British Medical Association Proceedings of Sections at the Annual Meeting, Nottingham, 1926

1926 BMJ (Clinical Research Edition)  
this combined session. In abdominal surgery anaesthesia is of greater importance than in operations on the extremities, for through of the abdomiiinal organls, such as acute appendicitis cholelithiasis, serious chaniges in the liver are that a comiiplete anaesthesia with chloroform or which the liver is affected, may cause fatal hepatic insufficicncy, which in cases of operations on the extremities not to be feared. If the power of resistance l)eritoneum is weakened by a proloniged deep
more » ... oniged deep niarcosis, the infection of the abdomiiinal cavity, possible abdomiiinal operation, can miiore easily lead to fatal itis. Finally, many abdominal operations, operations for gastro-jejunal ulcer, belong to the and most difficult operations, in which death is to be feared. In view of this, every enideavour improve anaesthesia in abdominal surgery is Since it is impossible in this small paper to developmient of all the methods of anaesthesia, devote myself more particularly to the most important. Naturally during my experience I have used all of anaesthesia for abdominal surgery, but for maniy I have practically employed only the regional combined methods. I am so convinced of the of conibined and regional anaesthesia over general alnaesthmesia th-at I do not niow operate on patients upon a general anaesthetic. The methods of can be classified into three groups: A. General Anaesthesia.-The whole operation pleted while the patient is unconscious and the occurs exclusively in the cerebrum. B. Combined Anaest7hesia.-Pain is eliminated partly as a result of interruption of the sensory nerves thriough unconsciousness during part of the as a result of temporary exclusioni of the cerebrum, through general narcosis. . C. Regional-Anaesthesia3-The conduction of interrupted by injecting effective drugs near senysory nerves, but consciousness is unaffected. This interruption may be effected (1) in the spinal canal (spinal anaesthesia); (2) near the spinal column (paravertebral, parasacral anaesthesia); or (3) the splanchnic nerves (splanchnic anaesthesia) or their branches in the mesenterl'es (mesenteric anaesthesia) can be blocked. A. GENERAL ANAESTHESIA. Ether and chloroformli, alone or mixed, are commonly used to-day. Chlorofor m is giradually being frequently because of its injurious effect tlhe3 parenchymatous organs (liver, heart, kidniey). The injjury to these parenchymatous organs can be diminished if less of the anaesthetic be used. Thiis Is achieved through the use of morphine or pantopon, whicl affect tIme cerebrum. Scopolamine acts as an excellent synergist, but is dangerous. Atropine decreases the secretion of the mucous membranes, and both morphine and atropine should be used together prior to every ether narcosi, The quantity should be proportioned to the strength of the patient. To elinminatethee disadvantages of general narco-iis chloroform or ether is substituted by the gas anaesthetics, prim iarily nitrous oxide, which favourably me in America. Whieniprooper ly used, it is practically without danger (Crile told mne personally that lie no, fatalities in over 50,000 cases). It does not a drop in blood pressure or damage to the brain, liver, etc. (as shown experimienltally by Crile), and on this acconnt it has beeni a marked advancement in the question cf general narcosis. Its disadvantages are, taat frequently there is not enough l relaxation of the abdominal musculature, necessitating the associated use of ether to obtain complete relaxation-. .This, however, cani he obtained morec ssiply and more effectively by the injection of novocain [ Tnz B Rrri MEDICAL JOUBASh I
doi:10.1136/bmj.2.3423.290 fatcat:i7va23smh5gbtojyt4tfisoh6e