. Anaesthetics : their uses and administration. ule, when the intra-cranial pressure is relieved the respira-tion greatly improves, but until the cranium has been openedand the dura mater incised, breathing may be very unsatis-factory, and even may cause alarm if, owing to the steps ofthe operation, increased pressure occurs. When the breathingis at all hampered the chloroform should be withheld alto-gether for a time, until it improves, when more chloroformpan be given, care being taken that the strength of the 344 IN SPECIAL SURGERY 345 vapour is as slight as is consistent with
. Anaesthetics : their uses and administration. ule, when the intra-cranial pressure is relieved the respira-tion greatly improves, but until the cranium has been openedand the dura mater incised, breathing may be very unsatis-factory, and even may cause alarm if, owing to the steps ofthe operation, increased pressure occurs. When the breathingis at all hampered the chloroform should be withheld alto-gether for a time, until it improves, when more chloroformpan be given, care being taken that the strength of the 344 IN SPECIAL SURGERY 345 vapour is as slight as is consistent with maintenance of anaes-thesia. As a rule, when induction is complete, oS per cent, toI per cent, is sufficient. In operations upon the cerebellum,the dangers of respiratory failure and shock are even moreimminent, especially if there is pressure on the medulla. Itmay happen that, as soon as the trephine is applied, thebreathing ceases. If the patient has been deeply anaesthetised,death is very likely to occur ; but if only i per cent, of vapour. Fig. 75.—Carter Braines arm-rest. is being inhaled, the chances are in favour of the life beino-saved, since, as soon as the pressure is relieved, the breathingstarts afresh, and the blood pressure rapidly reo-ains itsnormal height. I have known cases of cerebral and cere-bellar abscess in which this respiratory failure occurred • ashowever, only small quantities of chloroform had been inhaledthe patients recovered, and the operations were satisfactorilycompleted. Ether produces too much vascular excitementin the meninges and brain substance, and so is contra-indicated for these cases. In treating the collapse—often very severe 1 have found inhalation of warmed oxygen, raising the tempera- 346 AN/ESTHETICS. ture of the body by hot water bottles, and towels wrung outof hot water, and hypodermic injections of digitaline, to be themost valuable means to adopt. The circulatory depression isoften extremely severe. Some anaesthetists emp
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