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PENTOTHAL SODIUM ANÆSTHESIA FOR CYSTOSCOPY
111 administered to patients of other than group 0, the use of the suspension reduces the risk of a reaction due to the transfusion of large quantities of iso-agglutinin. A group of 5 outpatients, who suffered from refractory chronic hypochromic ansemia, received a small series of transfusions, and 4 of these patients derived great benefit which has persisted, so far, for 8-9 months. The rise in .Hb. following transfusion of red-cell suspensions is considered, and a relationship is shown to exist between the amount of Hb. transfused, and therise in Hb. in the recipient. The rate of transfusion, the reciprocal of the rate of transfusion, the volume transfused, the reciprocal of the volume transfused, the age of the red cells, the concentration of the suspension, and the presence or absence of a transfusion reaction have been shown to exert no influence on the rise in Hb. in the recipient. As the Hb.-raising power of any transfusion medium cannot be expressed accurately (or even helpfully) in terms of " so much % rise in Hb. per pint transfused," a simple method of calculating the transfusion volume is suggested ; this method is especially valuable in transfusing the young. The utilisation of red-cell suspensions, which are prepared from a discarded by-product, reduces the calls made on the blood-donor panel. I wish to thank the honorary staff of the Leeds General Infirmary and the Leeds Public Dispensary and Hospital for giving me access to cases under their care, Dr. W. S. Stanbury for the supply of the red-cell suspensions, and Mr. R. C. Palmer for assistance with the statistical analysis. .
recovers consciousness quickly, the cystoscopy may still be continued satisfactorily, since he remains sufficiently stuporous for about ten minutes longer ; during this period he can respond to instructions and appears to be quite comfortable. The withdrawal of the cystoscope may cause a momentary twinge of pain, but the patient rarely remembers this afterwards. The only
patient
complaint on recovering consciousness is, as a rule, a pressing desire to micturate. Delirium and excitement are absent. Unless the injection is made rapidly, the patient will be incompletely anaesthetised, and without supplementary anaesthesia cystoscopy will be difficult ; moreover, complete return to consciousness will be delayed. There is on an average three minutes complete anaesthesia during which the bladder neck and trigone may be examined comfortably. After this time any but gentle movements*of the cystoscope will tend to wake the patient and result in some reaction on his part, but he is easily controlled by a few encouraging words. At the beginning of anaesthesia there was in nearly every case cessation of breathing for varying periods up to half a minute. None of the patients became cyanosed, no anxiety was ever felt, and there was never any need for restorative measures. Ureteric catheterisation was carried out on 11 patients satisfactorily. In all these 0-3 g. was followed by 0-2 g. The patients remained deeply unconscious for an average of three minutes, the average time of operation being ten minutes. The completely anaesthetised period was almost the same as when only 0-3 g. was used; the postanaesthetic stupor was deeper and enabled the catheterisation to be carried out without any trouble. In all cases the patient recovered sufficiently to cooperate fully with the radiographer in the X-ray room adjoining the theatre by the time he was taken there. The ages of patients ranged from 19 to 44 years and there appeared to be no appreciable difference in reaction to the anaesthetic on this score. All patients were able to get off the table with assistance and to walk to their wheeled chairs, although at this time their behaviour and gait were drunken in character ; this was 10-15 minutes after the first injection. Full recovery was invariable within an hour, although at the end of this time some patients still complained of slight muzziness ; they were, however, considered to be fully capable of going home. Except for one patient who complained of violent nausea, there were no unpleasant
REFERENCES
Beumer, H. and Schwartzer, K. (1939) Klin. Wschr. 18, 1604. Castellanos, A. (1937) Arch. Med. Infant. 6, 319. — and Riera, R. (1937) Bol. Soc. cubana, Pediat. 9, 234. Davidson, S. and Stewart, C. P. (1941) Brit. med. J. i, 644. MacQuaide, D. H. G. and Mollinson, P. L. (1940) Ibid, ii, 555. Med. Res. Coun., Lond. (1940) War Memorandum No. 1. Riddell, V. H. (1939) Blood Transfusion, London. Robertson, O. H. (1918) Brit. Med. J. i, 691. Vaughan, J. M. (1941) Lancet, i, 178. Whitby, L. E. H. (1941) Proc. R. Soc. Med. 34, 257. Williams, G. E. O. and Davie, T. B. (1941) Brit. med. J. ii, 641.
PENTOTHAL SODIUM ANÆSTHESIA FOR CYSTOSCOPY
a.ft.nr fPFf’=!
-
GltLlJt:::::.1.- CJtJLC’0.
