Volume 9b - History of Anaesthesia Society

mved by screws for exact dosage. A rubber tube allowed limited movement
of t"e syringe -2
In practice, the patient was placd in a lateral position with an
elevated pelvis. The spine had to form an angle of 25 degrees to the
horizontal and the coccyx had to be at the highest point of the spine.
Lwnbar puncture was then performed approximately at the spinal segment
of the upper, cranial, level of analgesia. The puncture site recamended
by Kirschner was L2/L3 for analgesia of the lower extrenities and D12/L1
for the atdomen and thorax. However, the puncture site had no decisive
effects on the spread of analgesia.
Then the double syringe was tightly connected to the pmcture cannula.
Now the needle was situated approximately at the upper level of the CS'.
In order to bring this level of C S to the exact position of the desired
height of analgesia, a certain ~lwre of air had to be insufflated.
Kirschner suggested 10-15ml air for analgesia below the umbilicus and
20-25m1 air for analgesia below the breast. The result of this procedure
was a bubble of air in the sacral part of the dural sac. The tight
connection of the two cylinders of the syringe set enabled the
subsequent ii~jection of the ocal anaesthetic without disconnection of
the syringe from the cannula.
3
Because of the lateral position of the outlet of the needle, injection
of the local anaesthetic was pssible in a designated direction: for
analgesia of the aManen it was injected cranially, and for the legs,
caudally. Initially, Kirschner recamended the m i n k dose of local
anaesthetic. The hypobaric local anaesthetic now f o d a 'pl~'
snrimning on the surface of t3e CSF just below the sacral mle of alr.
The segmental spread of spinal anaesthesia was determined by the cranial
extension of the bubble and the volume of the local anaesthetic 'plug'.
After some minutes the spread of local analgesia had to be tested. If it
was insufficient or wrongly placed, an increase in the dose or
correction of the position of the 'plug' was p3ssible by insufflating or
removing air. In this way dosage and spread of analgesia could be
adapted to individual circumstances. Rfter attaining
anaesthesia, the needle was raved and the patient laid on his back. ""Q?2
During and after the operation, the patient had to rmin in a head-down
position for as long as the analgesia took to canpletely wear off. Not
till then could the patient be brought t,f the horizontal position, and
some hours later to the head-up position.
The results of this technique in the hands of Kirschner were very good.
Cmly one patient died in 1000 cases of the new spinal anaesthesia and
significant changes in blood pressure did not occur. Each case was
exactly reprted and documented for later evaluation. An imp3rtant
innovation ms also a'psychic narcotist' o had always to be present
with a ptient. Kirschner and his t e 2 gained a great deal of
experience from this method (some 1OOO cases were reported after 1932
with excellent results) but it seems that other authors had only limited
practical knowledge, probably because of the exacting technique.