ADRENALIN 641 



dermic use within a few minutes and lasting for three to six 

 hours. Neither ecchynioses nor sloughing occur after the 

 proper injection of the drug. Secondary hemorrhage does 

 not ordinarily appear after the use of adrenalin, hut it will 

 prevent the secondary relaxation, congestion and pain some- 

 times seen following the use of cocaine. 



Uses. — External. — Adrenalin chloride is commonly sold 

 in a 1 to 1000 aqueous solution in the shops. It has proven 

 of most value when comhined with cocaine for subcutaneous 

 use in operative work. One part of the 1-1000 solution may 

 he added to nine parts of normal salt solution (one heaping 

 teaspoonful of sodium chloride to the quart of sterile water) , 

 to which is added 1 per cent, of cocaine, or more if desired. 

 A stronger solution of adrenalin chloride than this (1 to 

 10,000) is not usually desirable in operative work, because 

 it is irritating, and in some instances when stronger solu- 

 tions were used so much ischemia was produced that the 

 blood vessels could not be found and ligated and secondary 

 hemorrhage ensued. It is usually sufficient to add nix.-xx. 

 adrenalin solution (1-1000) to §ss. of cocaine solution. 



The combination of cocaine with adrenalin is coming 

 into general favor and marks a .distinct progress in local 

 anassthesia. Four advantages are claimed for this com- 

 bination ; 1, that the operation is made comparatively blood- 

 less ; 2, that the cocaine is retained in the operative field a 

 longer time, owing to the contracted state of the vessels, and 

 does not escape into the general circulation ; this is a double 

 advantage — in prolonging ansesthe^ia and in preventing sys- 

 temic effect of cocaine; 3, that adrenalin is a circulatory 

 stimulant and will offset the toxic action of cocaine ; 4, that 

 adrenalin counteracts the vascu.lar relaxation seen sometimes 

 after the use of cocame.* 



Adrenalin has also proven of great service in arresting 

 hemorrhages from wounds, mucous membranes and cavities 

 of the body. A solution equivalent to a 1 to 5000 of ad- 

 renalin in sterile salt solution may be applied for this purpose 

 directly to the bleeding surface, or gauze saturated with it 

 may be packed into wounds and cavities, as the nose, uterus 



* Some able surgeons fear secondary hemorrhage from the use of 

 adrenalin. 



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