A NEW ANAESTHETIC.

Hauraki Plains Gazette, Volume XXXVIII, Issue 5129, 23 May 1927, Page 4

A NEW ANAESTHETIC.

ElO7 AND ITS CLAIMS. DRAWBACKS OF SOME DRUGS. The ideal anaesthetic is still undiscovered. W& need a substance pleasant to take and absolutely safe to administer. It must be rapidly absorbed and as rapidly got rid of ; it must minimise the shock which operation inflicts on the nervous system ; it must cause adequate relaxation of muscles, so as to make the surgeon’s task less difficult, and it must leave the patient as healthy as it found him.

This is asking a great deal ; winch makes it the more astonishing how nearly these requirements are already met by the methods in common use (says the medical correspondent of the “Observer”). The people, who once condemned antesthesia because it interfered with Natur&’s design would certainly be distressed if they knew how comfortably their descendants undergo extensive alterations ami repairs.

Nevertheless, an even higher efficiency is being confidently sought, and if perfection remains beyond the horizon it is not ,because there have been no advances during the last few years.

Many different compounds have recently been on trial, but most of them, though partly successful have hardly justified the enthusiasm of their first sponsors. Probably the same fate will eventually attend the latest anaesthetic called ElO7, whose discovery by chemists of the German Dyestuffs Federation was announced by Professor Unger to the Berlin Medical Association recently. In the meantime the claims made suggest that it has remarkable qualities.

Though the composition of ElO7 is as yet a secret, i,ts effects have been investigated by seven independent observers on several hundred cases. Administered rectally into the intestine-, it is found to produce unconsciousness and complete muscular relaxation wtihin four or five minutesThere arc no unpleasant symptoms during induction, and there are none when the patient comes round from the anaesthetic. The only blot on the picture seems to be that in a few cases—possibly because the compound used was not fresh —it caused intestinal irritation, whilst in some others the- patient became blue and needed artificial respiration. Evidently the drug is unsuited to certain subjects, but it is claimed that these can now be detected before the- treatment is given, all danger being thus avoided. There are, of course, several different ways of giving anaesthetics. For instance, opium diminishes pain and sensibility if given by the mouth ; Epsom salts (magnesium sulphate), though harmless when taken internally, is a powerful anaesthetic if injected under the skin, whilst drugs such as hedonal may be injected either into a vein or into a muscle to facilitate or produce surgical anaesthesia.

Such methods obviate the- use of a mask or mouthpiece, and they do not lead to bronchial irritation or pneumonia. They have, however, one serious disadvantage—the dose of anaesthetic has to be estimated in advanceand cannot easily be regulated to the patient’s actual needs during the operation. Some other anaesthetic may thus have to lie given as an adjuvant.

This objection applies with considerable force to the rectal administration of anaesthetics such as ElO7. It is hard to say how much or how quickly a drug will be absorbed .from the lower intestine, and within fairly wide limits absorption is uncontrolled

by the anaesthetist. Much good evidence- will be needed to persuade medical men that a new drug given in this way is really safer than such time-honoured anaesthetics as ether and laughing-gas (nitrous oxide), whose dose can be adjusted with every breath the patient draws.

Accepting the need for easy regulation of dosage, research has largely been directed towards finding a new respiratory anaesthetic safer than chloroform, less irritating to the lungs than ether, and more useful in major operations than laughing-gas. Chief, perhaps, among the substitutes recommended ’have been acetylene, ethylne-, and propylene—gases hitherto better known in other walks of life.

Acetylene proves to be a faiidy safe anaesthetic, but, -of course, it is very inflammable, and patients object to its smell, which can only be removed by elaborate purification. Narcylen, which consists of oxygen ’and purified acetylene flavoured with .pine oil, is used a good deal on the' Continent. Ethylene is growing in . popularity, and may find ,a permanent place in practice, but it does not relax muscles nearly so well- as either. Propylene, dichloren, and many other compounds are on tlujir trial, and have not so far come- into general favour.

Until something better can establish itself ether, chloroform, ethyl

chloride, and laughing-gas remain in routine use in this country, and in competent hands they give excellent results. The combination of oxygen with laughing-gas, the use of carbon dioxide- to stimulate respiration and thus wash excess of ether out of. the lungs, and the prevention of shock by regional injection of local anaesthetics —these measures are daily improving the technique and results of surgical operation. The more special methods also have an increasing number of successful exponents—for example, the injection of, anaesthetics into the spinal canal, which removes sensation only from particular regions, according to the requirements of the case.

The general level of training and skill in anaesthetics is steadily rising. Whilst ft has been objected that the number of deaths under anaesthesia has lately increased, it is ‘necessary to remember that improved methods enable the surgeon to operate- on a. larger percentage of serious or desperate cases than formerly.