. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. developed technic and agreater degree of watchful supervision than does the use of ether; herethe surgeon is both anesthetist and operator. For this reason its useby those in situations where anesthetists are not obtainable may bequestionable as occasional operators may not possess efi&cient technicor the judgment or experience necessary. 454 LOCAL ANESTHESIA
. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. developed technic and agreater degree of watchful supervision than does the use of ether; herethe surgeon is both anesthetist and operator. For this reason its useby those in situations where anesthetists are not obtainable may bequestionable as occasional operators may not possess efi&cient technicor the judgment or experience necessary. 454 LOCAL ANESTHESIA There are definite limitations placed upon our means of combatingdangerous sjnnptoms. An excessive dose, whether absolute or rela-tive, as in the case of idiosyncrasy, is more immediately and hope-lessly fatal than in the case after ether or chloroform, because itcannot be antagonized by mechanical eliminative means. In thetreatment of emergencies one runs the danger of fatal syncope if wesit the patient up; if we invert him, we increase the toxic action onthe higher centers and he may succumb. About one hour before the administration of spinal puncture it isadvisable to give a hypodermic of a small dose of morphin (y^ or 3^^. Thijr/^ for Fig. 127.—The point for lumljar puncture. (Keens Surgery.) gr.). Many observers prefer the combination of morphin and scopo-lamin, as recommended by the writer, before major operations underlocal anesthesia. By this method the bad after-effects are muchlessened and the analgesic effect intensified and prolonged. The doseshould never be large enough to produce somnolence, but just sutti-cient to allay the fears and anxiety of the patient by inducing drowsi-ness and indifference. Morphin, gr. ^-s or Y^, with scopolamin, gr.^50, is the dose recommended by the writer. Under this influencethe fear and psychic influences which may contribute to shock aregreatly lessened or entirely eliminated. This is particularly usolul in SPIXAL AKALGESIA 455 ne
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