ACCIDENTS AND DA^TGERS ATTENDING ANESTHESIA 303 



scion.sness 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 abbve. 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 : 



1. Kemove 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. 



3. Invert small animals, particularly with chloroform, 

 to allow blood to flow to the brain. 



4. Use forced, artificial respiration with bellows and 

 rubber tube introduced into larynx. Practice ordinary 

 artificial respiration in small animals by carrying the fore- 

 legs outward and forward till they meet in front of the 

 head, and then bring them back till they touch, and com- 

 press the sides of the chest. These movements should be re- 

 peated twenty times a minute. Massage over the heart, 

 together with artificial respiration, is useful in sudden car- 

 diac arrest in small animals. Artificial respiration may be 

 done in the horse by two persons compressing intermittently 

 one side of the chest with the knees and hands. Ehythm- 

 ical traction of the tongue, at intervals of five seconds, has 

 proved successful in restoring respiration. Dash hot or 

 cold water or ether upon the chest or epigastrium ; or use 

 the faradic battery to stimulate respiration by moving the 

 electrodes over the chest and abdomen. Stretch the 

 sphincter ani apart by placing the thumbs in rectum and 

 separating them with force. This is a powerful reflex 

 stimulus to heart and respiration. 



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