Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice . andage (Bier). 2l8 LOCAL ANESTHESLA. is upon the upper extremity, 50 of percent, novocain in normalsalt solution is used; if upon the lower extremity, 80 of the samesolution is used. Any large syringe can be used for making the in-jection, although to faciUtate the work a special syringe has beendevised (Fig. 28). A stout piece of tubing can be us
Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice . andage (Bier). 2l8 LOCAL ANESTHESLA. is upon the upper extremity, 50 of percent, novocain in normalsalt solution is used; if upon the lower extremity, 80 of the samesolution is used. Any large syringe can be used for making the in-jection, although to faciUtate the work a special syringe has beendevised (Fig. 28). A stout piece of tubing can be used for making theconnection between the nozzle of the syringe and the cannula withinthe vein; it must be firmly attached to both and the syringe be ingood working order, as it requires some Httle pressure to drive thesolution into the veins. The Matas infiltration apparatus is admirablysuited for this injection. The injection should not be made too rapidly,but done slowly, allowing time for the solution to flow into the veins,which are seen slowly distending as they are filled with the solution diffuses through the vein walls into the surroundingtissues, the distended veins becoming less and less distinct until they. Fig. 28.—Large syringe for Bier intravenous anesthesia. (From Braun.) are no longer discernible. The valves in the veins ofifer no obstruc-tion to the injection, as they are forced by the fluid and the distentionof the veins. Anesthesia is said to be produced almost immediately in the areabetween the bandages (direct anesthesia). In the parts distal to thelower bandage anesthesia is complete in from fifteen to twenty min-utes (indirect anesthesia). Anesthesia does not reach quite to theupper bandage, and frequently leaves a strip on the side opposite tothe vein which reaches down to the second bandage only partially, ornot at all, anesthetic. The circumferential spread of the anesthetic solution can befavored and increased by massage and kneading of
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