Open drop ether: No. 2 (1944) Pt. 1 of 2

the simplest method of inducing anesthesia is by dropping ether onto a mask through which the patient inhales the vapor although better results can be obtained by more elaborate method ether is relatively safe and as comparatively few accessories are necessary its valuable as a standby when other equipment is lacking it's one of difficult anesthetics to give really well first we'll show you how it should be done here is the apparatus you will need amidst an bottle for the ether which is fitted with the Bellamy Gardner dropper if you haven't made some bottle and dropper an ordinary stop bottle will do and you can improvise a dropper from the cork cut two grooves one on each side of it what ergo Zwick in one groove and ran the coke in firmly this will give you a steady flow the mask is a shimmer bush or other standard design it has a spring band to hold the both in position the gauze has been folded into ten or twelve thicknesses it's clipped into position over the mask you will also need a piece of Gamgee eight inches by ten with a four-inch slit in the center a piece of oiled silk or Jack a net with a small hole in the middle you'll want a tube with sterile Vaseline to lubricate the airways this is a water's metal airway which is curved to fit the pharynx it will be tolerated at a lighter depth of anesthesia than will the older type of rather airway the nasal airway is an intrical tube cut to about five inches this is transfixed by a safety pin to prevent it disappearing down the nose it also is carefully lubricated before use other accessories include a gag a swab holder a bowl of God's pods and a bottle containing liquid paraffin or castor oil to drop in a patient's eyes after the operation now for the patient the most important points in preparation for an anaesthetic are rests in bed for 24 hours where possible no solid food for four hours and nothing to drink for two hours beforehand purging is unnecessary and only weakens the patient morphine and atropine are injected three quarters of an hour before the anesthesia is due to start the morphine acts as a sedative reducing the patient's mental anxiety and smoothing the course of anesthesia both the morphine and the atropine prevent excessive secretion of saliva and mucus which might obstruct the airway the suitable dose of morphine is one sixth of a grain for a woman one quarter of a grain for a man these quantities must be reduced if the patient is gravely ill or if he's over 60 years old to larger dose slows up the anesthesia by depressing the respiration the vet tripping 100 the grain is usually sufficient larger doses can be given but they cause great discomfort the time should be noted carefully on the chart in 3/4 of an hour the pre medication would have taken effect the patient will be ready for the anesthetic before starting you must know all about your patient find out when she last had anything to eat or drink if the operation is a hernia ask which side it is it may not be obvious when she's released the ties make sure that the heart and lungs have been examined and you're in tested and that the pre medication ordered has in fact been given in the correct amount and at the right time the more nervous the patient is the more difficulty induction will be and a few kindly words will help a great deal feel her pulse and try to reassure her tell her exactly what you're going to do and what is expected of her encourage her to relax and try to go to sleep examine her mouth to make sure that there are no loose teeth or dental plates that might become detached and cause obstruction also see that there is a clear airway through at least one nostril place the Gamgee over the patient's face tell her to protect her face from the anesthetic it also concentrates the ether vapor by ensuring that all the inhaled air comes through the mask make sure that her eyes are closed or the Gamgee might come in contact with them and b2 conjunctivitis if nothing worse then place the mask in position all would smell the eater before using it unless you've just filled a bottle yourself drop the ether onto the mask very slowly and cautiously at first to allow the patient to become accustomed to the smell ether vapor is irritating to the leggings and if it's given too rapidly at first it'll make her swallow cough or hold her breath if this happens tilt the mask away until she settled down and then lower it gradually again provided the breathing is regular the rate of flow should be progressively increased until you're pouring it on but don't soak the mask the chief guide during induction of anesthesia is the breathing with loss of consciousness it alters becoming irregular deeper and often noisy it will usually take 10 minutes to reach second stage of anesthesia don't look at the eyes or you may disturb the patient if she's not quite off but this is what they would look like the pupils very variable usually small and the eyes roving from side to side with a divergent squint to speed up the induction place the jackin it over the mask under this carbon dioxide will accumulate breathing will deepen and the anesthetic will be taken in more rapidly the jaw is not relaxed and you can't put in a nor layaway yet if the breathing is not free put the nasal tube down one nostril as you saw this is transfixed by a safety pin to prevent it disappearing down the nose speed up the flow of ether as fast as she will take it watch the breathing all the time after another five minutes also there's a fairly sudden change to regular so-called automatic breathing which shows that she's down to the third stage of surgical anesthesia you will find the eyes fixed and central with small pupils the jaw is now relaxed and the patient will tolerate an oral airway if you consider it necessary as the jaw relaxes the tongue falls back against the posterior pharyngeal wall and may obstruct the breathing the artificial airway holds it forward and proper support of the jaw will keep the breathing quite free this is how you should hold the head with the chin up and jaw held forward by pressure behind the angles you can keep a finger on the pulse in the facial artery where it crosses the lower jaw or in the superficial temporal artery in the angle between the upper border of the zygoma and the ear the patient is now ready for operation but will continue and show what happens as anesthesia is deepened remember that as anesthesia progresses and the tissues become saturated less and less ether is required to maintain a given depth listen always to the breathing any alteration in the automatic rhythm may be due to surgical stimuli in light anesthesia or as in this case to a change in depth of anesthesia the patient is now in deep surgical anesthesia and might be needed for an upper abdominal operation the pupils are larger as anesthesia deepens the intercostal muscles weaken and breathing is taken over more and more by the diaphragm when they are fully paralyzed the chest goes in instead of out as the diaphragm contracts giving a seesaw effect provided the airway is quite clear this is characteristic of deep anesthesia this case shows it particularly well usually in the theater the anesthetist misplaces hand underneath the towels on the chest to be able to detect it eater like any other anesthetic is a poison and the less you give the better the experience Denise the disc will vary the depth of anesthesia to suit the various stages of an operation for instance this any statists is lightening anesthesia during the performance of a gastroenterologist the eyes are now eccentric with small pupils indicating light anesthesia he deepens it again in time for the closure of the abdominal wall allowing a good five minutes bliss the eyes are now central and fixed indicating moderately deep anesthesia and muscular relaxation appears to be adequate however for the beginner and the occasional anesthetist it's best to aim at maintaining a steady level of moderately deep anesthesia with central fixed eyes and small pupils this will lead to less post-operative vomiting then to lighten anesthesia with its risks of laryngeal spasm and retching these demonstrations may seem a comedy of errors but such things do happen all too often here are some things you must not do to the conscious patient The Dropper hasn't been pushed in securely if it had fallen out during the induction the patient would have been considerably disturbed and he would have lost the confidence you took such pains to establish the anesthetist persists in dropping either too fast onto the mask not noticing that the patient has started to swallow he holds his breath and tries to take the mask away lift off the mask and reassure him never restrain a conscious patient lower the mask gradually and carry on with the eater very cautiously at first this patient is now in the second stage unconscious but not fully anesthetized here is where most of your troubles will arise struggling at this point is not always avoidable it's common in nervous patients and is often due to noisy surroundings attendants hold patient down while you concentrate on keeping the mask over her face one should lean across her knees while the other grips her arms above the elbows and presses them into her side keep dropping on the ether when she's quiet her limbs are straightened and her hands replaced by her side

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