The effects produced by ether may be divided into three stages:— 1. A stage in which the patient shows symptoms of mental confusion; the pulse is increased in strength and rapidity, and the respiration is acceler ated. There is usually some lividity, a few unconscious muscular movements. and rambling words. Spoken to loudly, however, he may understand what is said and respond. The patient may be hilari ous soon after the administration of the anaesthetic is begun, but the exhilaration usually marks the advent of the second stage. At this time occurs a period of "primary anaesthesia," during which cer tain small rapid operations, such as open ing an abscess, can be performed.
2. The second stage is one of excite ment. The patient acts, especially if the ether be given too vapidly, as if he were intoxicated, and endeavors to free him self from the attendants, who are obliged to hold him. He tries to remove the towel, cone, or inhaler, and to rise. Hal lucinations are frequent during this stage, and, when ether is administered to a woman, a third party should invari ably be present. These symptoms are less likely to occur if the anaesthetic is administered in the manner indicated above.
Struggling is usually due to the impa tience of the anaesthetist, who attempts to push the ether too rapidly, and in so doing partly asphyxiates the patient. Vallas (Revue de Chir., Apr., '93).
Auto-etherization used for twenty five years. It increases safety and adds to the comfort of the patient. The pa tient assumes a sitting posture and etherizes himself in this position, which prevents embarrassment to breathing. The cone employed is made of leather and packed with cotton-wool. From I '/, to 2 ounces of ether is poured into the cone, which is handed to the patient with instructions to apply it closely to the nose and mouth and to take long, full breaths; if the vapor be too strong or a sensation of choking be experi enced the patient is allowed to with draw the cone. When the patient's hands drop, a brief operation may be performed or the anresthetizer may take the cone and continue the etherization. F. Buller (Montreal Med. Jour., Nov., 11102).
Vertigo, tinnitus, and deafness, gradu ally followed by a feeling of heaviness, are experienced by the patient, who then passes into the third stage, that in which all consciousness has ceased to exist.
During this stage there is no ment, the breathing is regular and there may be snoring. When this is the case, however, the head should be turned to one side so as to cause the uvula to drop sidewise and increase the size of the pas sage. The skin is moist and the face is
red and suffused. The muscles are re laxed, the arm dropping when raised.
In operations upon the nose, throat, and ear personal method consists in bringing the patient partially under the amesthetie, as usual, and then placing him in the specially devised chair used, and gradually bringing the latter from a position of being tilted far back to an upright position, the patient being fastened to the chair. By the time the upright position is reached the patient is sufficiently under the anaesthetic for the operation to begin. No bad results have been experienced, and the writer claims for the upright position the three fold advantage of reduction in amount of blood lost; better naso-pharyngeal drain age, thereby lessening the liability to ear complications; and finally the ease, thoroughness, and accuracy with which operations can be done. T. R. French (N. Y. Med. Jour., Oct. 13, 1900).
Dose.—The quantity utilized cannot be established upon a fixed rule; but 7, to 1 ounce is usually employed dur ing the first two stages. Small quanti ties poured from time to time upon the inhaler are necessary to keep the patient "under." The intervals are necessarily shortened when operations about the rectum, vagina, or urethra are being performed, which seem to cause return to consciousness sooner than when other regions are being submitted to active procedures.
The pulse-rate is increased by haemor rhage; quickening of pulse and respira tion means an overdose. The breathing rate is increased reflexly by certain manipulations of the anus, rectum, and peritoneum. Campbell (Annals of Surg., Dec., '94).
The following method is of very great service in estimating the degree of an in infants and children: The index finger should be placed in the in fant's hand; during the earlier part of the administration the finger is grasped very tightly, the palmar reflex being active; but, as insensibility approaches, the infant's fingers gradually relax, and as soon as they become loose the opera tion may be commenced. In the infant the anfcsthetizer should devote his con stant attention to the amount of palmar and digital reflex action present. Care should be taken against cold air being breathed for several hours after the operation. F. Woodhouse Barine (Prac titioner, Oct., '90).