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Sodium Evipan; A New General Anesthetic
CORRESPONDENCE exceptional value. He had lived the greater part of his life in a region abounding in trachoma and was firmly convinced that this disease was based on a lymphoid constitution and that this in turn was due to constitutional 'deficiencies resulting from constitu tional syphilis, tuberculosis, alcoholism or other causes lowering the resistance, causing a deficiency of calcium, making ready susceptibility to the infective ele ment passing from one to another. So insistent was he on the presenta tion of his convictions that at times he urged them perhaps too importunately and too insistently but his teaching has already born fruit throughout Italy in more extensive treatment of the youth in the schools. In prolonged medico-legal debate carried on between himself, Cirincione, de Bono and Gennaro on the relation ships between a pituitary tumor and an earlier traumatism, principles were laid down that were of fundamental im portance and would make a valuable text-book. His wide general scholar ship, his knowledge of the arts and sci ences, his familiarity with foreign tongues, his mental alertness, and his prodigious activity made Angelucci easily one of the most noted ophthal mologists of his time. His pupils were innumerable, many of them have them selves become celebrated teachers. His loss will be felt wherever civilization is found, but the results of his labor will endure. Requiescat in pace. Park Lewis. Jose de Jesus Gonzalez Dr. Jose de Jesus Gonzalez, a promi nent Mexican ophthalmologist of Leon, passed away some weeks ago. Dr. Gon zalez was a member of the Mexican Ophthalmological Society, a corre sponding member of the Academy of Medicine in Mexico City and a prolific writer in ophthalmology, having con tributed for many years to the Anales de Oftalmologia of Mexico, to the Gaceta Medica and other journals. He also published some papers in the American Journal of Ophthalmology. He was considered one of the leading ophthal
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mologists in his country and regularly attended the periodical meetings of the Medical Congress, where his articles and opinions were sought and re spected. Besides being an ophthalmolo gist he was interested in the medical ex amination of school children, and wrote an excellent book on School Hygiene which was used extensively in Normal Schools as a text book, and by medical inspectors as an authority on the sub ject. Some years ago he undertook the building of an eye clinic giving not only of his time and services but his own money to make possible in the midst of the civil war which ravaged Mexico, the construction and functioning of the hospital. On the 25th Anniversary of his graduation, 1922, he collected in two volumes "Estudios de Oftalmologia" and "Estudios de Neurologia" all the papers he had published on theses sub jects. A man of character and great integ rity a religious and pious soul, an inde fatigable worker and a sincere and loyal friend, his untimely death is a great loss for ophthalmology and his country. Manuel Uribe Troncoso. CORRESPONDENCE Sodium Evipan; A new general anesthetic Every so often comes the announce ment of a new agent for local or general anesthesia, usually heralded by an im pressive array of figures to prove how harmless it is or how efficacious or how rapid or how what not. During the course of the subsequent eighteen months, from six to ten further articles in praise of the preparation accumulate with probably one or two adverse criti cisms. By that time the various larger clinics are trying it and within about two years the real value has been de termined and the anesthetic has its place established in the cosmos. During the past year, a large number of articles have appeared in the German literature extolling the virtues of a new general anesthetic used by the intra venous route, called Sodium Evipan
450
CORRESPONDENCE
(Evipan Natrium). It is a barbiturate with a complex chemical formula. The anesthesia is complete within sixty sec onds from the beginning of the injection and lasts from fifteen to twenty minutes. There is a complete muscular relaxation, sufficient to permit of any type of surgery. The big advantages to the ophthalmologist are twofold; the elimination of the anesthetist from the neighborhood of the operative field, and the complete absence of excitation, or nausea, or vomiting upon awaking. Other general anesthetics possess one or the other of these advantages, but none have both. Sodium Evipan is used as a freshly prepared 10 percent solution and is in jected intravenously. The amount varies with the age, weight, and general condition of the patient, the maximum dosage being 10 c.c. The only known contra-indications are asthma, disease of the liver (the drug is eliminated rapidly by the liver), and such general debility as would render any anesthetic hazardous. The danger to life seems to be slight, as twenty thousand injections have been reported from one clinic with but one fatality. The first 4 c.c. must be injected very slowly, not faster than 1 c.c. per fifteen seconds. After that the rate of injection may be increased. The patient falls asleep, the eyes shutting and the jaw dropping, in from thirty to sixty seconds from the time the injec tion is started, that is to say, after 2 to 5 c.c. have been injected. The opera tion may be started when 2 more c.c. have been injected. The pulse rate rises
rapidly up to 130 or 140 per minute, but within four minutes is nearly normal again. A slight drop in blood pressure occurs simultaneously. The effects of the anesthetic last from fifteen to twenty minutes, depending upon the amount used and upon the weight and vitality of the patient. If more time is required, 2 c.c. additional may be in jected just before the patient wakes and repeated if necessary. Awakening from this anesthesia is not accompanied by any physical or mental excitation nor by any physical discomfort such as nausea. No untoward after-effects have been noted. I have used this anesthetic in about a dozen cases: enucleations, iridectomy upon painful eyes, muscle operations in apprehensive individuals, and other ophthalmic operations that require not more than fifteen minutes. Sodium Evi pan seems to fulfill the needs of the ophthalmologist for a general anes thesia of short duration unaccompanied by physical excitement or exertion upon awakening. Harry S. Gradle. ERRATUM In the review of Moreno's book on "Hospital de la Santa Cruz y San Pablo de Barcelona. El servicio de oftalmologia del Profesor I. Barraquer," on page 264, line IS, second column, para graph two in the March, 1934, issue of the Journal, the sentence should indi cate that it is the surgeon who is sitting and not the patient.
