Speculum - University of Melbourne

28 SPECULUM
Operations to be Performed with Spinal,
Epidural, Regional or Local Analgesia
By producing drowsiness and lessened
appreciation of discomfort, hypnotic, analgesic
and narcotic drugs contribute greatly
to the success of such procedures. In the
past excessively heavy pre-medications were
sometimes used so that at times the patients
were actually unconscious. The present
attitude is that such heavy premedications
are undesirable, and that if such degrees of
mental depression are necessary for the
operation to be performed it is better to
gain the effect with a more controllable
agent such as nitrous oxide, which can be
administered in addition to the spinal,
epidural, regional, or local analgesia. Such
combinations are very satisfactory.
When large doses of local analgesic
drugs are to be injected the pre-operative
medication should include a barbiturate to
lessen the tendency which the injected
solution may have to cause convulsions.
Examples: It is obvious that a great
number of acceptable combinations are
possible. The following are only to be regarded
as illustrations.
Healthy young man for ether anaesthetic:
Atropine 0.6 mgms with, or without
Pethidine 50 mgms.
Middle aged man for gastrectomy: Omnopon
20 mgms, Hyoscine 0.4 mgms,
by H.I. 1 hour pre-op.
Old man for T.U.R. prostate (low spinal
analgesia): H.I. Omnopon 15 mgms.
1 hour pre-op.
7-year-old child for tonsillectomy: Chlorbutol
(Chloretone) gr.V, with atropine
1.2 mgms., both orally 2 hrs. pre-op.
2-year-old child weighing 30 lbs. for
plaster of dislocated hip: Atropine 1
mgm. 2 hrs. pre-op. orally, 0.6 gms.
thiopentone rectally 15 mins. preoperatively.
Finally, it must be mentioned that correct
pre-operative preparation of the patient,
from a mental point of view, must never be
forgotten.
Women are not uncommon victims of
himsomnia.
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