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Ethyl alcohol intravenously as postoperative sedative
ETHYL ALCOHOL INTRAVENOUSLY AS POSTOPERATIVE SEDATIVE R. J. BEHAN, M.D. Surgeon, St. Joseph’s Hospital PITTSBURGH,
PENNSYLVANIA
A
NUMBER of years ago, in 1920 to be exact, I became convinced that alcoho1 given intravenousIy couId be beneficially used as a treatment for septicemia. The first patient with puerpera septicemia to be so treated was greatIy benefited. Since this initial case I have on many occasions intravenousIy injected aIcoho1 properIy diIuted for generalized infections with considerable success. During these treatments it was noted that quickIy foIIowing the intravenous injection of aIcoho1, patients became quieter and usuaIIy entered upon a peacefu1 sIumber. This suggested that aIcoho1 given intravenousIy might with benefit be used as a narcotic, thus taking the place of morphine as a routine postoperative sedative. AIcohoI belongs to the group of cerebra1 depressants and lessens the sensitivity to pain. It affects first the cerebrum, then the cord, and Iast of aI1, the respiratory centers, while morphine depresses the respiratory centers simuItaneously with the depression of the cerebrum and to a Iesser extent, the reflex excitabiIity of the cord.* Thus aIcoho1 shouId prove more effective as a postoperative sedative than morphine. In thirty consecutive cases in which I have given aIcoho1 intravenousIy, I have found it necessary onIy occasionaIIy to bolster the effect of the aIcohoI with morphine to relieve pain. At times the injection produces a feeIing of exhiIaration. One patient was badly intoxicated by a single injection. In no patient did we notice any deIeterious effect. In severa instances we thought that the immediate post-operative course of the patient was easier, quieter, and Iess disturbed than was usual in cases * MEYER, H. H. and GOTTLIEB, R. PhxrmacoIogy. P. 29. Philadelphia, 1914. J. B. Lippincott. 227
of simiIar operative type in which aIcoho1 had not been used. I have aIso given aIcoho1 intravenousIy in proper diIution to insane and restIess individuaIs with beneficia1 resuIts. Quiet and sedation quickIy foIIowed its introduction. The intravenous injection of aIcoho1 has aIso proved to be of vaIue in the treatment of aIcohoIics who, deprived of their usua1 stimuIant, were in the restIess and ungovernable period of deIirium tremens. Because of vomiting from an irritated stomach, they couId not take whiskey by mouth. AIcohoI intravenousIy was aIso used as a ready means of suppIying energy to severeIy debiIitated and weakened individuaIs and to those in sudden asthenic crises and shock. A good example was a marasmatic chiId who was unabIe to assimiIate nourishment. AIcohoI, pIus amino-acetic acid in proper diIution in gIucose, 3 per cent, and saline soIution, was given intravenousIy. The chiId quickIy recovered. Intravenous aIcoho1 was also found to be of vaIue in diabetics who were in coma and required quickly utiiizable energizing substances. It was found that properIy diIuted aIcoho1 used intravenousIy acted in a phenomenal manner in abolishing pain. It increased the periphera1 circuIation in patients with diabetic gangrene of the extremities and produced routine postoperative sedation and rest. We have aIso given aIcoho1 intravenousIy as a means of obtaining reIaxing sIeep in the excitabIe states so frequentIy present in paranoiacs.
228
American
Behan-AIcohoI
Journal of Surgery
IntravenousIy
TABLE
Aucusr.
,945
I
Pain
Special Symptoms
./
1:1 L
/
1
1,:
1
Slept at short intervals, had fair night Fairly good night; sIight pain VentraI hernia and retroversion of uterus Had to have morphine sulfate Had fair day Patient had numerous dense adhesions Fairly good operative day Perspiring, face Aushed AIcohoI had no perceptible effect y;;to sleep after injection; feIt like being r Patient had ffushed face, feIt warm Perspired freely, face flushed; inj. by hyperdermocIysis Drowsy, had to give morphine for pain Had good postoperative day; heat to abdomen, Rest.Iess; had poor day Only I inj. morphine necessary 8 hr. after intrav. inj. Drowsy and tingting sensation throughout body Had pain but sIept well after injection Did not affect pain in lower abdomen Had restful night; patient fairIy comfortable CompIained of vertigo after injection was started Vertigo Patient quiet aIthough she did not go to sIeep Good postoperative day Patient very drowsy; could not stay awake Has a fair day Patient slightly intoxicated Patient very resttess Patient very restIess and uncooperative Patient perspired moderately, pulse acceIerated
x
2
3 4
I Y
:
x x
s’
x
9 10
x
II
x
I2
x
‘3 ‘4 x 15 16
x x x x
I7 18
x x
‘9 20’ 21 22 x
x x
23 24’ 25 x 26
x x x
1:
x
27 28
>
29 X 3o 4
x
x
-
-I‘ -
2
Above cases were compiled
I -
from March
!2
I :
1
I
-
19, 1944 to JULY 13, 1944.
