. Regional anesthesia : its technic and clinical application . ntra-tracheal instillations; but the usual regional anesthesia straight needleserves as well. For the anesthesia of the lar3Tigeal portion of the mucosa,the patient is placed in Roses position, the needle is directed upward,and the solution injected drop by drop until the 2 syringe is dis-charged (Fig. 225). The solution spreads all over the mucosa and OPERATIONS ON THE NECK 305 produces the desired result. The patient should not be allowed tomove, speak, or cough during the injection. If it is necessary to anes-thetize the tr
. Regional anesthesia : its technic and clinical application . ntra-tracheal instillations; but the usual regional anesthesia straight needleserves as well. For the anesthesia of the lar3Tigeal portion of the mucosa,the patient is placed in Roses position, the needle is directed upward,and the solution injected drop by drop until the 2 syringe is dis-charged (Fig. 225). The solution spreads all over the mucosa and OPERATIONS ON THE NECK 305 produces the desired result. The patient should not be allowed tomove, speak, or cough during the injection. If it is necessary to anes-thetize the tracheal portion of the mucosa, the needle is directed down-ward and the instillations made in a similar manner (Fig. 226). Inpuncturing the cricothyroid membrane care should be exercised not(a) to create a false passage sideways, (b) to avoid puncturing the pos-terior wall of the larynx, and (c) to prevent the needle from being dis-placed or thrown out during a sudden deglutition (Georges Canuyt).The puncture of the cricothyroid membrane may be made after ex-. Fig. 226.—Anesthesia of the tracheal mucosa through the cricothyroid membrane.(After Georges Canuyt.) posing the membrane; but it is better, as already stated, to completethe anesthesia before the operation is begun. It is not the authors intention to discuss the indications for trache-otomy as an operation. In emergency cases the sole object is to savethe patients life. Anesthesia is of no use, since sensibility is alreadygreatly diminished by the state of shock in which the patient is. Butit is perfectly clear that inhalation narcosis, especially ether, is absolutelycontraindicated in all cases of stenosis of the air-passages, whateverbe its cause. Thyrotomy.—With the patient lying in the same position as for 3o6 REGIONAL ANESTHESIA tracheotomy, head a little more in extension, a rhombus is infiltratedfrom two points of entrance one on each side of the larynx, as illustratedin Fig. 227. The deep structures are first
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