. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. by a report of the following caseby the author. Laryngectomy.—The advantage of the routine use of local anes-thesia in all minor operations upon the upper respiratory passageswhich do not require great haste, such as tracheotomy, laryngotomy,etc., is readily conceded by most surgeons; many of whom, however,would hesitate to employ it for such major operati
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. by a report of the following caseby the author. Laryngectomy.—The advantage of the routine use of local anes-thesia in all minor operations upon the upper respiratory passageswhich do not require great haste, such as tracheotomy, laryngotomy,etc., is readily conceded by most surgeons; many of whom, however,would hesitate to employ it for such major operations as laryngec-tomy. This formidable procedure, attended by high mortality (about NECK 269 25 per cent, in cases collected from all sources), due largely to pneu-monia, no doubt partly contributed to by the irritating effects ofthe anesthetic, can be performed under purely local and regionalmethods of anesthesia with no greater difficulties to the experiencedthan those attendant upon herniotomy under local anesthesia, andshould certainly present a mortality far below the discouraging statis-tics presented under general anesthesia. The following case illustrates the technic employed in a bad caseinvolving the larynx and esophagus:. Fig. 61.—Area of anesthesia for laryngectomy. Over double-lined area on sides infiltrationis more liberal and is carried well down to sternomastoid muscle. May 30, 1912: Preliminary tracheotomy under local anesthesia to relieve the dysp-nea. June 3, 1Q12: Gastrostomy by the Ssabanajew-Frank method under local anesthesiato secure safe and easy access to the stomach and enable us to have full control over nutri-tion following operation. The Operation, June 10. 1912, 10 A. M.: Preliminary preparatory hypodermic ofmorphin, -J- grain; scopolamin, Tiff grain, to prevent any pscyhic disturbance or uneasi-ness on the part of the patient. The anesthetic solution used is the one in use in our clinic for general surgical pur-poses: novocain, per cent.,
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