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THE SURGICAL OPERATION: ANAESTHETICS
The operation will be painless because of anaesthetics that induce sleep or otherwise cause loss of feeling. Some affect the whole body (general) and some only part of it (local).
General anaesthetics. These anaesthetics put the patient to sleep. These anaesthetics are superior to some of the older gases because unpleasant after-effects—mainly vomiting—are practically eliminated. However, ether is still widely used because it is safe and reliable and its administration does not require complicated anaesthetic machines.
Intravenous anaesthetics are general anaesthetics that are administered through a needle inserted into a vein. For very short operations, a barbiturate can be used as an intravenous anaesthetic; it has the effect of a super-powerful sleeping pill. An intravenous anaesthetic may also be given to induce sleep quickly before ether or some other general anaesthetic is administered for the remainder of the operation.
Today, most major operations are performed by having the anaesthetic administered through a tube in the windpipe. The patient is first put rapidly to sleep with a medicine given intravenously. Then the tube is put into place by the anaesthetist and the anaesthetic is inhaled through the tube. This method allows extremely accurate control of breathing and of the amount of anaesthesia administered. After the operation, as the patient begins to awaken, the tube is removed.
Another class of general anaesthetics is given rectally. One of these is paraldehyde, which is sometimes prescribed for seriously disturbed alcoholics and psychotics. It is given like an enema, and the patient quickly goes to sleep when the drug is absorbed through the colon. Local anaesthetics. Operations on the skin or on the tissues just under the skin and operations on the teeth are frequently performed with local anaesthetics. In this method, the anaesthetic solution is injected into the operative area. Novocain and other preparations of procaine hydrochloride are well-known local anaesthetics.
In some cases where a main nerve supplies the area to be operated upon, the doctor injects the anaesthetic directly into the nerve. This is called a nerve block.
Spinal anaesthesia is sometimes used in patients with respiratory disease where a general anaesthetic might be irritating to the lungs. In this type of anaesthesia, the doctor first injects the skin and the tissues underneath it with Novocain, so that the patient will not feel any pain when the doctor inserts a needle with anaesthetic solution into a space between the vertebrae of the spinal cord. This deadens the nerves of the body below the place where it was injected. Spinal anaesthesia can be used for operations in the lower part of the body, usually below the navel; these include appendicitis, hernia, and haemorrhoids.
Caudal anaesthesia or continuous caudal analgesia is used during childbirth. A needle is inserted into the sacral canal, and a pain-killer such as procaine hydrochloride is injected. As the nerves of the uterus are numbed, the mother does not feel pain although she remains completely conscious, and the child is not affected. However, the needle is left in place throughout the delivery, which means that a skilled anaesthetist must supervise the procedure.
Another anaesthetic technique is hypothermia, or the chilling of the part of the body that is to be operated on. This is especially valuable in operations on the brain.
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