449
mologists in his country and regularly attended the periodical meetings of the Medical Congress, where his articles and opinions were sought and re spected. Besides being an ophthalmolo gist he was interested in the medical ex amination of school children, and wrote an excellent book on School Hygiene which was used extensively in Normal Schools as a text book, and by medical inspectors as an authority on the sub ject. Some years ago he undertook the building of an eye clinic giving not only of his time and services but his own money to make possible in the midst of the civil war which ravaged Mexico, the construction and functioning of the hospital. On the 25th Anniversary of his graduation, 1922, he collected in two volumes "Estudios de Oftalmologia" and "Estudios de Neurologia" all the papers he had published on theses sub jects. A man of character and great integ rity a religious and pious soul, an inde fatigable worker and a sincere and loyal friend, his untimely death is a great loss for ophthalmology and his country. Manuel Uribe Troncoso. CORRESPONDENCE Sodium Evipan; A new general anesthetic Every so often comes the announce ment of a new agent for local or general anesthesia, usually heralded by an im pressive array of figures to prove how harmless it is or how efficacious or how rapid or how what not. During the course of the subsequent eighteen months, from six to ten further articles in praise of the preparation accumulate with probably one or two adverse criti cisms. By that time the various larger clinics are trying it and within about two years the real value has been de termined and the anesthetic has its place established in the cosmos. During the past year, a large number of articles have appeared in the German literature extolling the virtues of a new general anesthetic used by the intra venous route, called Sodium Evipan
450
CORRESPONDENCE
(Evipan Natrium). It is a barbiturate with a complex chemical formula. The anesthesia is complete within sixty sec onds from the beginning of the injection and lasts from fifteen to twenty minutes. There is a complete muscular relaxation, sufficient to permit of any type of surgery. The big advantages to the ophthalmologist are twofold; the elimination of the anesthetist from the neighborhood of the operative field, and the complete absence of excitation, or nausea, or vomiting upon awaking. Other general anesthetics possess one or the other of these advantages, but none have both. Sodium Evipan is used as a freshly prepared 10 percent solution and is in jected intravenously. The amount varies with the age, weight, and general condition of the patient, the maximum dosage being 10 c.c. The only known contra-indications are asthma, disease of the liver (the drug is eliminated rapidly by the liver), and such general debility as would render any anesthetic hazardous. The danger to life seems to be slight, as twenty thousand injections have been reported from one clinic with but one fatality. The first 4 c.c. must be injected very slowly, not faster than 1 c.c. per fifteen seconds. After that the rate of injection may be increased. The patient falls asleep, the eyes shutting and the jaw dropping, in from thirty to sixty seconds from the time the injec tion is started, that is to say, after 2 to 5 c.c. have been injected. The opera tion may be started when 2 more c.c. have been injected. The pulse rate rises
rapidly up to 130 or 140 per minute, but within four minutes is nearly normal again. A slight drop in blood pressure occurs simultaneously. The effects of the anesthetic last from fifteen to twenty minutes, depending upon the amount used and upon the weight and vitality of the patient. If more time is required, 2 c.c. additional may be in jected just before the patient wakes and repeated if necessary. Awakening from this anesthesia is not accompanied by any physical or mental excitation nor by any physical discomfort such as nausea. No untoward after-effects have been noted. I have used this anesthetic in about a dozen cases: enucleations, iridectomy upon painful eyes, muscle operations in apprehensive individuals, and other ophthalmic operations that require not more than fifteen minutes. Sodium Evi pan seems to fulfill the needs of the ophthalmologist for a general anes thesia of short duration unaccompanied by physical excitement or exertion upon awakening. Harry S. Gradle. ERRATUM In the review of Moreno's book on "Hospital de la Santa Cruz y San Pablo de Barcelona. El servicio de oftalmologia del Profesor I. Barraquer," on page 264, line IS, second column, para graph two in the March, 1934, issue of the Journal, the sentence should indi cate that it is the surgeon who is sitting and not the patient.