In most instances aIcoho1 given intravenousIy postoperativeIy can repIace the usua1 doses of morphine or other narcotics. The aIcoho1 empIoyed is the ordinary ethy1 (95 per cent) aIcoho1 as obtained from the manufacturers. Before intravenous injection, it is diIuted with at least I 20 to 240 cc. of saIine soIution or it may be added to the usua1 intravenous postoperative gIucose, 5 per cent, and saIine. As a ruIe we add 50
of pure 95 per cent ethy1 aIcoho1 to 1,000 cc. of the gIucose, 5 per cent, and saline solution. The rate of flow is reguIated so as not to exceed more than 60 drops per minute. Intravenous injection of aIcoho1, if given too rapidIy, may be painfu1 and in a few patients has caused a sIight sensation of syncope. During the injection the patient very quickIy experiences a feeIing of we11 being cc.
NEW
SERIES VOL. LXIX, No.
2
Behan-AIcohoI
and is conscious of a gentIe superficia1 warmth. If the pain for which the aIcoho1 injection is given is not controIIed and an excitabIe state persists, the injection may be repeated. In one patient, due to a nurse’s misinterpretation of directions, 200 cc. of aIcoho1 was given in twenty-four hours without deIeterious effects except that it produced a too sound sleep associated with restIessness and a muttering stupor. I have compiIed a Iist of thirty consecutive operative cases in which intravenous aIcoho1 was given postoperativeIy. Of these there were only five patients who postoperativeIy required morphine in addition to the aIcoho1. See tabIe in next column. The thirty Iisted cases include four of abdomina1 adhesions, six of acute appendicitis, two incisiona hernias with retroversion of uterus, four of acute choIecystitis, two tuba1 pregnancies, three of subacute appendicitis, two of chronic appendicitis, one hysterectomy, one ptosis of kidney, one thyroidectomy, two of intestina1 obstruc-
IntravenousIy
American Journal of surgery
229
tion, one inguina1 hernia, and one synovectomy (knee‘j.
ChoIecystitis Chronic appendicitis Acute appendicitis IntestinaI obstruction Adhesions; chronic appendi citis
gr. 96 gr. % One inj. morphine 8 hrs. after alcohol injection. gr. 56 gr. fb
The resuIts after intravenous injection of aIcoho1 in glucose and saline were as fol10~s: twenty had no pain, four had slight pain, in five pain was stiI1 severe, twentythree rested weI1, seven were restIess, two did not sIeep, eight sIept at intervaIs, twenty sIept weI1, in one instance the effect on pain was not recorded. Tabulated presentations of the resuIts of the intravenous injection of aIcoho1 are shown in TabIe I.
PENNSYLVANIA
A
NUMBER of years ago, in 1920 to be exact, I became convinced that alcoho1 given intravenousIy couId be beneficially used as a treatment for septicemia. The first patient with puerpera septicemia to be so treated was greatIy benefited. Since this initial case I have on many occasions intravenousIy injected aIcoho1 properIy diIuted for generalized infections with considerable success. During these treatments it was noted that quickIy foIIowing the intravenous injection of aIcoho1, patients became quieter and usuaIIy entered upon a peacefu1 sIumber. This suggested that aIcoho1 given intravenousIy might with benefit be used as a narcotic, thus taking the place of morphine as a routine postoperative sedative. AIcohoI belongs to the group of cerebra1 depressants and lessens the sensitivity to pain. It affects first the cerebrum, then the cord, and Iast of aI1, the respiratory centers, while morphine depresses the respiratory centers simuItaneously with the depression of the cerebrum and to a Iesser extent, the reflex excitabiIity of the cord.* Thus aIcoho1 shouId prove more effective as a postoperative sedative than morphine. In thirty consecutive cases in which I have given aIcoho1 intravenousIy, I have found it necessary onIy occasionaIIy to bolster the effect of the aIcohoI with morphine to relieve pain. At times the injection produces a feeIing of exhiIaration. One patient was badly intoxicated by a single injection. In no patient did we notice any deIeterious effect. In severa instances we thought that the immediate post-operative course of the patient was easier, quieter, and Iess disturbed than was usual in cases * MEYER, H. H. and GOTTLIEB, R. PhxrmacoIogy. P. 29. Philadelphia, 1914. J. B. Lippincott. 227
of simiIar operative type in which aIcoho1 had not been used. I have aIso given aIcoho1 intravenousIy in proper diIution to insane and restIess individuaIs with beneficia1 resuIts. Quiet and sedation quickIy foIIowed its introduction. The intravenous injection of aIcoho1 has aIso proved to be of vaIue in the treatment of aIcohoIics who, deprived of their usua1 stimuIant, were in the restIess and ungovernable period of deIirium tremens. Because of vomiting from an irritated stomach, they couId not take whiskey by mouth. AIcohoI intravenousIy was aIso used as a ready means of suppIying energy to severeIy debiIitated and weakened individuaIs and to those in sudden asthenic crises and shock. A good example was a marasmatic chiId who was unabIe to assimiIate nourishment. AIcohoI, pIus amino-acetic acid in proper diIution in gIucose, 3 per cent, and saline soIution, was given intravenousIy. The chiId quickIy recovered. Intravenous aIcoho1 was also found to be of vaIue in diabetics who were in coma and required quickly utiiizable energizing substances. It was found that properIy diIuted aIcoho1 used intravenousIy acted in a phenomenal manner in abolishing pain. It increased the periphera1 circuIation in patients with diabetic gangrene of the extremities and produced routine postoperative sedation and rest. We have aIso given aIcoho1 intravenousIy as a means of obtaining reIaxing sIeep in the excitabIe states so frequentIy present in paranoiacs.
