Anæsthesia in Gynæcology: (Section of Anæsthetics)

The operations of gynaecology are divided into two classes: (1) Minor: including perineal repairs, colporrhaphies, vaginal hysterectomies, dilatations and curettings, etc., and (2) Major: abdominal sections. For both groups routine premedication is a combination of morphia and nembutal, the former in (1/6)-grain, and the latter in 3-grain doses.For Group 1 three methods of anaesthesia are described: (a) Ethylene and oxygen, producing in nearly all cases an adequate depth of anaesthesia without the addition of ether. A safe type of anaesthesia and one from which recovery takes place quickly. (b) Planocaine in 20% solution, made up with sodium bisulphate, as a spinal anaesthetic, described by Mr. Dickson Wright. The dose usually injected is 0.5 c.c. (c) Sodium evipan given intravenously, though rather uncertain in action seems to serve well for such minor operations as curettage and insertion of radium.In Group 2 (major operations), the author's choice is between (a) ether administered with a little additional oxygen to counteract the asphyxial tendency which the Trendelenburg position occasions, and (b) spinal anaesthesia with percaine. For intra-abdominal pelvic surgery the latter is a very safe method for two reasons: (1) The dose required is comparatively small, and (2) the Trendelenburg position helps materially to prevent the fall of blood-pressure which a spinal anaesthetic tends to produce.