The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . afety of the administration of chloroform inthese operations often occurs. I believe that it may always be givensafely except in cases of extreme sjmcopal asph^xia, where, as sensibilityno longer exists, it is unnecessary. Laryngeal inflammation and ob-struction are always associated with so much spasm, more particularlyin children, tliat it will often be found that the patient respires moreeasily and fully whilst under the influence of chloroform than before itsinhalation was commenced ; and, as
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . afety of the administration of chloroform inthese operations often occurs. I believe that it may always be givensafely except in cases of extreme sjmcopal asph^xia, where, as sensibilityno longer exists, it is unnecessary. Laryngeal inflammation and ob-struction are always associated with so much spasm, more particularlyin children, tliat it will often be found that the patient respires moreeasily and fully whilst under the influence of chloroform than before itsinhalation was commenced ; and, as the anaesthesia materially facilitatesthe operation by doing away with his writhings and strugglings, I nowinvariably have recourse to it when I perform tracheotomy on laryngotomy in the adult it does not appear to me to be necessary. Difficulties—Tliis operation is often attended l)y extreme diflficulty,and not unfrequently by much danger. The difficulties occurring in tracheotomy are chiefly referable to fourheads: 1. Difficulty in Exposing the Trachea; 2. Profuse Haemorrhage;. 647.—Operation of Tracheotomy. 54-4 OPERATIONS OX TIJE AIR-TUBE AND CHEST. 3. Diflicult^ in Opening the Trachea; and 4. Trouble in Introducing theJrachea-tube. 1. The difficulty in Exposing the Trachea increases greatly as theincisions approach the sternum, and is especially great in children andin stout short-necked persons. Tlieie are three situations in which the trachea may be opened; eitherabove, underneath, or below the isthmus of the thyroid body, whichusually crosses the air-tube opposite its fourth ring. Above theisthmus, the trachea is comparatively superficial, and is not covered byany venous plexus, nor does any other source of difficidt3- j)resent itseifto the Surgeon. Where the isthmus crosses the trachea, this tube isoverlaid by a venous plexus as well as by the glandular the thyroid glancl, the air-tube is overlapped by the sterno-hyoidand stern
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