Anesthesia In Heart Disease

Categories: Uncategorized
Sources: Disturbances Of The Heart

While no physician likes to give an anesthetic to a patient who has

valvular disease of the heart, and no surgeon cares to operate on

such a patient unless operation is absolutely necessary, still in

valvular disease with good compensation the prognosis of either

ether or chloroform narcosis is good.



When there are evidences of chronic myocarditis or a history of

broken compensation and the borderline of ompensation and

dilatation is very narrow, or when there is arteriosclerosis, the

danger from an anesthetic and an operation is much greater; it may

be serious, in fact, and the decision must be made whether or not

the operation is absolutely necessary. Under any circumstances it is

understood that the anesthetist must be an expert, as there can be

no carelessness and nothing but the best of judgment in causing

anesthesia when there is cardiac defect.



The anesthetic to select is a subject for careful decision, as one

cannot assert which anesthetic is the best.



While chloroform seems occasionally to cause a fatty degeneration of

the heart, or if given too rapidly at first may cause sudden death,

especially in cardiac weakness, ether has its disadvantages, owing

to the increased tension (especially if there is likely to be much

valvular or cerebral excitement), and the greater amount of ether

that must be given, with the attendant danger to the kidneys, which

may have been disturbed from the cardiac conditions. Generally,

however, the better method is perhaps to administer first chloroform

to the point of producing sleep and then to change to ether, the

first mild chloroform narcosis preventing the ether from causing

acute stimulation, and ether being better for the operation, as it

is more of a stimulant. Some anesthetists believe that it is better

to administer morphin, with perhaps atropin hypodermically before

the anesthesia, and then to use ether. Nitrous oxid gas would be

contraindicated as tending to increase arterial pressure, and

therefore endanger a damaged heart; it is a serious danger to

damaged blood vessels.