Fig. 43
Showing inversion of patient and method of performing artificial respiration simultaneously. (Hare.)
Fig. 44
Same as Fig. 43.
There is a delay in the management of the patient after the conclusion of an operation which is too often neglected—namely, prevention of such exposure as shall produce a sudden checking of perspiration. The patient should be wrapped in several thicknesses of blanket, leaving only the face exposed; and only when fully conscious should he be uncovered gradually and well dried with a bath towel. Such procedure takes away much of the danger of congestion of the lungs, or of the kidneys, which may cause serious disturbance should they occur.[10]
[10] The following is quoted from a recent journal article by an unknown writer:
Acid Intoxication after Anesthetics.—Occasionally some surgeon reports a case of peculiar rapid fatal toxemia after a prolonged operation, the cause of which is obscure. We have also heard of this trouble after parturition, during which chloroform was given for a prolonged period, and the ultimate cause of the violent symptoms has been unknown. Now we are beginning to believe that anesthetics, especially chloroform, can produce a destructive effect on the liver and kidney cells very similar to phosphorus poisoning. In many cases a peculiar idiosyncrasy seems necessary to explain the toxic effect, but certain predisposing causes have been noted, e. g., hemorrhage. The symptom-complex makes its appearance from a few hours to a few days after the anesthesia, and consists of vomiting, restlessness, delirium, convulsions, coma, irregular breathing, cyanosis, and icterus in varying degree. The disease as described by Bevan and Favill is a hepatic toxemia, resulting from acute fatty degeneration of the liver, and seems to be a clinical entity. It is characterized by an acid intoxication, acetone, diacetic acid, and beta-oxybutyric acid being found in the blood and urine. Several clinical varieties must receive renewed interest in the light of this investigation. First is acute yellow atrophy of the liver, many cases of which occur after chloroform anesthesia. Next, the rapid death after abdominal operations, which have hitherto been attributed to intestinal toxemia; and lastly, certain fatal cases of nephritis after operation need a more careful study.