kept in any position during anesthesia, upright or prone; (6) no cyanosis need occur during administration; (7) the patient recovers promptly without after-effects; (8) it is inexpensive; (9) it can be used for a long or short operation with equal success; (10) it is especially useful as a preliminary to other anesthetics, decreasing the time required for the production of anesthesia and avoiding shock and discomfort to the patient.