Page 342 - My FlipBook

340 DENTAL MEDICINE. ;

The third stage is one of profound narcosis, with stertorous
breathing, intense muscular relaxation, abolition of the ordinary
reflexes, and fall of bodily temperature. This is a dangerous
stage, and its induction is not justifiable, except under very pecul-
iar circumstances.
The following are some of the practical conclusions of the
second Hyderabad Commission : " The recumbent position on
the back and absolute freedom of respiration are essential. If
during an operation this position cannot be from any cause main-
tained during the administration of chloroform, the utmost atten-
tion to the respiration is necessary to prevent asphyxia or an
over-dose. If there is any doubt about the state of respiration,
the patient should be at once restored to the recumbent position
on the back. To insure absolute freedom of respiration, tight
clothing of every kind, either on the neck, chest, or abdomen, is
to be strictly avoided; and no assistants or bystanders should be
allowed to exert pressure on any part of the patient's thorax or
abdomen, even though the patient be struggling violently. If
struggling does occur, it is always possible to hold the patient
down by the shoulders, pelvis, or legs, without doing anything
that can possibly interfere with the free movements of respira-
tion. An apparatus is not essential, and should not be used, as,
being made to fit the face, it must tend to produce a certain
amount of asphyxia, and take up part of the attention required
elsewhere. However it is made, it introduces an element of
danger into the administration. A convenient form of inhaler is
an open cone or cap with a little absorbent cotton inside at the
apex. At the commencement of inhalation care should be taken
by not holding the cap very close over the mouth and nose, to
avoid exciting, struggling or holding the breath. If struggling or
holding the breath does occur, great care is necessary to avoid an
over-dose during the deep inspirations which follow. When
quiet breathing ensues, as the patient begins to go over, there is
no reason why the inhaler should not be applied close to the face
and all that is then necessary is to watch the cornea and see that
the respiration is not interfered with.
In children, the free admission of chloroform into the lungs