2. The theatre should be maintained at a temperature between 65 and 75 degrees Fahrenheit. The table should be suitably warmed.
3. The patient’s body should be covered with warm blankets, and, in the more serious cases, the lower extremities may be bandaged, from below upwards.
It has been recommended that the brain, if exposed, should be protected from the cooling effects of the atmosphere by irrigation with saline solution at a temperature between 110 and 115 degrees Fahrenheit. Personally I prefer to keep the operative field as dry as possible.
An assistant should be told off, whose duty lies in keeping a record both of blood-pressure and pulse-rate. The lowering of blood-pressure is the surest guide to the surgeon of approaching danger.
It is often considered that rapidity of operation is essential. There can be no greater error. To ensure success the utmost care must be taken to control the loss of blood, for which it is essential that each step of the operation should be carried out deliberately and carefully.
The anæsthetic.
Needless to say, it is essential that the surgeon should have at his disposal an anæsthetist of great experience in head operations.
Ether is regarded with favour in the United States, and in other countries, but we prefer chloroform on the ground that, by its lowering effect on the blood-pressure, there is less venous oozing, and added to this there is probably less tendency to post-operative vomiting. I have recently had the opportunity of seeing the open ether method as carried out in the States, on one occasion for an operation lasting four hours, and in this and in other cases the patient left the operation table in excellent condition, recovering also rapidly from the effects of the anæsthetic.
The lowering of blood-pressure as produced by chloroform might be advanced as an argument against the use of that drug, shock being the greatest danger to be feared in these operations. Still, I must say that I prefer chloroform so long as it is administered by a skilled anæsthetist.
In any case, it is advisable to have oxygen ready to hand.