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anaesthetised. For this type of case, therefore, other drugs have to be
used. The two in common use are Ethyl Chloride and Vinesthine. Until
last year the former held the field but was rather unsatisfactory for several
reasons. It has a pungent smell which gives rise to screaming and
struggling; children are "dazed" for from five to ten minutes after
recovery; vomiting during this period is common and there is frequently
lack of bladder control during the operation. This last complication
causes much distress and embarrassment among accompanying relatives.
Last year with the discovery of Vinesthine all this was remedied. Most
children go to sleep quietly, vomiting is rare, bladder control the rule
and recovery so sudden that the child walks out of the surgery with little
or no assistance. About a teaspoonful of the drug is dropped into a
rubber bag where it immediately vapourises and it is breathed in and
out through a mask covering both nose and mouth. When the patient is
asleep the mask is removed and anaesthesia lasts any time up to two
minutes according to the length of administration.
A Dental-Anaesthetist's task is not solely limited by the actual
administration of gas. Thus he has to steady the head and insert or
change mouth gags from one side to the other, but his chief pre-occupation
is to ensure that nothing obstructs the free flow of gases or air in and
out of the lungs. During extractions of lower teeth the jaw is apt to be
depressed and as the tongue is attached to its lower surface this latter
may be pressed against the back of the throat thus preventing the patient
from breathing. Gentle upward pressure under the chin remedies this.
Again, a tooth (or tooth splinter) may fly out of the forceps and lodge in
the windpipe. If large enough this would cause death by suffocation
unless an immediate operation were performed upon the neck and the
windpipe opened up below the obstruction. Even small pieces of tooth
might be sucked into the lungs and there give rise to infection. We
therefore consider it of the utmost importance that before any teeth
are touched, a gauze pad should be pressed into the back of the mouth.
This pad is porous enough to permit breathing to take place but will
prevent anything from being sucked into the lungs. A long piece of silk
cord is attached to such pad to enable it to be recovered if any attempt
is made to swallow it.
Such are the various duties of an anaesthetist which may be summed
up in the terse motto of the Canadian Society of Anaesthetists, "We watch
closely those who sleep."