On recent researches upon nitrous oxide narcosis : and their bearing upon the practical question, when and how should laughing gas be administered? : read at the Annual General Meeting of the British Dental Association at Brighton, August, 1889 / by Dudley Wilmot Buxton.

  • Buxton, Dudley Wilmot, 1855-1931.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: On recent researches upon nitrous oxide narcosis : and their bearing upon the practical question, when and how should laughing gas be administered? : read at the Annual General Meeting of the British Dental Association at Brighton, August, 1889 / by Dudley Wilmot Buxton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the danger of the anaesthetic. My own experience has been that the cases of syncope one meets with are usually not associated with old fatty hearts, but occur in persons in whom anaemia is present; the tissues, while demanding much, obtain little; and in those whose nervous system is more or less en- feebled. Of valvular heart lesions we must consider mitral and aortic obstruction, and mitral and aortic incompetence. Here again were nitrous oxide an asphyxiant we might and ought to refuse the solace of gas to patients whose valves were sufficiently diseased to cause symptoms, but as it is not an asphyxiant I have in ordinary cases seen no symptoms the least suggestive of heart failure consequent upon an additional strain. We know that syncope is a frequent and a dangerous symptom of advanced valvular trouble, and upon the fre- quency or infrequency of these attacks I should decide whether or not to administer gas. There is not any property of gas which would determine syncope in valvular disease. The group of cases falling under the heading of functional heart disease are far more dangerous. Such cases are those in which the heart’s action is weak, feeble, irregular, and of poor tone, the anaemic persons worn out by prolonged disease or debauch, persons of ill-nourished nervous system, who for want of better names are called hysterics—male and female,— hystero-epileptics, the gouty and dyspeptic; those whose fail- ing heart has ever been “ assisted ” along the downward path by nips of alcohol, et hoc genus ovine. These persons have nervous systems which will take large quantities of sedatives without much effect; they are timorous, peculiarly liable to fear re- flexes, and nitrous oxide has but a transitory effect on their cerebro-spinal axis, and not infrequently baulks us by its apparent failure. Another reason why nitrous oxide is often so unsatisfactory in these cases is that there is commonly a lack of due oxygenation of the tissues in these persons, and so when the full dose of nitrous oxide gas is administered there is a concurrent impoverishment of oxygen which induces an amount of apncea such as should be absent when gas is properly given. In our third class of cases we must group displacement of the heart by pericardial adhesions, by pleuritic effusions, ascites, ab- dominal or other tumours. Nitrous oxide gas, from the fixation