On spinal anaesthesia by stovaine : with remarks on 1,000 cases / by Frank Cole Madden ; with notes by Hassan Shaheen.

  • Madden, Frank Cole, 1873-1929.
Date:
1912
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Licence: In copyright

Credit: On spinal anaesthesia by stovaine : with remarks on 1,000 cases / by Frank Cole Madden ; with notes by Hassan Shaheen. 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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    than in any other situation. Lithotrity, suprapubic cystotomy, hernia, and hydrocele require proportionately larger doses, but amputations, excisions, and bone opera- tions on the lower extremities may be performed with quite moderate doses. The patients usually declare that below the level of the anaesthesia the parts are as if dead, yet occasionally some are quite conscious of the handling of the area of opera- tion, but experience no pain at all. In such cases, too, the application of a hot lotion is sometimes quite severely felt. The General Condition of the Patient during Operation. Most cases lie perfectly still and placid, and are not upset in any way. Others feel faint or giddy, become very pale and have urgent nausea. If they are sick they are much better at once; but if not, their pallor increases, they have repeated retching, and bring up some mucus, and may have all the usual symptoms of a mild collapse or even definite heart failure. A drink of water may recover them at once, or, if this is without effect, a dose of brandy is a most potent and rapid remedy. It is best, however, when these milder measures are not effective, to give 5 minims of a 1 in 1,000 adrenaline chloride solution, followed, if necessary, by strychnine. The milder cases usually react very quickly, but if not, and there are signs of a failing pulse and gasping for breath, more active measures, and particularly intravenous saline injections, must be resorted to and continued till a definite improve- ment takes place. In cases of high anaesthesia this “ air hunger,” associated with extreme pallor, is only too common and to an alarming degree, and on this account this form of stovaine anaesthesia should not be used. I have had two cases, both in private practice, in which symptoms of complete heart failure came on almost imme- diately after the injection; and it was only by dint of repeated injections of adrenaline, strychnine, caffeine, and sparteine, with artificial respiration, that I was able to save them and complete the operation. One case was an old full-blooded Turk, with advanced arterio-sclerosis, with an impacted stone in the urethra, who, after his narrow escape, surprised us all by taking French leave and walking out of hospital four hours afterwards. He came back two days later none the worse for his adventure. The second case was an alcoholic subject on whom I was operating for fistula in ano, and, though he had very alarming symptoms for a short time, he very rapidly recovered and had no further trouble. Another accident happened with an old Egyptian army officer who was very ill with diabetes and a large gan- grenous cellulitis all round the anus and ischio-rectal fossa. The operation was almost finished when he col- lapsed, and it took us all our time to bring him round. We eventually succeeded, and he went on well for nearly a fortnight, when he developed diabetic coma and died. The bad symptoms were, I think, due here to rough