Spinal anaesthesia by cocaine in gynaecology : with observations on eighteen cases / by Arnold W.W. Lea.

  • Lea, Arnold William Warrington, 1867-1916.
Date:
[1901?]
Catalogue details

Licence: In copyright

Credit: Spinal anaesthesia by cocaine in gynaecology : with observations on eighteen cases / by Arnold W.W. Lea. 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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    that laid down by Tuffier as the maximum safe one, which is one-fifth of a grain. If this amount is exceeded, dangerous symptoms may develop in rare cases. Thus, after a dose of two-fifths of a grain, symptoms of collapse, with vomiting, pallor, and sweats have been observed. These symptoms may imme- diately follow the injection, or may come on some hours after- wards. Attention was specially called to these symptoms by two Roumanian surgeons—Pitesci, who had operated upon 125 cases, and Severeanu (80 cases)—at the International Congress of Surgery in August, 1900. Great care, then, should be taken not to exceed one-fifth to one-fourth of a grain of cocaine solution for subarachnoid injection. In my series I have never observed any evidence of cocaine poisoning. The symptoms which usually follow the injection— sickness, headache, and rise of temperature—are due rather to disturbances of cerebro-spinal pressure than to the direct toxic effects of cocaine, and have been observed to follow injections of saline fluid into the subarachnoid space. As a precaution, I have in some cases injected half-a-grain of cocaine subcu- taneously the day before making the lumbar puncture, so that any undue sensitiveness to the drug, if present, may be discovered before the operation. VII. The 'possibility of death following the injection. A number of cases have been recorded in which rather sudden death has followed lumbar puncture carried out for exploratory purposes or for the evacuation of cerebro-spinal fluid. Gumprecht7 has collected 18 cases from various clinics, in which death followed quickly after lumbar puncture and could only be attributed to this cause. These, however, were all in patients suffering from serious affections of the central nervous system— hydrocephalus, cerebral tumours, or meningitis. Tuffier, in his series of 250 cases, read at the International Surgical Congress, had 5 deaths. Four of these could in no way be attributed to the anaesthetic, but in one case death occurred the next day. The patient was found to have extreme mitral stenosis, with multiple emboli in the lungs. It is very doubtful if this could in any way be due to the medullary injection. Pitesci, however, 7. Deutsche mtd. Wochenschrift, June 14, 1900.