ANAESTHETICS.

Star (Christchurch), Issue 16423, 11 May 1921, Page 6

ANAESTHETICS.

USE IN MODERN SURGERY. CLAIMS OF ETHER AND CHLOROFORM. The death of several patients under anesthetics in Christchurch recently was the subject of an interview yesterday with Hr Thacker, M-P- (.Mayor of Christchurch), who discussed the use of ansesthetics in the light of modern medeal experience and knowledge. He said that the greatest authorities on surgical anaesthesia agreed that there were few conditions of life or states of health, in regard to ago, injury, or disease, in which anaesthetics could not be resorted to with benefit in case of necessity ; but nobody should "take an anaesthetic of any kind until he or slio had gone into training for the occasion. All patients should be as fit as possible. People who had septic teeth should use mouth disinfectant, and all elderly patients should undergo tho ordinary tests to see if their kidneys were in order. The stomach should bo empty. Except in urgent cases, the patient 9 should abstain from all solid food and from milk for at least twenty-four hours before the anaesthetic was given. Beef tea, clear soup, or coffee could bo taken about two hours before tho anaesthetic was inhaled; and weak or exhausted patients might be given a little stimulant. The patients should bo dressed warmly, and, while under tho amosthetic, should have the body heat preserved. If ether was given on a full stomach the respiration might not become free and regular until vomiting had taken place, after which no further trouble need i>e expected from that source. No danger need be apprehended from vomiting during or after etherisation, except the danger of undigested .food being drawn into the trachea, which was a very uncommon cause of fatality. The administration of oxygen immediately after tho removal of the ether was a favourite practice by many doctors, who claimed that it reduced the time of recovery from the anaesthetic, and also reduced the nausea and vomiting- In using ether a complication sometimes was caused by the free secretion of mucus, which occasionally resulted in edema of the lungs. It was seen most frequently in stout and elderlv patients, inclined to chronic bronchitis or asthma, or in patients with weak hearts, or who were suffering from exhaustion, as from a strangulated hernia of long duration ; but those patients usually could take ether with safety, if care was observed not to give them too much. It had been pointed out that death from an anaesthetic was very different from death under an amesthetic. In the former case the drug was the principal cause; in the latter case the druf* might have little, if anything, to do with the result. One of the highest American authorities had stated that no anaesthetic yet discovered was absolutely free from danger under ail circumstances. The same authority stated that pure ether of high grade, carefully given, never killed a healthy person. Chloroform did so oceasionalfyAbout 40 per cent of the fatalities from chloroform occurred in the cases of reasonably healthy patients about to undergo a minor operation which, in itself, lacked tho elements of danger. Death, in many of those cases, took place in the early stages, or before simesthesia was complete, and in some

cases where the patient previously had taken the drug safely. No blame, in many cases, could be attached to the quality of the drug, or to the method of administration. Death had taken place in the hands of the most experienced and careful men, including Sir Jamas Y. Simpson, the father of chloroform anaesthesia, and other competent and reliable doctors. The authority ho had quoted commented : “Surely an agent that is not safe in the hands of such men cannot be irnplicitely rel;ed upon in the hands of tho ordinary practitioner. In this capricious. treacherous action of chloroform lies its chief danger as an anaesthetic for ordinary, use.” The general opinion amongst doctors was that ether killed slowly by asphyxia, while chloroform killed quickly by cardiac paralysis. The weight of evidence went to prove that ether primarily was a stimulant- to the circulation, and that chloroform was a cardiac depressant. Ether was slower in action, less pleasant to inhale, more bulky, more expensive, was inflammable, was, more or less irritating to the air-passages, and often was followed by nausea and vomiting ; but. jt was regarded as safer under all ordinary circumstances and, when pure, and properly given, never resulted fatally in reasonably healthy people. Chloroform, which was stated to be seven times as strong as ether, was quicker in its action, more pleasant to take, less irritating to the mucous membranes, less bulky and less expensive, not explosive, and usually was attended by less nausea and vomiting, but was not always safe. Chloroform had marked advantages over ether in military surgery in the field. Those advantages, the authority stated, could not be offset by the comparatively small percentage of increased danger; but in civil life those advantages did not count. Tn some countries an anaesthetic mixture, known as A.CE.. or “ Ace of Spades,” was commonly used. Its title was derived from the fact that it was composed of alcohol 1 part, chloroform 2 parts, and ether 3 parts. Many doctors, however, felt that it was better to us*'single drugs. It should be remembered that doctors had no method of detecting tho condition of a patient who would suddenly completely collapse while under an anaesthetic. Tho occurrence of a death under an anaesthetic need not alarm the community. At present there were, perhaps, 1000 per cent more deaths from motor accidents than under ansesthetics. At the. same time taking an anaesthetic was a very serious step, not a light one, and every patient should, above all, follow doctors’ inas to abstaining from food.