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Practical Points in Anesthesia

Chapter 8: Some Important Reflexes.
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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.

Some Important Reflexes.

Pharyngeal Reflex

(1) Pharyngeal reflex. Coughing does not necessarily indicate awakening. It usually means that the vapor of the anesthetic is too concentrated and irritates the air passages. “Holding the breath” occurs even in fairly deep narcosis and has the same significance. The treatment is to dilute the anesthetic by admitting air.

Ano-respiratory Reflex

(2) Ano-respiratory reflex. The crowing inspiration heard during operation on the perineum or rectum, does not indicate that the patient should have more anesthetic.

Splanchnic Reflex

(3) The reflex produced by traction on the gall bladder or mesentery is similar in its significance to that of the ano-respiratory reflex.