The Dangers of Modern Anaesthetics

The improvement in the preparation of the patient before operation with a view to restoring his general condition to normal, the use of less toxic anaesthetic drugs requiring more complex techniques and apparatus, and the development of post-operative care have been described. The alteration in the position of the anaesthetist in the surgical team and in his work has been discussed. The reasons for the investigation and a description of the manner in which it has been carried out have been given. A brief history of anaesthesia during the past fifty years shows such an increase in the scope of the subject that it now justifies the title of specialty. Great interest has been taken in the relief of the pain of labour, culminating, on the one hand, in a simple analgesic apparatus for use by midwives, and, on the other, the highly specialised continuous caudal analgesia for hospital use only. The use of anaesthesia in diagnosis and therapeutics has increased. Anaesthetic apparatus has become more complicated, more efficient, and with the advent of the closed circuit technique, less wasteful. New anaesthetic drugs have been discovered, some for inhalation anaesthesia, others for local and spinal analgesia, and for the first time, an efficient means of producing anaesthesia by intravenous injection. The techniques employed have become more complicated. Endotracheal anaesthesia has become firmly established in everyday use. The advent of curare has resulted in a decrease in the use of regional and spinal analgesia, the employment of which had been increasing up to that time. Statistics associated with anaesthesia have shown that there has been no apparent improvement in the results of anaesthesia during this century. The third section of the thesis has been concerned with the specific dangers of modern anaesthetics. The tendency has been to make anaesthesia more pleasant for the patient, but the use of the new agents and techniques has brought new complications and increased liability to others. The use of cyclopropane, with its depression of respiration, carbon dioxide retention, and blood pressure maintenance, has been associated with difficulty in estimating the condition of the patient under its influence. It has been shovwn to upset, in some cases gravely, the automaticity of the heart. The pleasant and time-saving induction of anaesthesia by the intravenous infection of thiopentone has been counteracted by the difficulty of estimating the dose of this drug so fatally easy to administer, especially to the patient with hypertension and arteriosclerosis, due to its aggravation of any pre-existing anoxia and rendering hyperactive the laryngeal and tracheal reflexes. The perfect relaxation of spinal analgesia has been shown to be obtained at the cost of terrible results if any fault be present in the aseptic technique of the anaesthetist. Palsies affecting the cranial and lumbo-sacral spinal nerves have been shown to occur following spinal analgesia with no apparent reason for doing so. Alterations in the composition of the cerebro-spinal fluid, and pathological changes in the meninges and spinal cord indicated that the injection of the analgesic drug was not to be undertaken needlessly, and trauma to the spinal column that lumbar puncture was not free from risk. The paralysis of the peripheral circulatory system in the area of analgesia was shown to have a profound effect on the blood pressure which in turn was influenced by the paresis of the muscles of respiration. The combined effect was shown to increase the danger from haemorrhage, especially in the operation of Caesarian Section. (Abstract shortened by ProQuest.)