Вы находитесь на странице: 1из 1

1247

the help of the bacteriologists to settle the matter, for This rate is more or less maintained until anaesthesia.
if they can show that pathogenic organisms are has been induced. When anaesthesia, is considered
destroyed by the ionisation of antiseptic chemicals sufficiently deep, the tap can be turned off ; or at the
such as iodine, and are not sensibly affected by the discretion of the anaesthetist more anaesthetic or
galvanic current alone, then the case is proved ; also isotonic solution can be given. The needle may be
the biochemists might help us very considerably by held in position during the administration by pieces
examining the body fluids. or sticking plaster. The dosage is estimated from the
body-weight of the patient (2 to 3 c.cm. of the 96 per
cent. pure alcohol per kg. of weight), but one is
GENERAL ANESTHESIA BY THE INTRA- seldom called upon to make use of the maximum
allowance.
VENOUS INJECTION OF ETHYL Results.
ALCOHOL. Induction may take from 2 to 15 minutes. There is
no initial stage of excitement such as may occur with
BY JULIEN D. CONSTANTIN, M.R.C.S. ENG.,
TO THE MILLER GENERAL HOSPITAL, GREENWICH,
inhalation anaesthesia. Perfect relaxation is said to be
ANESTHETIST
AND THE FRENCH HOSPITAL, SHAFTESBURY AVENUE. a chief feature, the breathing being very quiet ; and
naturally this is of great assistance to the surgeon in
all abdominal cases. The method should not be
IN view of the premature and mostly inaccurate employed for infants or in cases of advanced pulmonary
publicity given to the method of anaesthesia advocated tuberculosis, but the 300 cases already operated on
by Dr. Miguel Garcia Marin, of the Military Hospital, have included patients with definite cardiac lesions
Mexico City, it seems desirable to. describe the method and also diabetics. Brights disease is said not to be
in detail. a contra-indication. One curious contention is made-
Intravenous anaesthesia is not a new thing, but the
use of ethyl alcohol intravenously had not, as far as I namely, that alcoholics require a dose even smaller
than the average temperate subject.
know, been reported until Dr. Marins experiments Surgical anaesthesia is reckoned to last an hour and a
became known. The method consists in the administra-
half, but may be prolonged, by giving more anaesthetic,
tion, intravenously, of 96 per cent. pure ethyl alcohol up to four hours. The recovery is peaceful and there
in a solution of glucose. Dr. Marin has been experi- are no ill-effects, such as vomiting. The patient may
menting for over four years, during which time he even be fed if the nature of the operation so permits.
performed about 700 operations on animals before There is a period of post-anaesthetic analgesia that may
applying his technique to operations on human last three to four hours or more. During the experi-
beings. Some 300 patients have now been anaes- mental stage there were instances of haemoglobinuria,
thetised successfully in this way for various operations. but this trouble was soon eliminated when isotonic
Dr. Marin gives as his reason for using ethyl alcohol solutions of glucose were employed and the correct
that it " dissolves lipoids and penetrates by endos- dilution of alcohol was adopted, thereby ensuring
mosis the protoplasm of the nerve cells, hindering
their metabolism." proper diuresis.
He claims that the adoption of the intravenous My acquaintance with this type of anaesthesia is so
far limited to two cases, but I was greatly impressed
route does away with any risk of initial syncope
through direct irritation of the mucous membrane. by the results obtained. a

Further advantages of intravenous anaesthesia are: The first case was that of a woman, aged 58, with a slight
(a) No mask, or other appliances to the face or mouth, cardiac arrhythmia, who walked into the hospital a few
need be used during any operation to the head or face, moments before the operation for onychogryphosis, and,
which eliminates the possibility of infection from this therefore, had had none of the preparation one would expect
before an anaesthetic. Her weight was a little over 9 st.
source and also leaves a clearer field of action to the and it was reckoned that her allowance would be about
operator. (b) There is less danger of post-anaesthetic 150 c.cm. of 96 per cent. ethyl alcohol. The induction took
pneumonic complications. (c) The risks of fire during 13 minutes and was very peaceful, the anaesthesia being
the use of thermocautery or diathermy are done away gradual and uneventful. The corneal reflex was slow in
with. (d) The possibility of injury to the eyes from disappearing. Although the surgical part of the operation
was relatively a small one, I had the opportunity of testing
accidental contact with an irritating anaesthetic is
the relaxation of the abdominal walls by pressure, and
avoided. (e) Perfect control of administration obtained
everything seemed apparently as it should be, though I
(see below). (f) No material effect is noticeable on the should hesitate to say whether the patient would have
blood pressure. There is an initial rise, but this is of reacted to incision of the parietal peritoneum at that stage.
short duration, and the blood pressure soon falls to The systolic blood pressure, taken just before the anees-
normal again and remains normal. thetic, was 130, and when anaesthesia had been induced it
It is claimed that, since ethyl alcohol is 137 times less was still the same. The patient, seen two hours after the
toxic than chloroform, and since surgical anaesthesia anaesthesia, although conscious to a certain degree, was
can be obtained with a dose three to four times smaller
somewhat inclined to be " fidgety" with her arms and
incoherent in her speech ; otherwise she seemed to be quite
than the lethal one, there must be a large margin of comfortable. She suffered from incontinence of urine once,
safety. three hours after the operation.
Technique. The second case was that of a man of between 50 and 60
The usual aseptic and antiseptic precautions, as years of age, who had an excision of an epithelioma of the
"
for any other intravenous administration, should be upper lip with the diathermy knife. The same solution
taken. An ingenious apparatus has been devised as in the first case was again employed, and the total

by Dr. Rooul Ortiz, of Mexico, a collaborator of quantity of alcohol administered was 176 c.cm. The time
of induction here was also 13 minutes, and again there was
Dr. Marin, but a convenient, if not ideal, substitute no excitement, the man being inclined to be talkative and
may be found in the old Army 606 outfit, interposing a apparently experiencing no distress or discomfort. In my
two-way stop-cock at the junction of the two outlet opinion the operation was painlessly performed, and
tubes. except for a few twitchings of the facial muscles, due to
Two sterile solutions are used, one in each container. direct electrical stimulation, there was no movement of the
They are : (a) an isotonic solution of glucose, and body. The patient was conscious almost immediately after
(b) a solution of pure ethyl alcohol and glucose-viz., the operation, and an hour and a half afterwards he was
30 c.cin. of 96 per cent. ethyl alcohol in 70 c.cm. of a sitting up in bed taking nourishment. He had not vomited,
and he said he did not feel any nausea ; he talked sensibly,
25 per cent. solution of glucose. Any vein may be but seemed to be somewhat " merry and bright," as after
selected to suit the convenience of the anaesthetist or a mild potation.
the surgeon. Once the needle is ascertained to be well
inside the lumen of the vein, solution (a) is allowed to I observed that in these two cases the respiration
flow and a few cubic centimetres are injected ; then had a tendency to be perhaps too shallow, but there
the two-way tap is turned over to allow solution (b) was immediately a distinct improvement whenever
to flow at a rate of not more than 10 c.cm. in 30 seconds. the tap was switched over to the isotonic glucose
solution only. I point this out to show that great
1 Thesis presented to the National University of Mexico, 1929. control is available during administration.

Оценить