Читать книгу The Surgery of the Skull and Brain - Louis Bathe Rawling - Страница 22

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It is almost inevitable that all serious head-operations should be associated with some degree of shock, though, from my experience, I am convinced that, with due precautions, it is far less serious than is generally supposed. The development of shock is very largely dependent on the amount of blood lost during the operative procedures. The various methods adopted to control hæmorrhage are enumerated later. In addition, attention should be paid to the following details:—

1. Half an hour before the operation an injection of a quarter of a grain of morphia should be given hypodermically. The addition of one-hundredth of a grain of atropin, recommended by some surgeons, interferes somewhat, by its action on the pupil, with the data deemed necessary for the administration of the anæsthetic.

2. The theatre should be maintained at a temperature between 65 and 75 degrees Fahrenheit. The table should be suitably warmed.

3. The patient’s body should be covered with warm blankets, and, in the more serious cases, the lower extremities may be bandaged, from below upwards.

It has been recommended that the brain, if exposed, should be protected from the cooling effects of the atmosphere by irrigation with saline solution at a temperature between 110 and 115 degrees Fahrenheit. Personally I prefer to keep the operative field as dry as possible.

An assistant should be told off, whose duty lies in keeping a record both of blood-pressure and pulse-rate. The lowering of blood-pressure is the surest guide to the surgeon of approaching danger.

It is often considered that rapidity of operation is essential. There can be no greater error. To ensure success the utmost care must be taken to control the loss of blood, for which it is essential that each step of the operation should be carried out deliberately and carefully.