Practical Points in Anesthesia

Chapter 13: The Influence of Morphine on Narcosis.

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About This Book

Practical techniques for inducing and maintaining inhalation anesthesia with chloroform, ether, and anaesthol are presented, including mask configuration and gradual dropwise induction. Cautious administration and morphine premedication are recommended, with respiratory patterns and reflexes used to judge the surgical plane. Recognition and management of complications—cardiac and respiratory collapse, obstructed breathing from crowding, and reflex responses to surgical manipulation—are discussed. Airway measures such as breathing tubes, intubation, jaw and tongue maneuvers, oxygen, and artificial respiration are outlined. Advice on maintaining depth, when to stimulate, sequencing agents for different procedures, awakening, and postoperative distress completes the practical guidance.

The Influence of Morphine on
Narcosis.

Morphine

During the course of any operation, the surgeon is responsible for a long chain of ingoing impulses, which travel along the sensory paths from the site of operation to the spinal cord and brain. Morphine diminishes the awakening effect of these impulses by benumbing the perceptive centers in the brain. The correct plane of anesthesia for a patient who has had morphine, for example, one quarter of a grain of morphine sulphate hypodermatically half an hour before narcosis, must appear very superficial as compared with a case to which morphine has not been administered. Not only is considerably less of the anesthetic required, but the lid, for instance, may be quite tonic without indicating that more of the anesthetic is necessary. These observations apply cardinally to anesthesias with chloroform, or chloroform combinations, such as anaesthol.