228
American
Behan-AIcohoI
Journal of Surgery
IntravenousIy
TABLE
Aucusr.
,945
I
Pain
Special Symptoms
./
1:1 L
/
1
1,:
1
Slept at short intervals, had fair night Fairly good night; sIight pain VentraI hernia and retroversion of uterus Had to have morphine sulfate Had fair day Patient had numerous dense adhesions Fairly good operative day Perspiring, face Aushed AIcohoI had no perceptible effect y;;to sleep after injection; feIt like being r Patient had ffushed face, feIt warm Perspired freely, face flushed; inj. by hyperdermocIysis Drowsy, had to give morphine for pain Had good postoperative day; heat to abdomen, Rest.Iess; had poor day Only I inj. morphine necessary 8 hr. after intrav. inj. Drowsy and tingting sensation throughout body Had pain but sIept well after injection Did not affect pain in lower abdomen Had restful night; patient fairIy comfortable CompIained of vertigo after injection was started Vertigo Patient quiet aIthough she did not go to sIeep Good postoperative day Patient very drowsy; could not stay awake Has a fair day Patient slightly intoxicated Patient very resttess Patient very restIess and uncooperative Patient perspired moderately, pulse acceIerated
x
2
3 4
I Y
:
x x
s’
x
9 10
x
II
x
I2
x
‘3 ‘4 x 15 16
x x x x
I7 18
x x
‘9 20’ 21 22 x
x x
23 24’ 25 x 26
x x x
1:
x
27 28
>
29 X 3o 4
x
x
-
-I‘ -
2
Above cases were compiled
I -
from March
!2
I :
1
I
-
19, 1944 to JULY 13, 1944.
In most instances aIcoho1 given intravenousIy postoperativeIy can repIace the usua1 doses of morphine or other narcotics. The aIcoho1 empIoyed is the ordinary ethy1 (95 per cent) aIcoho1 as obtained from the manufacturers. Before intravenous injection, it is diIuted with at least I 20 to 240 cc. of saIine soIution or it may be added to the usua1 intravenous postoperative gIucose, 5 per cent, and saIine. As a ruIe we add 50
of pure 95 per cent ethy1 aIcoho1 to 1,000 cc. of the gIucose, 5 per cent, and saline solution. The rate of flow is reguIated so as not to exceed more than 60 drops per minute. Intravenous injection of aIcoho1, if given too rapidIy, may be painfu1 and in a few patients has caused a sIight sensation of syncope. During the injection the patient very quickIy experiences a feeIing of we11 being cc.
NEW
SERIES VOL. LXIX, No.
2
Behan-AIcohoI
and is conscious of a gentIe superficia1 warmth. If the pain for which the aIcoho1 injection is given is not controIIed and an excitabIe state persists, the injection may be repeated. In one patient, due to a nurse’s misinterpretation of directions, 200 cc. of aIcoho1 was given in twenty-four hours without deIeterious effects except that it produced a too sound sleep associated with restIessness and a muttering stupor. I have compiIed a Iist of thirty consecutive operative cases in which intravenous aIcoho1 was given postoperativeIy. Of these there were only five patients who postoperativeIy required morphine in addition to the aIcoho1. See tabIe in next column. The thirty Iisted cases include four of abdomina1 adhesions, six of acute appendicitis, two incisiona hernias with retroversion of uterus, four of acute choIecystitis, two tuba1 pregnancies, three of subacute appendicitis, two of chronic appendicitis, one hysterectomy, one ptosis of kidney, one thyroidectomy, two of intestina1 obstruc-
IntravenousIy
American Journal of surgery
229
tion, one inguina1 hernia, and one synovectomy (knee‘j.
ChoIecystitis Chronic appendicitis Acute appendicitis IntestinaI obstruction Adhesions; chronic appendi citis
gr. 96 gr. % One inj. morphine 8 hrs. after alcohol injection. gr. 56 gr. fb
The resuIts after intravenous injection of aIcoho1 in glucose and saline were as fol10~s: twenty had no pain, four had slight pain, in five pain was stiI1 severe, twentythree rested weI1, seven were restIess, two did not sIeep, eight sIept at intervaIs, twenty sIept weI1, in one instance the effect on pain was not recorded. Tabulated presentations of the resuIts of the intravenous injection of aIcoho1 are shown in TabIe I.