Post-Operative Distress.
Post-operative gas pain is often the source of great distress to patients who have undergone the ordeal of laparotomy. It is due to a temporary paresis of the gut and consequent distension with gas. When the trouble is in the lower bowel considerable relief may follow the insertion of the rectal tube. Irrigation of the colon, when permissible, may stimulate peristalsis in the higher segments of the bowel. A routine intended to militate against intestinal paresis in celiotomies, and worth a fair trial, is to administer with the morphine sulphate a small dose of eserine sulphate hypodermatically. For the ordinary adult the dose should be about one-fourth of a grain of morphine sulphate and one fiftieth of a grain of eserine sulphate given subcutaneously one-half hour before narcosis.
When it is important to avoid post-operative vomiting, gastric lavage with plain water, made faintly alkaline with lime water or milk of magnesia, may be done as soon as the narcosis is ended and while the patient is still on the operating table. During the procedure the head end of the table is lowered a few degrees.
I have gathered the impression that crowding is one of the prime causes of excessive vomiting after anesthesia. It has been my experience that cases in which I could truly say that I had not crowded the anesthetic and where it was not swallowed to any extent during the induction, have suffered little or not at all from this disagreeable after-effect of the narcosis.
The attentive nurse will find that there are numerous little things, seemingly insignificant, that help greatly toward the patient’s comfort. She may support the wound during a coughing spell or if the patient vomits. If her charge is tormented with nausea a piece of cotton saturated with a mixture of alcohol and acetic acid can be dropped into a tumbler and the |Thirst| patient allowed to inhale the vapor. If the lips and throat are dry and parched, moisture is grateful and small pieces of gauze wet with iced water may be laid over the lips and nostrils.
If the patient is suffering after operation, one should be generous with morphine. It should always be given hypodermatically. To the adult less than one quarter grain as a dose is of little avail. In such post-operative use there need be no fear of inculcating the morphine habit.