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British Journal of Anaesthesia, 1930, Vol. 7, No. 3 120
© 1930 The Board of Management and Trustees of the British Journal of Anaesthesia

correction

ADDENDUM

O. G. MORGAN, F.R.C.S.

For some time avertin anæsthesia has been used by me more or less as a routine in the Ophthalmic Department at Guy's Hospital. Children and one or two elderly patients with some renal deficiency, have been excluded. Atropin suiph. 1/100 and morphine hydrochior. 1/4 are injected before hand, and the dose of avertin has varied in adults from 0.06 to 0.08 gm. per kilo according to the nature of the operation. The results have been extremely satisfactory, especially where a local anæsthetic has been added.

For intraocular operations cocaine is instilled into the conjunctival sac; for removal of the eye this is reinforced by a retrobulbar injection of novocaine if the smaller dose of avertin is given. For removal of the lacrymal sac, muscle operations, or plastics on the lids, a small injection of novocaine is ample to keep the patient perfectly quiet. If the larger dose of avertin is given, the local an is usually unnecessary. Occasionally the patient has moved or remarked sleepily about pain, or the eye, but in all cases there has been complete amnesia.

The method is extremely satisfactory for urgent intraocular operations on an acutely inflamed eye.

The operator has plenty of room in which to work, plenty of time, and there is none of the increased venous engorgement which one gets with a general anæsthetic and which makes the operation so much more difficult. Several cataract extractions have been performed under avertin, but the patient's control of his own eye is of such enormous advantage to the operator, that I would only use avertin in these operations in the case of an extremely nervous individual.

During the operation an airway was usually inserted, and none of the patients seemed to resent this. There was, as a rule, some cyanosis of the face and lips, shallow breathing alternating with intervals of deep breathing due to the morphine, but the pulse kept full and slow, and never gave cause for any anxiety.

There was post-operative vomiting in one case only; others waking up slowly and quietly, and putting no strain on the operated eye.


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