Transactions - Michigan. University. Clinical Society (Volume 1) (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated.1910 Excerpt: ... The chief danger of anesthesia lies in the possibility that there may be a sinking of the blood-pressure. This may be caused by hemorrhage, cardiac insufficiency, or vasomotor paresis. No doubt the causes of low blood-pressure are more or less dependent on one another, and that the maintenance of the blood-pressure is greatly affected by the condition of the heart cannot be denied. Everyone knows the difference in bloodpressure when the heart is strong and when it is weak and insufficient. From a practical standpoint the important thing to know is, what heart conditions or lesions are serious, and which are less important. Thus the question resolves itself into a consideration as to what, as far as the heart is concerned, constitutes a contraindication to a surgical operation or anesthetic. A healthy normal heart may be considered one that is able to do the ordinary amount of work easily and in addition has in reserve a surplus energy which enables it to hold up well even under severe strain. The anesthetic or operation without doubt throws extra work on the heart, and the important question to decide is whether the particular heart under consideration will have the reserve power to bear up under the anesthetic and operation contemplated. As all operations are not the same, each case is a problem by itself. For instance, a heart might be judged as being capable of standing the strain of supravaginal amputation of a fibroid uterus. Yet that same heart would not necessarily have sufficient reserve power for a long and severe radical operation for carcinoma of the cervix. In the treatment of acute pyosalpinx this principle is often recognized. For while one feels sure that the heart can stand the strain of a vaginal incision for drainage, in many cases one wou...