ANAESTHETICS

Te Awamutu Courier, Volume 75, Issue 6442, 5 November 1947, Page 9

ANAESTHETICS

DEVELOPMENT OF THIOPENTONE REDUCING FEAR OF OPERATIONS The anaesthetist took a glass ampoule of yellowish powder, dissolved the contents in sterile water from another ampoule. There was a green-ish-yellowish effervescence, then the liquid cleared. “This may hurt a little,” he said, as he advanced with his hypodermic and thrust the needle into the patient’s arm. “That didn’t hurt much, doctor,” she replied, and almost immediately fell asleep, to wake an hour later, her operation over, feeling as fit as a fiddle, and ready for a square meal. There had been none of that reek of ether which most people associated with operations; none of that suffocating feeling, the vertigo, the roar of head noises as she “went under”; none of the sickness and misery which so many suffer as they emerge from the anaesthetic. She had had her operation under intravenous thiopentone—“the needle” which sends a sleep-drug coursing through the bloodstream in a few seconds; the needle which has replaced terror with calm and relaxation; the needle for which so many surgical patients are asking to-day. Intravenous Method A suitable drug for producing anaesthesia by injection into the veins had been sought for many years without much success, even as long ago as in the 1870’s, but it was not until 1932 that an answer to the problem was found in a German preparation of the barbiturate series (there are said to be 1100 varieties of barbiturates) called “Evipan Sodium.” This drug had the novel and remarkable property of rapid destruction within the body, so that the duration of the anaesthesia which it produced was short, which made it safe for intravenous use. However, evipan was not sufficiently perfect for use in the bigger surgical operations. Better was “Pentothal Sodium,” which made its debut in America in 1934, and which with the much more recent British product, “Interval Sodium,” is so widely used to-day. Pentothal reached Australia in 1936, when three Australian doctors who specialised in anaesthesia visited America to learn the latest advances in their specialty. It was at first treated here with much reserve because of its novelty, but the medical profession gradually accepted the gospel preached by the specialists who advocated its use, and now most general practitioners apply it with considerable skill for many purposes. Has Come to Stay The drug now appears in the British Pharmacopoeia under the name of “Soluble Thiopentone,” and its incorporation in that august list means that it has come to stay. Although intravenous anaesthesia is not suitable for every type of operations, its scope is now very extensive, its utility depending on the practitioner’s experience of, and familiarity with, its use. It is quite commonly adopted for many of the commoner operations such as hernia, appendicitis, amputations, skin grafting, removal of tumours, abscesses and foreign bodies. It is extensively used for brain operations, but is not suitable for operations on the lungs or heart because of mechanical difficulties associated with the patient’s breathing, and it is hardly powerful enough for operations on the upper part of the abdomen. Neither is it suitable in the hands of the average doctor for operations on the mouth, including dental operations, or for tonsils, because of the danger of inhalation of blood clots or tooth fragments. However, besides its use as a total anaesthetic, intravenous pentothal can also be used as a supplement to other forms of anaesthesia, and it can be, and often is used as a preliminary or “basal” anaesthetic to put a patient “under” before another agent, total or local, is given for the operation itself. -When it is used in conjunction with other anaesthetics, its effect is to minimise the unpleasant factors associated with those other drugs. Its chief danger is that breathing may be depressed or interrupted, but experts state that this is easily corrected ij the proper facilities are at hand. Deep, Refreshing Sleep The course of the anaesthetic, those experienced in its use say, is very smooth, with quiet breathing. It is administered by vein in fractional doses, and by retaining the needle in I position, and continuing from time to time to administer more of the drug straight into the vein, the patient may he kept under the anaesthetic even for several hours. The effect of the injection is that of falling into a deep and refreshing sleep, the emerging from the anaesthetic similar to that of awakening from such a sleep. Sick-

ness from the drug is rare. Some patients have told their doctors. “I don’t mind the operation, but I dread the anaesthetic.” From them, where it can be used, intravenous anaesthesia seems to be the answer, as it is for those who dread the operation itself, for doctors familiar with its use, say that with its help patients are able to face the surgical ordeal with comparative equanimity. The Doctor’s View From the doctor’s point of view, points of comparison with ether as an anaesthetic are these:— It is injected straight into the bloodstream and so takes full effect in a few seconds, whereas ether has to go through the lungs before reaching the blood and so the brain, and thus takes minutes before producing its full effect. Unlike ether, which has to be excreted through the lungs, this drug is destroyed within the body, and so puts no undue strain on the excretory organs such the lungsi kidneys, etc., while if carefully given it can often be used for very ill patients, provided that oxygen is kept supplied to them. It is not commonly employed for very young children, mainly because their veins are so small, but has been successfully used for many children over six years of age, and it has been found that with those small unfortunates who have to face a series of operations once “the needle” has been accepted the first time they are quite ready to receive it the next. A doctor tells of a deaf and dumb youngster who after no experience of “the needle” nodded his head and made motions towards his arm, but shook his head and made motions of repulsion towards the ether apparatus. He also tells of an adult patient who was asked to count aloud as the injecton was given and who counted “1, 2,3, 4,5, 6,7, 8,9, 10, 11, 12,—it’s lovely—l 3, 14 .... ” He was “under,” and liked it. Counting Outmoded Nowadays counting is not so commonly employed as a guide. The idea is to get the subject to relax, to avoid any mental effort whatever. Thus the anaesthesia is “taken” better, and adverse reactions occur less frequently. As is the case with so many other things, receptiveness and confidence are all-important. Doctors dislike drama; its spurious implications upset their judgment and insult their knowledge. But there is drama in the modern miracle of the safe transfer of a conscious persons to complete insensibility in a few moments. There is drama, too, in the case of a man who always fought viciously after the first few breaths of ether and required several persons to restrain him during recovery, for with thiopentone the imperative urge to sleep conquered his impulse to resist, and he awoke surprised, yet relieved, that all was over.—Sydney Morning Herald.