A note on thrombosis in the veins of the pelvis and lower extremities after operations / by K.G. Lennander ; (translated from the Swedish by I. Walker Hall).

  • Lennander, Karl Gustav, 1857-1908.
Date:
1900
Catalogue details

Licence: In copyright

Credit: A note on thrombosis in the veins of the pelvis and lower extremities after operations / by K.G. Lennander ; (translated from the Swedish by I. Walker Hall). Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    occurred during; three years. As a rule the foot of the bed is raised from 15 to 30 centimetres (from six to 12 inches) but during convalescence it can be lowered to from 10 to 15 centimetres (from four to six inches), and the latter height ought to be maintained in many cases even when the patient has returned home. In cases of cardiac lesions or cardiac debility and in those of local venous changes the elevation is even more important. The elevation should then be from 25 to 40 or 50 centimetres (from 10 to 15 or 19 inches) for the first few days. Cardiac tonics, digitalis, camphor, strychnine, and subcutaneous or intravenous salme injections should be administered before and after narcosis in all cases of cardiac debility. With famished and emaciated patients subcutaneous injections may be given of from 500 to 1000 cubic centimetres (from 17 to 35 ouncesdpf solution of grape sugar (strength from 5 to 10 per cent.Tas well as injections of olive oil, from 50 to 200 cubic centi- metres ^ronpjmeLjyn3_a n ounces) in 24 hours 'With from 2 to 3 per cent, of alcohoft The injections can be given in such a way that from 5 to 10 per cent, dextrose and from 2 to 3 per cent, alcohol may be added to normal saline solutions, but 10 per cent, dextrose solution causes pain during and after injection and shows a little sugar in the urine. It is equally important to suit the narcosis as far as possible to the patient’s condition (viz., morphia, CH013, ether combined with local anaesthesia, &c.) in order to maintain the circulation and in this way prevent throm- bosis. According to Ziegler thrombosis is caused (1) by slowing of the blood-stream, and (2) by local vascular changes. In laparotomy and hernia patients there are several conditions leading to slowing of the blood-stream and more particularly in the veins of the lower extremities. Many have weak hearts from long illness and are feeble almost to starvation point. Hence after the anaesthetic one often fears fatty degeneration of the cardiac muscle. Furthermore the circulation in the calf of the leg in weak patients may be almost stagnant from the continued supine position, and if there are any varicose veins (especially saccular, where the sacs communicate with the main vessel by narrow orifices) the blood readily stagnates. Laparotomy patients are also frequently troubled by more or less “ meteorism ” and each increased tension of the bowels increases the intra-abdominal pressure, diminishes the extent of inspiration, lowers the negative intra-thoracic pressure, and so lessens all the forces