Читать книгу Practical Points in Anesthesia - Frederick-Emil Neef - Страница 8

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As soon as the first, unimpeded, snoring respirations are heard, the cleansing of the field of operation may begin. If the cleansing manipulations do not disturb the rhythm of the snoring respiration, the rate of the pulse does not increase and the patient makes no defensive movements, he is very likely already in the proper plane of anesthesia. Note is at once made of the state of the pupil and lid corresponding to this plane.

Initial Incision

When the surgeon makes the initial incision observation is again made as to whether the rhythm of the respiration and the rate of the pulse remain undisturbed and whether the patient continues to be passive; if this is the case, the patient is considered to be in the correct plane of anesthesia—the plane in which he must be kept throughout the operation.

Awakening Stimuli

Of course, it is clear that the depth of the narcosis must, in a measure, be proportionate to the magnitude of the awakening impulses set up by the surgeon’s manipulations. In abdominal work these impulses are more intense near the solar plexus of nerves, that is, in the upper part of the abdomen. Traction on the mesentery or the introduction of long gauze tampons into the abdominal cavity for “walling off” sets up powerful awakening stimuli.