Anesthesia, General and Local.
Dr. C. E. Montgomery quotes the following conclusions based on a report of 2,300 cases operated on with general anesthesia by Armstrong, of Montreal General Hospital.
- Cooling of the body surface contributes largely to the lung complications.
- The existence of septic foci, particularly in the abdomen, is a common cause, for when the abdominal muscles are painful they do not aid in expelling mucus that collects in the bronchial tubes, and the transmission of septic emboli from the abdomen to the lung is easy.
- Aspiration of vomitus and accumulation of blood and mucus in the air passages in unconscious cases is a very common cause.
- The larger percentage of cases occurred in the right lung, because the right bronchial tube is larger and allows more ready aspiration.
- Patients should have stomach lavage when food is present, and the mouth and pharynx should be cleansed well before and after anesthesia, and especially when the patient is unconscious.
- Septic peritonitis cases develop lung complications more frequently than any others.
- Common predisposing causes are weakened heart with hypostatic congestion, age, alcoholism, cachexia and sepsis. In the preparation of the patient these points should be kept in mind, since neglect of any of them may cause disagreeable symptoms following the anesthetic.
The relations of the attendants to the anesthetized patient should be just as asthetic as when the patient is awake, and careless lifting and moving of the limbs, uncomfortable strained position and the barbarous use of the mouth gag and tongue forceps for some fleeting disturbance of respiration should never be allowed. If the cause is sought the disturbance can be avoided without injuring the patient's mouth and tongue.
Oftentimes by simply turning the patient's head to one side, or pushing the lower jaw well forward, the disturbance for which the tongue forceps are so often used will be avoided. Thirst after anesthesia can be almost entirely prevented by colonic injections of warm saline, one-half to one pint, every hour or two, beginning as soon as the patient is removed from the operating table. This does not cause nausea, nor is it often contraindicated by the nature of the operation, and is of inestimable value in protecting the kidneys from the concentrated irritant.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.