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The Justification of Special Anesthesia in Obstetrics
868
AMERICAN JOURNAl, OF OBS'rE'fRICS AND GYNECOLOGY
8. The cell volume for the third postpartum day can be calculated at tbe time of delivery from the graph in Fig. 2. If this calculated cell volume is belo\v 30 per cent, that patient should receive a trans· fusion within the first twelve hours following delivery. The amount of blood required depends on the weight of the patient, the blood loss, and the cell volume before delivery. This can also be calculated from Fig. 2. 9. In the toxemias of pregnancy the cell volume during the puerperium deviates from the normal course. The patients with eclampsia and preeclampsia have a greater drop in cell volume than is expected from the blood loss. The reverse is true in the nephritic patient. The low reserve kidney is not a pure type of toxemia as far as the rell volume is concen1ed. 10. 'rhe cell volume determination is a simple, accurate, and reliablt> procedure, and should be used more frequently in obstetrics. REFERENCES
(1) Dieckmann, W. J.: AM. J. OBST. & GYNEC. 26: 543, 1933. (2) Dieckmann, W. J., and Wegner, C. R.: Arch. Int. Med. 53: 71, 1934. (3) Dieckmann, W .•J., and Daily, E. F.: AM. J. 0BST. & GYNEC. 30: 221, 1935. (4) Eden, T. W.: J. Obst. & Gynec. Brit. Emp. 29: 386, 1922. (5) Miller, J. R., Keith, N. M., and Rowntree, L. G.: J. A.M. A. 65: 779, 1915. (6) Oberst, F. W., and Plass, E. D.: AM. J. 0BST. & GYNEC. 31: 61, 1936. (7) Pastore, J. B.: AM. J. 0BST. & GYNEC. 29: 866, 1935. (8) Pastore, J. B.: AM. J. 0BST. & GYNEC. 31: 78, 1936. (9) Peck· ham, C. H.: AM. J. 0BST. & GYNEC. 29: 27, 1935. (10) Plass, E. D., and Bogert, J. J.: Bull. Johns Hopkins Hosp. 35: 36, 1924. (11) Skajaa, K.: Acta Obst. & Gynec. Scandinav. 8: 371, 1929. (12) Stander, H. J., (md Tyler, M.: Surg. Gynee. Obst. 31: 276, 1920. (13) Stander, H. J., and Creadick, A. N.: Bull. Johns Hop· kins Hosp. 35: 1, 1924. (14) Wintrobe, M. M.: J. Lab. & Clin. Med. 15: 287, 1929.
Bittm.ann, o.: The Justification of Special Anesthesia in Obstetrics, Monatsehr. f. Geburtsh. u. Gyniik. 102: 223, 1936. The advantages of spinal anesthesia for operative obstetrics are as follows: Absolute insensitivity of the field of operation, complete relaxation of the lower uterine segment, diminished blood loss as the result of the action of spinal anesthesia in the contractility and retractility of the uterus, absence of worry on the part of the operator, no alteration in the vitality of the newborn babies, subjectively favor· able influence on the puerperium, especially on the involution of the uterus, and therapeutically good results in eclampsia because convulsions diminish. Among the disadvantages the author mentions the drop in blood pressure, which may be serious, especially where there has been a great loss of blood. The danger of severe atonic hemorrhage after the effee.t of the spinal anesthetic wears off may be prevented by the prophylactic injections of pituitary extract and ergot. Pituitary extract perhaps also diminishes the severity of the headache which often follows spinal anesthesia. J. P. GREENHILL.
AMERICAN JOURNAl, OF OBS'rE'fRICS AND GYNECOLOGY
8. The cell volume for the third postpartum day can be calculated at tbe time of delivery from the graph in Fig. 2. If this calculated cell volume is belo\v 30 per cent, that patient should receive a trans· fusion within the first twelve hours following delivery. The amount of blood required depends on the weight of the patient, the blood loss, and the cell volume before delivery. This can also be calculated from Fig. 2. 9. In the toxemias of pregnancy the cell volume during the puerperium deviates from the normal course. The patients with eclampsia and preeclampsia have a greater drop in cell volume than is expected from the blood loss. The reverse is true in the nephritic patient. The low reserve kidney is not a pure type of toxemia as far as the rell volume is concen1ed. 10. 'rhe cell volume determination is a simple, accurate, and reliablt> procedure, and should be used more frequently in obstetrics. REFERENCES
(1) Dieckmann, W. J.: AM. J. OBST. & GYNEC. 26: 543, 1933. (2) Dieckmann, W. J., and Wegner, C. R.: Arch. Int. Med. 53: 71, 1934. (3) Dieckmann, W .•J., and Daily, E. F.: AM. J. 0BST. & GYNEC. 30: 221, 1935. (4) Eden, T. W.: J. Obst. & Gynec. Brit. Emp. 29: 386, 1922. (5) Miller, J. R., Keith, N. M., and Rowntree, L. G.: J. A.M. A. 65: 779, 1915. (6) Oberst, F. W., and Plass, E. D.: AM. J. 0BST. & GYNEC. 31: 61, 1936. (7) Pastore, J. B.: AM. J. 0BST. & GYNEC. 29: 866, 1935. (8) Pastore, J. B.: AM. J. 0BST. & GYNEC. 31: 78, 1936. (9) Peck· ham, C. H.: AM. J. 0BST. & GYNEC. 29: 27, 1935. (10) Plass, E. D., and Bogert, J. J.: Bull. Johns Hopkins Hosp. 35: 36, 1924. (11) Skajaa, K.: Acta Obst. & Gynec. Scandinav. 8: 371, 1929. (12) Stander, H. J., (md Tyler, M.: Surg. Gynee. Obst. 31: 276, 1920. (13) Stander, H. J., and Creadick, A. N.: Bull. Johns Hop· kins Hosp. 35: 1, 1924. (14) Wintrobe, M. M.: J. Lab. & Clin. Med. 15: 287, 1929.
Bittm.ann, o.: The Justification of Special Anesthesia in Obstetrics, Monatsehr. f. Geburtsh. u. Gyniik. 102: 223, 1936. The advantages of spinal anesthesia for operative obstetrics are as follows: Absolute insensitivity of the field of operation, complete relaxation of the lower uterine segment, diminished blood loss as the result of the action of spinal anesthesia in the contractility and retractility of the uterus, absence of worry on the part of the operator, no alteration in the vitality of the newborn babies, subjectively favor· able influence on the puerperium, especially on the involution of the uterus, and therapeutically good results in eclampsia because convulsions diminish. Among the disadvantages the author mentions the drop in blood pressure, which may be serious, especially where there has been a great loss of blood. The danger of severe atonic hemorrhage after the effee.t of the spinal anesthetic wears off may be prevented by the prophylactic injections of pituitary extract and ergot. Pituitary extract perhaps also diminishes the severity of the headache which often follows spinal anesthesia. J. P. GREENHILL.