. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. ning the back a little towardthe operator when the patient lies on the side, as in Fig. 121. From a photograph by Dr. (Barker, in Brit. Med. Jour.) injected fluid toward the dorsal curve before it becomes diluted bydiffusion. It must not be forgotten, however, that in raising the27 4i8 LOCAL ANESTHESIA pelvis, while the head and neck are support
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. ning the back a little towardthe operator when the patient lies on the side, as in Fig. 121. From a photograph by Dr. (Barker, in Brit. Med. Jour.) injected fluid toward the dorsal curve before it becomes diluted bydiffusion. It must not be forgotten, however, that in raising the27 4i8 LOCAL ANESTHESIA pelvis, while the head and neck are supported forward on a pillow,the lumbar curve is diminished, while that of the dorsum is pelvis would have to be raised very high indeed to bring thelevel of the dorsal curve at the fifth or sixth spine above that of theforamen magnum, with the head and neck bent forward, as is, therefore, but little likelihood of the heavy compound reach-ing the medulla, or even into the cervical region at all. In some casesin Germany inversion has been carried to a very extreme degree, thehead being unsupported, with the idea of displacing the whole mass ofthe cerebrospinal fluid toward the cranial cavity. But we must remem-. Fig. 121 .—Photograph of patient In typical position on side, with head and neck raisedand a i-inch padded board under the trochanter and iliac crest. The line of the iliaccrests is given crossing the fourth lumbar spine. The level of the first cervical spine isseen to be well above that at which the injection compound pools, and will be relativelyhigher when patient rolls on the back, as in Fig. 122. From a photograph by Dr. E. Wor-rall. (Barker, in Brit. Med. Jour.) ber that in these cases the compounds have usually been of low spe-cific gravity, and in the case of Biers (see above) actually lighterthan the spinal fluid, so that it would not be likely to move as far asthe neck by any oscillation of the column of the spinal fluid. Therehave bee
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