Anesthetics

In the American Journal of Surgery last week Dr. Frank Howard Lahey of Boston, who founded the Lahey Clinic, New England's No. 1 surgical establishment, and supervises 5,000 surgical operations a year, solemnly declared: "The field of anesthesia within the last few years, exclusive of thoracic surgery, has perhaps shown greater progress and development than that of surgery itself."

In theory, law and practice the surgeon has complete responsibility for everything which happens to a patient on the operating table. The new developments in anesthetic drugs and methods of administering them are too numerous for the average surgeon to know. To bring surgeons up to date on the procedure without which their art would for the most part be useless butchery, the Journal of Surgery turned over its entire December issue to anesthetists. Editor for the occasion was Dr. Henry Swartley Ruth, 37, plump & ruddy chief anesthetist of four Philadelphia hospitals. Result of anesthetist Ruth's editing was a 21 7-page survey of anesthetics, their purposes, ad ministration, risks. The 11,339 surgeons, gynecologists, obstetricians, orthopedists, proctologists and anesthetists of the U. S. and Canada could add this unique compendium to their shelves with the satisfaction of knowing that it contained about all there is to know about anesthesia as of 1936. Some facts for laymen:

Kinds. There are only five anesthesia agents which completely relax a patient: ether, chloroform, ethyl chloride, vinyl oxide, cyclopropane. Ether, first utilized (1846), is most dependable. Chloroform is most toxic. Cyclopropane, a new gas, is most respected because a trifle of it quickly anesthetizes the patient and causes no bad aftereffects. But the anesthetist must be very careful in its use.

Of the less effective anesthetics, ethylene is a gas which is not toxic in small doses. Nitrous oxide (laughing gas) is respected because it will not explode. But the difference between nitrous oxide anesthesia and asphyxia is slight, hence the occasional death of a patient in a dentist's chair where laughing gas used to be popular. Where the surgeon wants a short, deep anesthesia or a long light one, his anesthetist gives the patient tribromethanol by rectum or barbiturates by mouth, rectum or hypodermic. These drugs are also used to quiet a patient's nerves or put him to sleep before he undergoes deep anesthesia. Local and spinal anesthetics include cocaine (very toxic, as well as habit-forming), novocain, metycaine.

Methods. Gaseous anesthetics are generally administered through a mask fitting over the face. Dr. Paluel Joseph Flagg of Yonkers has such a horror of death by asphyxia that he organized a Society for the Prevention of Asphyxial Death, invented intratracheal anesthesia. Dr. Flagg bends the patient's head far back and through the gaping mouth slides a tube into the windpipe. Through this tube the anesthetic quietly flows in & out of the lungs, forestalls troublesome gagging and spasms. Goitre specialists like the intratracheal method because the hard tube prevents the collapsing of the throat.

The method which has developed most rapidly in recent years is spinal anesthesia. Best practice is to inject the drug (e. g., nupercaine, pontocaine) into the fatty tissue which lies in the spinal canal between the vertebrae and the cord. The technique is difficult and not always safe. But the patient is rendered relaxed and numb from chin to soles, remains conscious throughout the operation if he wishes, suffers no anesthetic aftereffects. Spinal anesthesia is urged for operations on the stomach, intestines, lungs, liver, kidneys or heart.

For operations on the anus, rectum or urinary bladder, tribromethanol or barbiturates, which cause no nausea or vomiting, suffice. For thyroids, mastoids and cervical lymph nodes, general gas anesthesia is best. Superficial operations on the face, mouth, nose and nasal sinuses may be done under regional anesthesia. After the scalp has been desensitized by a local anesthetic, the head may be opened and the brain worked on with no further use of anesthetic, the patient remaining conscious all the while (LIFE, Nov. 30).

Risks. A patient runs practically no risk of dying under the surgeon's knife if he is under 55, is not debilitated or fearful, if he is not very fat or has not lost much weight shortly before the operation, and if he can hold his breath for 25 seconds.

He does run some risk, which the well-informed, alert anesthetist can discount, if his lungs are defective; if he suffers from coronary occlusion, angina pectoris, congestive heart failure, syphilitic inflammation of the aorta; if his liver fails to store sugar or is affected by obstructive jaundice; if he is in a diabetic coma; if his kidneys are defective and his urine is no heavier than pure water; if he has a goitre, has lost more than one-fifth of his weight, has a pulse rate over 100; if a second major operation is performed soon after the first; if he is a drunkard.

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