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Practical Points in Anesthesia

Chapter 15: Awakening.
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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.

Awakening.

If the narcosis has been conducted correctly the patient should become conscious promptly after operation. The premonitors of awakening are readily recognized, the corneal reflex becomes more active, the tonicity of the eyelid approaches the normal, a tear may appear in the eye, beads of perspiration are seen on the forehead, the patient may begin to mutter incoherently, the pulse becomes faster, the breathing loses its snoring character, and the patient begins to move his head.

Termination of Narcosis

If the operation is a laparotomy and the patient is under the influence of morphine-anaesthol, the narcosis is terminated by giving a drop occasionally when the surgeon puts his first sutures into the abdominal wall; after the fascial repair, the anesthetic is stopped entirely. The narcosis may be so timed that the patient becomes conscious and responds to questions promptly after the last stitch has been placed.

If the morphine-anaesthol narcosis has been continued with ether by the drop method, as is frequently indicated, and if considerable ether has been used, the patient will be a little tardier in arousing, and the administration of the narcotic should be stopped at an earlier period. To be less abstract, in the case of a laparotomy the anesthetist desists at once from giving ether when the surgeon has applied the peritoneal suture for the closure of the abdominal wound.