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AN EPISIOTOMY DIRECTOR
464
(5) The apparatus
New Inventions
anaesthetist to
is simple and foolproof, enabling the concentrate on the condition of the
patient. APPARATUS FOR ADMINISTRATION OF PENTOTHAL AND CURARE SOLUTIONS THE introduction of the use of curare has producedL method of obtaining adequate relaxation at any time during the course of anaesthesia. This property makes: it a valuable adjunct to the use of ’Pentothal,’ and the: combination of these drugs can produce anaesthesia suitable for major abdominal and thoracic surgery. Administration over a long period, however, is often troublesome, and the -following apparatus has been designed to facilitate the technique. The apparatus (see figure) consists of a combination tap A, two small-bore rubber tubes B of suitable lengths, connected to a right-angled junction which fits into an anchoring device c. This is mounted on a metal plate, which is strapped to the splinted arm. A small length of transparent tubing with male and female ends connects the junction to the needle. A drip of saline, blood, or plasma, as required, is attached to the central inlet of the apparatus, and pentothal or curare solution can be injected from ’Record ’ syringes into their respective inlets. Adjustment of the tap permits only the required solution to flow to the needle, and the possibility of backwash is eliminated. Pentothal is delivered through one of the small-bore tubes, and the drip solution through the other. The curare, when injected, mixes with the drip solution, ensuring adequate dilution and removal of any residual "
a
,
We make no apology for introducing yet another " method for the use of continuous pentothal," since the physical difficulties of this combined administration would otherwise prohibit its widespread use. For the construction of this device we are indebted to Messrs. Alexander & Fowler, Pembroke Place, Liverpool, from whom it may be obtained, and who supply a convenient
Qf.n_nrl -frn"
nQA
U7t.h t,
G. V. OSBORNE
T. CECIL GRAY M.B.
M.B. Lpool
Lpool, D.A.
David Lewis Northern Hospital, Liverpool.
AN
EPISIOTOMY DIRECTOR
IN
performing a mediolateral episiotomy there are two advantages to be gained by placing the stitches before the perineum is incised. This applies particularly when the operation has to be conducted under difficult conditions and with inadequate assistance. The advantages are (1) a bloodless field ; and (2) a more accurate apposition of the tissues by preventing the backward
retraction of the muscles. To facilitate the operation I have designed a simple director (fig. 1), which serves the double purpose of
-
Fig.I the foetus when the needles are passed, and the underlying sutures when the perineum is divided. It consists of a suitably curved handle with a serrated thumb grip for the assistant, a director, and " a foetal guard." Both director and guard are parallel and slightly curved. The gap between the director and guard is about s in. throughout, and both are absolutely rigid, which is essential. Method of Use.-]3oth guard and director are placed beneath the perineum. The needles may then be passed boldly through the tissues on one side of the director until the guard is touched, then skidded along the guard under the director to emerge from the perineum on the opposite side. When the required number of stitches have been passed, the ends, right and left respectively,
protecting protecting
pentothal from the neighbourhood precipitation is prevented.
of the needle.
In
this way Before
use. air is cleared from the tubes by running to the needle first the drip solution and then pentothal. Successful venepuncture will be indicated by a reflux of blood into the transparent tubing. The whole apparatus can be sterilised by boiling. The tap has thus the following special features : (1) Blockage of the needle is by a continuous drip of saline, plasma, or blood. (2) Pentothal is delivered not into the drip but directly to the needle, thus ensuring immediate action. (3) Precipitation of the curare in concentrated solution by
through
prevented
the pentothal is prevented. (4) Remote control of the administration of the anaesthetic is attained, and the possibility of accidental withdrawal of the needle from the vein eliminated, whatever the required position of the limb. .
- v/t
Fig.2
grouped, clipped with two heemostats, and laid aside delivery has been completed (fig. 2). Knife or episiotomy scissors can now safely divide the perineum without risk to the underlying sutures. I have found a no. 4 half-curve Hamilton Bailey needle suitable for the are
until the
purpose. My thanks are due to Messrs. Down Bros. the director, for their cooperation.