I. N. BLUSGER F R C S SURGEON EMS, AND TEMPORARY SURGEON TO THE CONNAUGHT HOSPITAL
J. H. DIXON
In 3 cases the recovery of consciousness brought with it evacuation of the bladder alongside the cystoscope ;; this was probably due to the fact that the bladder had been overfilled. When this happened it was found satisfactory to stop the examination for a short period until the patient was sufficiently awake to follow instructions. Cystoscopy, using the above technique, was carried out in a further 5 patients whose ages ranged from 59 to 77 ;the number of cases in this group is so small that we do not feel disposed to express any opinion except to record that results were uniformly satisfactory.
MB CAMB., D A ANÆSTHETIST, EMS
THE purpose of this artiole is to suggest
a method by cystoscopy may be carried out with comfort both patient and the operator. The use of intravenous anaesthesia for cystoscopy is well known, but as used up to date it has been inconvenient for outpatient purposes on account of the long recovery period. Although only 55 cystoscopies have so far been performed, using the
which to the
method of ansesthesia described here, success of the method in all cases seems to warrant publication at this stage. The investigation was primarily conducted with a view to finding a method of anaesthesia suitable for
SUMMARY
outpatient cystoscopy.
.
Method.-In 6 c.cm. of distilled water 0-5 g. of ’Penthothal Sodium’ (Abbott) is dissolved. The patient and instruments are prepared so that the cystoscope can be passed as soon as anaesthesia, is obtained, and 4 e.cm. of the solution (0-3 g. of pentothal) is injected intravenously as rapidly as possible through a no. 14 SWG needle. Needle and syringe are left in situ and the patient is asked to count ; when consciousness is lost a few seconds are allowed to elapse before the cystoscope is passed. The average time taken to lose consciousness was 18 sec. from the beginning of the injection. If the patient was not completely unconscious by this time we administered the remaining 2 c.cm. of the solution, but this was rarely necessary for simple cystoscopy. Where retrograde catheterisation of the ureters was to be carried out 0-3 g. was given, the cystoscope was passed and a further 0-2 g. was injected two minutes later, as rapidly as before. Rapid injection is essential to ensure complete loss of consciousness with the small dose of anaesthetic used, and also to bring about rapid recovery. Though the
’
.
Pentothal sodium anaesthesia has been found successful in 55 consecutive cystoscopic investigations. A dose of 0-3-0-5 g. seems to be completely safe. It is essential to inject the anaesthetic rapidly if adequate anaesthesia is to be attained. FoR SURGEONS’ SoNs.-Under the will of Mrs. Emily Wilson Barkworth grants can be made to the sons of fellows and members of the Royal College of Surgeons of England who need financial assistance to meet the cost of their education at Winchester College.. The number of candidates so far does not suggest that this limited application will lead to sufficient use being made of the income of the trust.- The trustees are therefore considering whether they should apply for permission to make selections from a wider field, but before consenting to any enlargement of the field the council of the college wish to be certain that applications from fellows and members are not likely to be sufficient to ensure full use of the trust. Theytherefore ask if fellows and members who are anxious to take advantage of the bequest will communicate with Sir Alfred Webb-Johnson, PROS, at their earliest convenience.
recovers consciousness quickly, the cystoscopy may still be continued satisfactorily, since he remains sufficiently stuporous for about ten minutes longer ; during this period he can respond to instructions and appears to be quite comfortable. The withdrawal of the cystoscope may cause a momentary twinge of pain, but the patient rarely remembers this afterwards. The only
patient
complaint on recovering consciousness is, as a rule, a pressing desire to micturate. Delirium and excitement are absent. Unless the injection is made rapidly, the patient will be incompletely anaesthetised, and without supplementary anaesthesia cystoscopy will be difficult ; moreover, complete return to consciousness will be delayed. There is on an average three minutes complete anaesthesia during which the bladder neck and trigone may be examined comfortably. After this time any but gentle movements*of the cystoscope will tend to wake the patient and result in some reaction on his part, but he is easily controlled by a few encouraging words. At the beginning of anaesthesia there was in nearly every case cessation of breathing for varying periods up to half a minute. None of the patients became cyanosed, no anxiety was ever felt, and there was never any need for restorative measures. Ureteric catheterisation was carried out on 11 patients satisfactorily. In all these 0-3 g. was followed by 0-2 g. The patients remained deeply unconscious for an average of three minutes, the average time of operation being ten minutes. The completely anaesthetised period was almost the same as when only 0-3 g. was used; the postanaesthetic stupor was deeper and enabled the catheterisation to be carried out without any trouble. In all cases the patient recovered sufficiently to cooperate fully with the radiographer in the X-ray room adjoining the theatre by the time he was taken there. The ages of patients ranged from 19 to 44 years and there appeared to be no appreciable difference in reaction to the anaesthetic on this score. All patients were able to get off the table with assistance and to walk to their wheeled chairs, although at this time their behaviour and gait were drunken in character ; this was 10-15 minutes after the first injection. Full recovery was invariable within an hour, although at the end of this time some patients still complained of slight muzziness ; they were, however, considered to be fully capable of going home. Except for one patient who complained of violent nausea, there were no unpleasant
REFERENCES
Beumer, H. and Schwartzer, K. (1939) Klin. Wschr. 18, 1604. Castellanos, A. (1937) Arch. Med. Infant. 6, 319. — and Riera, R. (1937) Bol. Soc. cubana, Pediat. 9, 234. Davidson, S. and Stewart, C. P. (1941) Brit. med. J. i, 644. MacQuaide, D. H. G. and Mollinson, P. L. (1940) Ibid, ii, 555. Med. Res. Coun., Lond. (1940) War Memorandum No. 1. Riddell, V. H. (1939) Blood Transfusion, London. Robertson, O. H. (1918) Brit. Med. J. i, 691. Vaughan, J. M. (1941) Lancet, i, 178. Whitby, L. E. H. (1941) Proc. R. Soc. Med. 34, 257. Williams, G. E. O. and Davie, T. B. (1941) Brit. med. J. ii, 641.
