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Ethyl chloride in children's dentistry
ETHYL WILLIAM
CHLORIDE
IN CHILDREN’S
L. FUNKHOUSER,
DENTISTRY
JR., D.D.S., ATLANTA,
GA.
THYL CHLORIDE is not a new anesthetic agent; it has been used for about the last thirty years. It was banned in England about twenty years ago a+s a result of the number of deaths caused by it. Its use was revived in Boston in It has been used routinely since that 1915 at the Forsyth Dental Infirmary. time by the internes, and the records show that it has been administered to one The chilhundred and twenty-five thousand children without a single fatality. dren to whom it has been administered were from the public schools, and no physical examinations were made. For an agent with the above record it is certainly worthy of note. It is true that generally speaking ethyl chloride as a general anesthetic has a bad name. There are many authorities on the subject who have condemned it. Their grounds for condemnation may be logical; however, we are not using the agent as a general anesthetic but as a deep analgesic, and wo are confining its use to children not over fourteen years of age. That is the secret of the safety factor. The agent may be used successfully by any practitioner with a little practice in the administration. The only equipment necessary is a tube of a standard r&&e of ethyl chloride, a rubber mouth prop, and a piece of double mesh, six by six, gauze. To go into the signs and symptoms of general anesthesia would only be repetition, so I shall describe only the signs in the operating stage of ethyl chloride. The breathing becomes rhythmic and at times a snore is noted; the pupils of the eyes are neither dilated nor contracted, and are usually rolled to one side or the other and fixed off center; the lid reflex is present but sluggish. We term this the operating stage. Do not expect to relax the patient, for if relaxation is reached the patient is in a very deep anesthesia and this is dangerOUS. The child may be humming, fighting, or trying to talk during the operating stage; therefore an assistant is always necessary. The technic for the administration is very simple. First the patient is prepared physically; the bladder is emptied and any tight clothing is loosened; the child is seated in the chair wit.h the head well back, to assure free breathing; the mouth prop is then inserted; the gauze is placed over the mouth and nose, the nostrils being held closed with the thumb and forefinger of the operator’s left hand. This causes the patient to breathe through the mouth. The patient is then instructed to breathe deep and to blow the gauze off and he will go to sleep. Ethyl chloride is sprayed intermittently on the gauze over the mouth; the meshes of the gauze are never allowed to become clogged with frost. The child will usually take about four deep breaths, then the breath is held for quite a number of seconds. Do not become alarmed at this. When breathing is re-
E
278
Ethyl
Chloride
in Children’s
Dadistvy
279
Watch for the signs of the operating stage; sumed anesthesia is very rapid. this usually takes from sixty to ninety seconds. When the operating stage is reached, proceed without delay to remove the necessary teeth. Anesthesia lasts from one to three minutes. If the induction takes a. long time, the child is likely to become nausea.ted; or if anesthesia is induced on a full stomach, nausea is likely to occur. If for any reason the operation is not completed the first time, do not repeat the anesthetic for at least twelve hours. The complications are rare, but -we must know how to relieve them should they occur. If cyanosis occurs, look for closure of air passages for cyanosis is not caused from the ethyl chloride. If the child stops breathing, use artificial respiration. Syncope is manifested by a sudden change of color and is caused by cerebral anemia. Lower the patient’s head and apply stimulants. Shock is manifested by pallor, fast feeble pulse, shallow respiration, and slowness in returning to consciousness. Keep the patient warm, watch his respiration, and apply stimulants. Ethyl chloride is indicated as an analgesic in children who are not more than fourteen years old for the extraction of deciduous teeth or for any minot oral surgery which will not take over three minutes to complete. It is contraindicated in cases of respiratory obstruction, tuberculosis, bronchitis, anemia, leucemia, or any form of heart lesion, Ethyl chloride may be successfully used by the practitioner, and its success will be determined by his good judgment, careful use, and knowledge of the physiologic action of the agent.
CHLORIDE
IN CHILDREN’S
L. FUNKHOUSER,
DENTISTRY
JR., D.D.S., ATLANTA,
GA.
THYL CHLORIDE is not a new anesthetic agent; it has been used for about the last thirty years. It was banned in England about twenty years ago a+s a result of the number of deaths caused by it. Its use was revived in Boston in It has been used routinely since that 1915 at the Forsyth Dental Infirmary. time by the internes, and the records show that it has been administered to one The chilhundred and twenty-five thousand children without a single fatality. dren to whom it has been administered were from the public schools, and no physical examinations were made. For an agent with the above record it is certainly worthy of note. It is true that generally speaking ethyl chloride as a general anesthetic has a bad name. There are many authorities on the subject who have condemned it. Their grounds for condemnation may be logical; however, we are not using the agent as a general anesthetic but as a deep analgesic, and wo are confining its use to children not over fourteen years of age. That is the secret of the safety factor. The agent may be used successfully by any practitioner with a little practice in the administration. The only equipment necessary is a tube of a standard r&&e of ethyl chloride, a rubber mouth prop, and a piece of double mesh, six by six, gauze. To go into the signs and symptoms of general anesthesia would only be repetition, so I shall describe only the signs in the operating stage of ethyl chloride. The breathing becomes rhythmic and at times a snore is noted; the pupils of the eyes are neither dilated nor contracted, and are usually rolled to one side or the other and fixed off center; the lid reflex is present but sluggish. We term this the operating stage. Do not expect to relax the patient, for if relaxation is reached the patient is in a very deep anesthesia and this is dangerOUS. The child may be humming, fighting, or trying to talk during the operating stage; therefore an assistant is always necessary. The technic for the administration is very simple. First the patient is prepared physically; the bladder is emptied and any tight clothing is loosened; the child is seated in the chair wit.h the head well back, to assure free breathing; the mouth prop is then inserted; the gauze is placed over the mouth and nose, the nostrils being held closed with the thumb and forefinger of the operator’s left hand. This causes the patient to breathe through the mouth. The patient is then instructed to breathe deep and to blow the gauze off and he will go to sleep. Ethyl chloride is sprayed intermittently on the gauze over the mouth; the meshes of the gauze are never allowed to become clogged with frost. The child will usually take about four deep breaths, then the breath is held for quite a number of seconds. Do not become alarmed at this. When breathing is re-
E
278
Ethyl
Chloride
in Children’s
Dadistvy
279
Watch for the signs of the operating stage; sumed anesthesia is very rapid. this usually takes from sixty to ninety seconds. When the operating stage is reached, proceed without delay to remove the necessary teeth. Anesthesia lasts from one to three minutes. If the induction takes a. long time, the child is likely to become nausea.ted; or if anesthesia is induced on a full stomach, nausea is likely to occur. If for any reason the operation is not completed the first time, do not repeat the anesthetic for at least twelve hours. The complications are rare, but -we must know how to relieve them should they occur. If cyanosis occurs, look for closure of air passages for cyanosis is not caused from the ethyl chloride. If the child stops breathing, use artificial respiration. Syncope is manifested by a sudden change of color and is caused by cerebral anemia. Lower the patient’s head and apply stimulants. Shock is manifested by pallor, fast feeble pulse, shallow respiration, and slowness in returning to consciousness. Keep the patient warm, watch his respiration, and apply stimulants. Ethyl chloride is indicated as an analgesic in children who are not more than fourteen years old for the extraction of deciduous teeth or for any minot oral surgery which will not take over three minutes to complete. It is contraindicated in cases of respiratory obstruction, tuberculosis, bronchitis, anemia, leucemia, or any form of heart lesion, Ethyl chloride may be successfully used by the practitioner, and its success will be determined by his good judgment, careful use, and knowledge of the physiologic action of the agent.