Morphine-Anaesthol Sequence.
For general use in every day practice the morphine-anaesthol sequence already described is most satisfactory.
As indicated, the adult receives a quarter grain of morphine sulphate hypodermatically one-half hour before anesthesia.
Anaesthol, a fairly stable combination of chloroform, ether and ethyl chloride in molecular proportions, is given by the drop method, but in slightly greater quantity than pure chloroform. For the average “interval” case of appendicitis, for example, about 15 to 20 cc. should be used for the induction, and 40-60 cc. for the entire narcosis.
The morphine, in susceptible individuals, sometimes causes very shallow respirations so that the conduct of the anesthesia to the stage of unconsciousness becomes prolonged because the patient does not inhale sufficient of the anesthetic at each breath. Crowding would be incorrect. The solution is patience, and a little ether to excite deeper respirations. The patient has but a slight stage of excitement, often none at all. The narcosis is continued until the first unimpeded, snoring respiration is heard, and then the surgeon may begin. Much of the narcotic is not required and the anesthesia can be so conducted that the patient promptly becomes conscious after the placing of the last suture.
Post-anesthetic distress is, on the whole, less marked than with pure ether. Not infrequently there is neither nausea nor vomiting.