Transactions of the American Association of Obstetricians and Gynecologists for the year ... . snot give one the opportunity of carefully disseminating the solutioninto the tissues. The pneumatic injector, which we have used forten years, gives one the greatest opportunity for easy and painlessinfiltration of the tissues (Fig. i). Once the anesthesia is established, the incision should be madewith a sharp instrument, preferably between two towel clips which USE OF LOCAL ANESTHESIA. 57 elevate the skin and prevent pressure upon the abdominal viscera(see Fig. 2). During the making of the incisio
Transactions of the American Association of Obstetricians and Gynecologists for the year ... . snot give one the opportunity of carefully disseminating the solutioninto the tissues. The pneumatic injector, which we have used forten years, gives one the greatest opportunity for easy and painlessinfiltration of the tissues (Fig. i). Once the anesthesia is established, the incision should be madewith a sharp instrument, preferably between two towel clips which USE OF LOCAL ANESTHESIA. 57 elevate the skin and prevent pressure upon the abdominal viscera(see Fig. 2). During the making of the incision this skin elevation should becontinued without intermission and as soon as the peritoneum isopened, all the abdominal viscera will drop away from the site of theincision, provided the anesthesia is perfect (Fig. 3). A Trendelen-burg position, with lateral tilting, will expose any organ in the lowerabdomen. In the upper abdomen the entire stomach, gall-bladder,duodenum, liver, and colon may be examined visually as well asdigitally- The patient can of his own volition show the gall-bladder. Fig. 3.—Showing vertical retraction of abdominal wall—see especially cross-section in lower right hand corner. or stomach to the onlookers by an expulsive effort; and, by openingthe mouth and relaxing, can allow these organs again to drop backinto the abdomen. It is desirable to substitute suction for packs are used only when there is danger of soiling; thepacks are simply laid upon the viscera, and not forced with greatpressure against the serous-coated organs, as is so commonly prac-tised when the patient is under general anesthesia. TECHNIC. In all of my abdominal work, except in the operation for inguinalhernia, a direct infiltration of the tissues is effected and the completeinfiltration of the abdominal wall is made before the incision is be-gun (Fig. 4). This method is chosen because of its efficiency,simplicity, accuracy, and speed. This direct method is not us
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Keywords: ., bo, bookcentury1900, booksubjectgynecology, booksubjectobstetrics