PENTOTHAL SODIUM ANÆSTHESIA FOR CYSTOSCOPY
a.ft.nr fPFf’=!
-
GltLlJt:::::.1.- CJtJLC’0.
I. N. BLUSGER F R C S SURGEON EMS, AND TEMPORARY SURGEON TO THE CONNAUGHT HOSPITAL
J. H. DIXON
In 3 cases the recovery of consciousness brought with it evacuation of the bladder alongside the cystoscope ;; this was probably due to the fact that the bladder had been overfilled. When this happened it was found satisfactory to stop the examination for a short period until the patient was sufficiently awake to follow instructions. Cystoscopy, using the above technique, was carried out in a further 5 patients whose ages ranged from 59 to 77 ;the number of cases in this group is so small that we do not feel disposed to express any opinion except to record that results were uniformly satisfactory.
MB CAMB., D A ANÆSTHETIST, EMS
THE purpose of this artiole is to suggest
a method by cystoscopy may be carried out with comfort both patient and the operator. The use of intravenous anaesthesia for cystoscopy is well known, but as used up to date it has been inconvenient for outpatient purposes on account of the long recovery period. Although only 55 cystoscopies have so far been performed, using the
which to the
method of ansesthesia described here, success of the method in all cases seems to warrant publication at this stage. The investigation was primarily conducted with a view to finding a method of anaesthesia suitable for
SUMMARY
outpatient cystoscopy.
.
Method.-In 6 c.cm. of distilled water 0-5 g. of ’Penthothal Sodium’ (Abbott) is dissolved. The patient and instruments are prepared so that the cystoscope can be passed as soon as anaesthesia, is obtained, and 4 e.cm. of the solution (0-3 g. of pentothal) is injected intravenously as rapidly as possible through a no. 14 SWG needle. Needle and syringe are left in situ and the patient is asked to count ; when consciousness is lost a few seconds are allowed to elapse before the cystoscope is passed. The average time taken to lose consciousness was 18 sec. from the beginning of the injection. If the patient was not completely unconscious by this time we administered the remaining 2 c.cm. of the solution, but this was rarely necessary for simple cystoscopy. Where retrograde catheterisation of the ureters was to be carried out 0-3 g. was given, the cystoscope was passed and a further 0-2 g. was injected two minutes later, as rapidly as before. Rapid injection is essential to ensure complete loss of consciousness with the small dose of anaesthetic used, and also to bring about rapid recovery. Though the
’
.
Pentothal sodium anaesthesia has been found successful in 55 consecutive cystoscopic investigations. A dose of 0-3-0-5 g. seems to be completely safe. It is essential to inject the anaesthetic rapidly if adequate anaesthesia is to be attained. FoR SURGEONS’ SoNs.-Under the will of Mrs. Emily Wilson Barkworth grants can be made to the sons of fellows and members of the Royal College of Surgeons of England who need financial assistance to meet the cost of their education at Winchester College.. The number of candidates so far does not suggest that this limited application will lead to sufficient use being made of the income of the trust.- The trustees are therefore considering whether they should apply for permission to make selections from a wider field, but before consenting to any enlargement of the field the council of the college wish to be certain that applications from fellows and members are not likely to be sufficient to ensure full use of the trust. Theytherefore ask if fellows and members who are anxious to take advantage of the bequest will communicate with Sir Alfred Webb-Johnson, PROS, at their earliest convenience.