ANIESTHESIA IN CHILDREN General anaesthesia is necessary in order to perform major and delicate minor operations. It is often necessary in the case of children to den-den not only pain hut also consciousness in order to secure the quiet repose necessary for the operation, whereas the same operation in adults could be performed under local anaesthesia.
Chloroform and ether are both poisons and the dangers of placing the child under their influence should be appreciated. Ether, how ever, is more benign, and as larger quantities of it can be used, it is possible to control the narcosis more closely. A few grammes of chloro form are sufficient to anaesthetize a child, while more than twice the quantity of ether is required for the same purpose. This alone is a reason why ether is better suited for children who, as a rule, yield easily to its effect.
Chloroform is a pronounced cardiac poison, and all hough the heart is strong, it is peculiarly susceptible to poison. The number of deaths is considerably larger under chloroform than under et InT (5 : 1).
Ether has the had reputation of exerting a particularly baneful influence upon the organs of respiration and has been accused of causing bronchitis and pnemnonia, but this depends largely upon the method of administration and the selection of the cases.
A comparison of children inunediately after chloroform and after ether anesthesia will at once decide the question in favor of the latter.
The chloroformed child looks pale, the cardiac function is visibly altered, the pulse is small, and the appearance of the patient causes anxiety. The etherized child is red, the pulse is large and full, and the sleep resembles natural conditions.
Based upon the experience of more than 1000 amesthesias in children, I believe that ether an esthesia is preferable in childhood, especially in the form it has been practised in America for a long time and which is known as ether intoxication or the drop method.
As many text-books still recommend light chloroform anesthesia in chihlren, I will describe the method of amestbetizing as is exclusively used by us for the last eight years.
The most important point is that the smallest possible quantity of ether should be used.
The simplest and most convenient mask is the cuff mask which is generally used in America (Fig. 1).
A rectangular piece of stiff paper is rolled up with a small towel, the overlapping edges of which are turned inward at both ends and folded up inside the tube which receives the ether. This mask can be made rapidly anywhere and of any desired size. It is easily sterilized and, what is its greatest advantage, 't covers only the mouth and nose, leaving the rest of the face free (Fig. 1, e).
A few drops of ether are allowed to drop on one end of the cuff mask and the other end is placed near the child's nose and mouth. The respiratory air and the ether vapor become slowly mixed by the time the cuff is over the nose and mouth. If air hunger sets in (recognizable by oppressed breathing) the mask is raised and a few breaths of air are admitted, after which it is again slowly placed over the mouth and the analgesic condition known as ether intoxication soon appears.
The child should be kept in this state between sleep and waking. Deep anesthesia, which is easily attained by adding a few more drops of ether, is only necessary when operating on the peritoneum or the tonsils. All other operations can be carried out in the intermediary stage without danger.
The cuff is removed before the operation is completed, the after sleep being still painless or at least accompanied by diminished sensa tion. As soon as the last suture is tied the child should be awake, unless the dressings are painful.
If the child is still under the influence of the anesthetic after the operation, the anesthetist has either not been watchful or has allowed himself to give too much ether under the influence of the operator's impatience.
It is unquestionably possible to avoid the unpleasant after-effects of ether upon the respiratory tract by observing precision in dosage.