accidi<:nt8 and dangers attending anesthesia 285 



conteuis may then be drawn forward during inspiration 

 into the thoracic cavity, so that the abdomen is retracted 

 (Hare). When the latter condition is seen, etherization 

 should be stopped instantly. 



Heart failure occurs more frequently with chloroform, 

 but does occasionally result from the action of ether upon 

 animals with a fatty or otherwise weak heart. Cardiac 

 depression is shown by a weak, irregular and rapid pulse, 

 and pallor of the mucous membranes. The respiratory 

 movements are sustained after the heart ceases to beat in 

 fatal cases. Operations should never be done under 

 chloroform before the patient is fully under the influence 

 of the anaesthetic, as irritation of a sensory nerve caused 

 by even a slight surgical procedure may cause death by 

 reflexly stimulating the vagus and inhibiting the heart. 

 Such an accident is not likely to occur with ether, and 

 minor operations are often done with safety during the 

 first stage of anaesthesia (primary anaesthesia) when con- 

 sciousness and sensation are lost and the muscles begin 

 to relax. 



Shock from hemorrhage, or prolonged and severe sur- 

 gical operations, may lead to fatalities during anaesthesia, 

 and it sometimes occurs when an operation is begun before 

 the patient is fully under the influence of an anaesthetic — 

 particularly chloroform — as described above. In practice, 

 these causes of danger, i.e., respiratory failure, circulatory 

 depression and shock, are usually combined. 



We have already seen that asphyxia leads to circulatory 

 disorder, and both may be associated with surgical shock. 

 The following embraces the proper treatment of all these 

 conditions, and should be followed in every case where 

 danger threatens during anaesthesia : 



h Remove the anaesthetic and allow plenty of fresh air. 



2. See that there is no mechanical obstruction to the 

 movements of the chest, or to the free entrance of air. 

 Pull forward the tongue and lower jaw and extend the 

 head. 



