Choice of anesthesia

Abstract

The larger number of anesthetic agents and methods now available make the choice of anesthesia more difficult and confusing but assure the possibility of a more suitable choice than ever. While there are a multitude of factors which may influence the choice of the anesthetic in each case, yet in general the choice is governed by a few broad considerations. Of these the safety of the patient is paramount. Of the more commonly used drugs and methods regional and spinal anesthesia are least toxic and ether most, while chloroform is so toxic as practically to preclude its use. For abdominal operations spinal anesthesia is preferred where technical difficulties are anticipated and field block, or intratracheal gas, or gas ether with field block, for patients in poor condition. Ether is still a good anesthetic especially where equipment is lacking and a skilled anesthetist is not available. For most operations on the trunk and extremities the gases are satisfactory. The barbiturates intravenously are excellent, and tribromethanol is effective for a few operations where only the lightest anesthesia is necessary. Spinal anesthesia is indicated in a few operations especially on the anus and rectum and urinary bladder. For operations on the head and neck the gases or regional anesthesia cover most cases. The field of the surgeon and anesthetist may be kept separate by the use of intratracheal anesthesia, pharyngeal anesthesia or ether insufflation.