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Clarke: Anesthesia and Analgesia in Obstetrics
572
THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOI,oGY
to the child is slight, provided the drugs are not given late in labor. In a primipara scopolamine-morphine should not be given after the cervix is three-quarters dilated. The amnesia produced by these drugs during the first stage may be followed by nitrous oxide-oxygen administered with each pain during the early part of the second stage. As labor advanees and pains become more severe, ether is advisml. At the end of the second stage the patient is completely anesthetized aud the head delivered by Ritgen's maneuver. '1'he author helieves that ether may he administered much earlier in labor than is generally supposed. The usc of a closed cone method of administratiou, such as the "Ben Morgan" apparatus, is recommended for this purpose. The usc of chloroform is not advocated, having been abandoned by the writer ten years ago. 'fhe routine use of drugs which stimulate uterine contractions postpartum is advised following general anesthesia, as a prophylactic measure against postpartum hemorrhage. NORMAN P. MILLER. Clarke: Anesthesia and Analgesia in Obstetrics. Society, Oct., 1921, xxi, 313.
Journal of the Kansas }ledical
General observations on anesthesia and analgesia during delivery force the conclusion that women arc entitled tG relief from pain. Proper drugs help and do no harm. Standardization of methods for individual needs is not possible. The method u~cd must give the greatest relief with the least danger to both mother and child. Hot enemas, bromides and chloral, morphine with scopolamine lIlay be used in the first stage; nitrous oxide un(l oxygen, ether or chloroform in the second. Best results depend on the psychic control of the patient. The physician shoulU. not wait until the last minute to attend his patient.
'V.
K. FOHSTE](.
Haultain: Further Experience of the Conduct of Labor Under "Twilight Sleep." Edinburgh Medical Journal, 1921, xxvii, 2i. The author draws his conclusions from a series of over 800 labors, the last 130 are r eported. Complete amnesia was obtained in 80 per cent of the primiparro, in 50 per cent of the multiparro. Partial amnesia occurred in 20 per cent of primiparlll, in 30 per cent of multiparro, and short laoors prevented the drug being effective in the remainin.gI 20 per cent of the latter. The method employed is as follows: The patient, her cars filled with cotton, is pl:aced in a quiet, darkened room from which lhe relatives are excluded. When labor is fairly well established (pains occurring regularly every ten minutes in a primipara, earlier in a multipara) morphine gr. 14 and hyoscine gr. 1/150 are given hypodennatically. Three quarters of an hour later and every hour after, the patient receives gr. 1/450 of hyoscine. To control restlessness morphine is used in the first stage, chloroform in the second. Chloroform is used when needed at delivery. On awakening il'om the sleep that usualIy follows delivery, the patient is unaware that labor has occurred. The author has found that large doses of morphine do not cause fetal oligopnea or .asphyxia. The largest number of doses of hyoscine given in any successful case was 53, the smallest 4. Although the patients may be restless, complain of pain or even be delirious, the end result is usually complete amnesia. Haultain thinks that the routine dosage of hyoscine is without danger, that these patients require less personal attention than those delivered in the usual way. An expert nurse
THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOI,oGY
to the child is slight, provided the drugs are not given late in labor. In a primipara scopolamine-morphine should not be given after the cervix is three-quarters dilated. The amnesia produced by these drugs during the first stage may be followed by nitrous oxide-oxygen administered with each pain during the early part of the second stage. As labor advanees and pains become more severe, ether is advisml. At the end of the second stage the patient is completely anesthetized aud the head delivered by Ritgen's maneuver. '1'he author helieves that ether may he administered much earlier in labor than is generally supposed. The usc of a closed cone method of administratiou, such as the "Ben Morgan" apparatus, is recommended for this purpose. The usc of chloroform is not advocated, having been abandoned by the writer ten years ago. 'fhe routine use of drugs which stimulate uterine contractions postpartum is advised following general anesthesia, as a prophylactic measure against postpartum hemorrhage. NORMAN P. MILLER. Clarke: Anesthesia and Analgesia in Obstetrics. Society, Oct., 1921, xxi, 313.
Journal of the Kansas }ledical
General observations on anesthesia and analgesia during delivery force the conclusion that women arc entitled tG relief from pain. Proper drugs help and do no harm. Standardization of methods for individual needs is not possible. The method u~cd must give the greatest relief with the least danger to both mother and child. Hot enemas, bromides and chloral, morphine with scopolamine lIlay be used in the first stage; nitrous oxide un(l oxygen, ether or chloroform in the second. Best results depend on the psychic control of the patient. The physician shoulU. not wait until the last minute to attend his patient.
'V.
K. FOHSTE](.
Haultain: Further Experience of the Conduct of Labor Under "Twilight Sleep." Edinburgh Medical Journal, 1921, xxvii, 2i. The author draws his conclusions from a series of over 800 labors, the last 130 are r eported. Complete amnesia was obtained in 80 per cent of the primiparro, in 50 per cent of the multiparro. Partial amnesia occurred in 20 per cent of primiparlll, in 30 per cent of multiparro, and short laoors prevented the drug being effective in the remainin.gI 20 per cent of the latter. The method employed is as follows: The patient, her cars filled with cotton, is pl:aced in a quiet, darkened room from which lhe relatives are excluded. When labor is fairly well established (pains occurring regularly every ten minutes in a primipara, earlier in a multipara) morphine gr. 14 and hyoscine gr. 1/150 are given hypodennatically. Three quarters of an hour later and every hour after, the patient receives gr. 1/450 of hyoscine. To control restlessness morphine is used in the first stage, chloroform in the second. Chloroform is used when needed at delivery. On awakening il'om the sleep that usualIy follows delivery, the patient is unaware that labor has occurred. The author has found that large doses of morphine do not cause fetal oligopnea or .asphyxia. The largest number of doses of hyoscine given in any successful case was 53, the smallest 4. Although the patients may be restless, complain of pain or even be delirious, the end result is usually complete amnesia. Haultain thinks that the routine dosage of hyoscine is without danger, that these patients require less personal attention than those delivered in the usual way. An expert nurse