ANAESTHESIA.

Auckland Star, Volume LXI, Issue 33, 8 February 1930, Page 7 (Supplement)

ANAESTHESIA.

THE MENTAL PROCESSES.

WHAT BECOMES OF THEM ?

INFLUENCES OF THE MIND.

(By PERITIJS.)

In natural sleep—of which, as a phenomenon of life, we know little there are sometimes dreams—of which we know less, and still less do we know of the mental manifestations occurring during artificial sleep —anaesthesia. In the enforced unconsciousness of the nearly drowned, of those affected by concussion and in other forms of suspended animation" duo to injury and accidents, there seem to be revivals of past events recorded in the hrain, and relieved, or brought again to present •memory, during the period of what we call, unconsciousness. In delirium and insanity the memory of past events becomes bewilderingly interwoven with the present, and the spirit of the afflicted goes groping in semi-darkness for something stable and definite, but drifts hither and yon in the fanciful atmosphere of visions and unreality. The mental experiences of patients under anaesthetics have never yet been, classified and recorded, nor have the varyin o, effects of different anaesthetic agents upon the nature of the dreams encountered by the anaesthetised being studied. However, a leading English anaesthetist has gone some way in the direction of symptom analysis, both mental and physical, in patients coming under his personal observation, ana his report is both useful and interesting, professionally and otherwise. The expert says:. "Evidence is accumulating to show that emotion, imagination, anxiety and reason in a patient before anaesthesia create such a disturbance as to excite active vomiting afterwards. The influence of the mind is present throughout the conscious, subconscious and unconscious state, and the personal temperament dominates in many patients the whole pre, post, and immediate anaesthetic period. Dread of the anaesthetic is ■the arch-enemy of the anaesthetist, and, more, the arch-enemy of the patient. The effect of apprehension, fear, or anxiety is underestimated. Much will ? depend upon whether these have been' expressed or repressed before ; the anaesthetic is given. If the former, after' effects will be reduced, if the latter, after effects will be increased to the -maximum. The unusual environ- ' ment disturbs- the patient's equanimity. There is loss of appetite and secretory functions are disturbed and the secretions altered. Pain controls the mental element in a remarkable degree and appears to increase the safety of anaesthesia, which explains why maternity patients 'go off'-bo easily and recover

so well." In ordinary surgery there is fear of the results, in maternity there is anxiety to obtain, rest and comfort and freedom from pain and the anaesthetic is welcomed, and the patient feels confident that all will be well. "The sensation of tension in the head or of suffocation or of strangulation which may occur in the early stage of the induction is a very real and dramatic one. It gives actual form to the emotional apprehensions of the preanesthetic stage and creates the mental impression of impending disaster. The climax is reached in the second stage of the induction when acute brain-storms break over the patient. These are expressed in sudden excitement, active resistance, and rigidity followed by depression and exhaustion of the vital centres. It is surprising that the psychologist is interested to know what the post-anaesthetic effects of these profound impressions are and whether there are any prophylactic measures which might reasonably be taken to protect the patient?"

It is therefore obvious that there should not be too prolonged, a "preparation," nor long abstention from food, and that preliminary sedative treatment of a simple kind should be ordered. Just how a dose of morphia may "agree" with anaesthetic agents which circulate in blood soon afterwards is not known, but experience in this connection has shown no definite objection to its use.

"For practical purposes the conscious mind, the sensation of pain, are out of action during surgical anaesthesia. On the other hand, it appears that the subconscious and unconscious of a patient under surgical, anaesthesia may be abnormally active and alert. I have frequently noted that in the course of even a short anaesthetic period years of personal history, long forgotten, or recent, pleasant or otherwise, may be reviewed by the patient, with coi responding consequences in the returning consciousness.

"These points have been emphasised to-show that processes of nerve excitement and exhaustion, begun in the preanaesthetic period, may continue and gain force throughout surgical anaesthesia and cause profound disturbance to convalescence." A local anaesthetic applied to tlie actual field of operation appears to protect the patient from shock and aftereffects to a surprising degree, for even in unconsciousness the body sends its message to "headquarters" and resents and resists interference. "In the preparation of the surgical patient there is a misdirected zeal which dies hard. The nearer the patient can be brought to or allowed to remain in the normal standard of physiological efficiency, the easier and less interrupted will , the convalescence be. One of the surest methods of reducing a patient's vitality and resistance to infective, processes is to subject him to purgation, enemata and starvation."

The expert deals with these three at. great length, and would modify them all almost to extinction, and adds: "Has the surgeon any views upon,the matter, or has the anaesthetist? If so, why is such an important item in the preoperative preparation of the .patient left largely to the discretion of;the nursing staff? The anaesthetic agent has too long been made the scapegoat of post-anaesthetic

sickness, whereas it is at most only an isolated factor, and in many cases has no responsibility. There are patients who tend to have post-anaesthetic sickness irrespective of the agent used to produce anaesthesia. They belong to the highly emotional type whose endeavours are concentrated' upon concealing their dread and apprehension of the operation and the anaesthetic and who volubly express their complete indifference to both." < In all medical and surgical affairs the personal mental condition of the patient is of the gravest importance, and, as an old physician has said, "Approval and faith make half the cure." Once the patient is assured that the best possible thing is to be done, and done with the greatest possible care, and has faith in his advisers and their methods, he is partially if not entirely protected from that train of after-operation symptoms unpleasant alike to patient, doctor and the nurse.