A text-book of minor surgery.

  • Foote, Edward Milton, 1866-
Date:
1914
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of minor surgery. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    755/868 (page 721)
    Pulse.—Every anesthetist should practice mil i 1 he is able to test the pulse in the carotid'and temporal arteries as easily as in the radial. He can then form his own judgment of the heart's action, and not have to.ask a nurse or other bystander what the pulse is like. It is a mistake, however, to judge of the state of anesthesia solely by the pulse. It varies too much and too rapidly. Moreover, it almost always outlasts respiration, and may be fairly good when respiration has stopped altogether and the patient re- quires immediate attention. It is valuable as showing by its rapid- ity and weakness that excessive hemorrhage has taken place or that the operative trauma has been prolonged or severe. Under such circumstances the anesthetist may be able to give the operator warning in time to save the patient from more than he can bear. Intra-abdominal manipulation produces a shock which shows itself at once in rapid, feeble pulse and altered respiration. If the manipulation is stopped the symptoms are quickly relieved. In deep dissections of the neck or axilla, pressure or traction of the pneumogastric nerves and sympathetic ganglia may also give a weak and rapid pulse. Signs of Surgical Anesthesia.—The time required to pro- duce surgical anesthesia varies between less than two minutes in some cases in which gas or ethyl chlorid is used, to twenty minutes in difficult cases in which ether is used from the start. With such wide variations an average is meaningless. As anesthesia is produced respiration becomes deep and regu- lar. Nervous tension of the muscles, if such, existed, disappears. The patient is unable to answer questions and^gives no sign that they are heard. Keflexes to touch and pain are-next lost. A good way to test these is by an attempt to raise the, upper lid. The effort will be resisted by a patient not completely anesthetized. Some anesthetists make the stupid mistake of touching the eyeball or the margin of the eyelid with the finger to determine the pres- ence of the conjunctival reflex. When there are other reflexes eas- ily and safely obtainable there is no excuse for subjecting a patient to the risk of conjunctivitis. If chloroform or ether is dropped into the eye it should immediately be washed out with saline solution. If the patient resists raising of the upper lid more anesthetic is required. When the lid can be raised without resistance the reaction of the pupil to light may be observed. The size of the