SHOCK
Shock, particularly in operations on the nose, is apt to be marked in young children and in elderly persons. It is for this reason that we try to avoid the removal of adenoids in patients under 3 years of age, or of polypi in those over 60; and that in all cases we endeavour to operate as rapidly as possible.
This possibility of shock is guarded against and treated in the usual way. The use of cocaine and adrenalin—even in patients under a general anæsthetic—helps to avoid it,[49] and anæsthesia should never be too deep or prolonged. When operating under local anæsthesia it is sometimes wiser not to attempt too much at one sitting, e.g. to treat only one side of the nose at a time. In certain conditions, and when a general anæsthetic is employed, it may be safer to try and complete treatment at one operation.
SEPSIS AND OTHER COMPLICATIONS
Deaths have been recorded after the simple use of the galvano-cautery, or the removal of nasal polypi, and of course are more to be feared after major operations, such as the radical cure of sinus suppurations.
Septic infection from nasal operations may spread to the accessory sinuses, meninges, ear, eye, tonsils, glands, gastro-intestinal tract, bronchi, and lungs. From the naso-pharynx, the ears and the lower food and air tracts are chiefly threatened. The orbit may be invaded in operations on the ethmoid; the external muscles of the eye may be injured in the frontal sinus operation; and optic atrophy may be due to plugging of the ophthalmic vein.
While these accidents may sometimes be directly due to operation, it is well to remember that in treating such septic conditions as are entailed by nasal suppuration, the complications may only be precipitated by traumatism and may also be purely coincident. It is not to be forgotten that latent infection—of influenza, erysipelas, measles, scarlatina, diphtheria, or other disease—may develop immediately after an operation upon the nose or throat, and until its true character is recognized the operation is often unjustly blamed. Septic infection, in these necessarily exposed wounds of the air-passages, may be traced to insanitary surroundings.
ASEPSIS
The field of operation in rhinology can never be rendered completely sterile, and in many cases is particularly septic. Wounds through the mucous membrane cannot be protected with dressings in the usual way; so that the local methods of repair require particular study.
In the nose, when there is no suppuration, it is safer to make no attempt to purify the cavity, beyond cleansing the vibrissæ and vestibules. The Schneiderian membrane will not tolerate any antiseptic lotion of such a strength as to be effective, and weaker solutions only interfere with the action of the cilia, the protective power of the mucus, and other defensive arrangements of the nose. If pus, scabs, or foreign bodies exist in the nose, it should be well washed with a simple tepid alkaline solution.