Spinal anaesthesia by cocaine in gynaecology : with observations on eighteen cases / by Arnold W.W. Lea.

  • Lea, Arnold William Warrington, 1867-1916.
Date:
[1901?]
Catalogue details

Licence: In copyright

Credit: Spinal anaesthesia by cocaine in gynaecology : with observations on eighteen cases / by Arnold W.W. Lea. 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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    been noted. To prevent tlie possible introduction of skin organisms by the needle, a minute incision may be made with a scalpel before making the puncture. III. Difficulty in entering subarachnoid space. This may be met with in very stout amd muscular patients, in whom it is not easy to recognise the lumbar spines and iliac crests; or, again, if any deformity of the spine is present, it may be necessary to make more than one puncture. If the needle is directed too far laterally, it will impinge upon one of the laminae, and must be partially withdrawn; or if, again, it penetrates too deeply, it may enter the body of the vertebra or an intervertebral disc. If difficulty is met with, it is best to remove the needle and make a fresh puncture. IV. Failure to 'produce ancesthesia. Some persons appear to be peculiarly insensitive to the influence of cocaine, and cases have been recorded in which, although the injection was clearly made into the subarachnoid space, no anaesthesia was produced. Some of these cases are explained by failure to use an active preparation of the drug, or by the use of too large a needle,6 in which case the fluid may escape through the needle puncture. In other cases, however, an idiosyncrasy appears to exist, in which even large doses of cocaine fail to produce complete anaes- thesia. V. Organic changes in the cord or meninges. No cases have been recorded in which any symptoms of this nature have followed medullary injection. Nieoletti, of Naples (Internat. Congress, Paris, Aug., 1900), has made numerous experiments on animals, and has found that no histological lesions develop as a result of cocaine injections into the spinal cord in subjects with healthy nervous systems. VI. Toxic effects of cocaine. It is well known, that the sus- ceptibility to cocaine varies much in individuals, and alarming symptoms have followed the hypodermic injection of small quan- tities, not exceeding half a grain. A number of cases have been recorded during the past year in which evidences of the poisonous effects of cocaine have followed injections into the subarachnoid space. In all of these, however, the dose has been greater than 6. Goldan, Philadelphia Med. Journ., Nov. 3, 1900.