Ltd., who make
NORMAN FLOWER
B.M. Oxfd
(5) The apparatus
New Inventions
anaesthetist to
is simple and foolproof, enabling the concentrate on the condition of the
patient. APPARATUS FOR ADMINISTRATION OF PENTOTHAL AND CURARE SOLUTIONS THE introduction of the use of curare has producedL method of obtaining adequate relaxation at any time during the course of anaesthesia. This property makes: it a valuable adjunct to the use of ’Pentothal,’ and the: combination of these drugs can produce anaesthesia suitable for major abdominal and thoracic surgery. Administration over a long period, however, is often troublesome, and the -following apparatus has been designed to facilitate the technique. The apparatus (see figure) consists of a combination tap A, two small-bore rubber tubes B of suitable lengths, connected to a right-angled junction which fits into an anchoring device c. This is mounted on a metal plate, which is strapped to the splinted arm. A small length of transparent tubing with male and female ends connects the junction to the needle. A drip of saline, blood, or plasma, as required, is attached to the central inlet of the apparatus, and pentothal or curare solution can be injected from ’Record ’ syringes into their respective inlets. Adjustment of the tap permits only the required solution to flow to the needle, and the possibility of backwash is eliminated. Pentothal is delivered through one of the small-bore tubes, and the drip solution through the other. The curare, when injected, mixes with the drip solution, ensuring adequate dilution and removal of any residual "
a
,
We make no apology for introducing yet another " method for the use of continuous pentothal," since the physical difficulties of this combined administration would otherwise prohibit its widespread use. For the construction of this device we are indebted to Messrs. Alexander & Fowler, Pembroke Place, Liverpool, from whom it may be obtained, and who supply a convenient
Qf.n_nrl -frn"
nQA
U7t.h t,
G. V. OSBORNE
T. CECIL GRAY M.B.
M.B. Lpool
Lpool, D.A.
David Lewis Northern Hospital, Liverpool.
AN
EPISIOTOMY DIRECTOR
IN
performing a mediolateral episiotomy there are two advantages to be gained by placing the stitches before the perineum is incised. This applies particularly when the operation has to be conducted under difficult conditions and with inadequate assistance. The advantages are (1) a bloodless field ; and (2) a more accurate apposition of the tissues by preventing the backward
retraction of the muscles. To facilitate the operation I have designed a simple director (fig. 1), which serves the double purpose of
-
Fig.I the foetus when the needles are passed, and the underlying sutures when the perineum is divided. It consists of a suitably curved handle with a serrated thumb grip for the assistant, a director, and " a foetal guard." Both director and guard are parallel and slightly curved. The gap between the director and guard is about s in. throughout, and both are absolutely rigid, which is essential. Method of Use.-]3oth guard and director are placed beneath the perineum. The needles may then be passed boldly through the tissues on one side of the director until the guard is touched, then skidded along the guard under the director to emerge from the perineum on the opposite side. When the required number of stitches have been passed, the ends, right and left respectively,
protecting protecting
pentothal from the neighbourhood precipitation is prevented.
of the needle.
In
this way Before
use. air is cleared from the tubes by running to the needle first the drip solution and then pentothal. Successful venepuncture will be indicated by a reflux of blood into the transparent tubing. The whole apparatus can be sterilised by boiling. The tap has thus the following special features : (1) Blockage of the needle is by a continuous drip of saline, plasma, or blood. (2) Pentothal is delivered not into the drip but directly to the needle, thus ensuring immediate action. (3) Precipitation of the curare in concentrated solution by
through
prevented
the pentothal is prevented. (4) Remote control of the administration of the anaesthetic is attained, and the possibility of accidental withdrawal of the needle from the vein eliminated, whatever the required position of the limb. .
- v/t
Fig.2
grouped, clipped with two heemostats, and laid aside delivery has been completed (fig. 2). Knife or episiotomy scissors can now safely divide the perineum without risk to the underlying sutures. I have found a no. 4 half-curve Hamilton Bailey needle suitable for the are
until the
purpose. My thanks are due to Messrs. Down Bros. the director, for their cooperation.
Ltd., who make
NORMAN FLOWER
B.M. Oxfd