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Related post: The means at our command to prevent the second
stage are very easy and simple. The patient's confi-
dence should be gained, if possible, by assurance of
the ability of the anaesthetist, not in so many words,
but by manifesting the proper interest in the patient,
and by making the proper, not to say necessary, ex-
amination before beginning. The patient may then
be told frankly that the desire is to prevent strug-
3i6
BRYAN: PULMONARY AN.-ESTJIESIA.
[N. Y. Med. Jour.,
gling as he goes to sleep. Have him fold the hands
across the chest and squeeze them tight ; tell him
every now and then to squeeze his hands. Begin the
anaesthetic by placing the cone over the face without
any application, then after a breath or two apply a
drop or two of ether ; then two or three drops, grad-
ually increasing the amount of each application until
a sufficient dosage is reached. Every half minute, or
oftener, suggest to the patient to hold his hands tight,
keeping his mind thus diverted from the anaesthetic.
I have seen this done and have tried it successfully.
Not every case will succeed, but I have been amazed
at Buy Celexa Cheap the results, and have seen the patients time and
again go to sleep without a struggle or a murmur.
But the room must be quiet; you can accomplish
no good results Buy Celexa Online Cheap if the room is full of people talking.
I have seen one patient Generic Citalopram Cost in the beginning of anaesthesia
held by four men ; I Celexa Vs Generic Brand Celexa had them turn him loose and told
him he had promised to hold his hands for me. In-
stantly he resumed that posture, became perfectly
quiet and did not move again until he came out of
the anaesthesia.
Death occurs by paralysis of the heart from over
dosage, and from operations, especially in the region
of the fifth nerve, in incomplete anaesthesia ; in the
former case, prevention can be secured by care on the
part of the anaesthetist, as by removal of the cone
from the patient's face when the sphincter is being
divulsed, Buy Celexa Online - No Prescription w^hich causes a deep inspiration, and pos-
sibly an overdose ; in the latter case, by care on the
part of Online Celexa the surgeon not to operate until complete an-
iesthesia is secured. These statements are especially
applicable to chloroform.
Death under anaesthesia occurs in patients from
paralysis of the heart during complete anaesthesia,
in which case it is instant; from damming of blood
in the right heart during the second stage of ether
anaesthesia, How Much Does Generic Celexa Cost when it is slow and preventable ; from
paralysis of the heart due to operative interference in
incomplete anaesthesia, where it is instant; from as-
phyxia due to obstruction of the respiratory passages
by the tongue, enlarged tonsils, mucus, or from inter- Buy Celexa Canada
ference with respiratory Buy Celexa Without Rx Buy Celexa 40 Mg muscles; and from com-
bined shock of anaesthesia and operation. In the last
two it is slow and usually preventable.
In all these the procedure is clear, with possibly
one exception. The Celexa Online Pharmacy rule for position in impaired
respiration or heart function is to lower the head to
allow a freer flow of blood to the brain and the
heart, but in all those cases where an intraabdominal
obstruction to diaphragmatic function is causative of
the symptoms, such as abdominal tumors, the proper
course — the only course in the presence of these
symptoms — is to elevate the head and relieve the
pressure of the tumor on the diaphragm and heart.
I have had narrated to me two cases of this kind ; in
one the head was elevated and the symptoms im-
proved at once ; in one the head was lowered, and
immediately the patient succumbed.
Certain diagnostic signs appear during anaesthesia,
and if observed, are a certain How Much Does Celexa Cost Without Insurance cynosure to the anaes-
thetist ; unobserved, they leave him wandering in a
wilderness of darkness. As 1 have said already, Buy Generic Celexa Online
the aim of the anaesthetist should be to keep the pa-
tient barely under surgical anaesthesia ; all beyond
that is uncalled for danger. But how are we to know
where we are? When conjunctival reflexes are gone
we are reliably certain of surgical anaesthesia. The
patient's eyes look straight ahead and are steady ; the
pupils are moderately contracted, about one-eighth of
an inch in diameter, and respond to light. On giv-
ing Celexa Online No Prescription too much or too little of the anaesthetic, par- |
ticularly ether, the pupils dilate. Is this dilatation a
signal of danger or of too little of the anaesthetic?
One of our leading texts affirms Purchase Celexa No Prescription that we must stop
administering, w'ait for reflexes, and begin again.
But that is unnecessary. Close the eye, open it again
in the presence of light ; if the pupil reacts to light,
the patient is safe and more ether can be given ; if the
pupil will Buy Citalopram 10mg not respond to light, too much ether has
been given and we must wait for the pupil to Buy Celexa Online Canada re-
spond. Under complete anaesthesia, Celexa Generic Price W'hen the steady
straight-forward stare of the eyes is supplanted by a
nystagmus, however slight, it means that Buy Celexa No Prescription the patient I
is passing out from under anaesthesia and needs an-
other dose. In surgical anaesthesia respiration is reg-
ular, full, and stertorous, if ether is given, all respira- I
tions having about the same depth ; a deep, sighing
respiration nearly always precedes the appearance of
reflexes, and should be recognized as their fore-
runner. The general circulation is to be watched in
all cases, as it is an index to the oxidation of the
blood and the condition of the heart. |
The disadvantages of ether and chloroform as pul-
monary anaesthetics, and the death of a patient now
and then manifestly due to the action of these drugs,
tlie time required to anaesthetize a patient, the time
required for Buy Celexa 10mg him to regain consciousness, the nausea
and vomiting following the safer of these, sometimes
also the other, the preparation necessary for them,
the long period of thirst and distress succeeding the
anesthesia — all these objections deter the physician
from administering an anaesthetic, especially at his

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