THE INDUCTION OF ANAESTHESIA IN PATIENTS LIKELY TO VOMIT WITH SPECIAL REFERENCE TO INTESTINAL OBSTRUCTION

Abstract

Vomiting or regurgitation during the induction of anaesthesia is a special hazard and the type of patient at risk is detailed. The preparation of such patients for operation is described and the care that must be taken over aspiration of the stomach contents is emphasized. The use of cricoid pressure during induction is considered to be valuable. The induction of anaesthesia using intravenous agents is described for cases in whom the advantages outweigh the risk of regurgitation, but the method preferred by the author is a purely inhalational technique. This method is described in detail and is based on a nitrous-oxide, oxygen, ether sequence using carbon dioxide as a respiratory stimulant. The disadvantages of a thiopentone-relaxant technique are considered and some of the reasons for believing that an inhalational technique is safer are given. Aspects of the recommended technique examined include the effects of hyperventilation on the vomiting mechanism, the carbon dioxide levels used, and the subsequent course of anaesthesia. Other techniques which may be used in special circumstances, with special reference to intubation whilst the patient is conscious, are considered.