Premedication in Anæsthesia

PREMEDICATION is one of the most valuable elements in the production of good anesthesia and is of great psychological importance. Every an3esthetist knows how difficult it is at times to get good relaxation, without deepening the anesthesia to a dangerous degree; with a suitable narcotic administered one hour before operation, these difficulties should be greatly lessened. There would seem to be several main indications for premedication (1) To render the patient sleepy or sedative before coming into the theatre annd to eliminate fear. (2) To shorten the period of induction, and lessen the amount of general anaesthetic needed, without interfering with the depth of the anaesthesia. (3) To diminish the amount of mucus secreted, and to try to avoid post-operative vomiting. (4) To procure a'longer period of insensibility to pain. In the early days when morphia was first used, it was used to deepen the anaesthesia and to prolong the period of insensibility. Later, it was noticed that when morphia was given less-nansthetic was needed. Atropine was added to prevent cardiac inhibition, it also acts as a respiratory stimulant, and so counteracts the depressing effect of morphia, and it inhibits the excessive secretion of mucus caused by ether. To-day more attention is being paid to the psychological effect of premedication, the very definite influence that the mind has over the body being more fully recognised. This is not altogether a new theory, but a very old one that is becoming better understood. It is probable that the amulets and talismen of the early centuries had a psychological value, for there is evidence that some of the sick got well, without any other aid. At a meeting of the Royal Society of Medicine, Dr. Bernard Hollander was able to show from his own experience and of others, that full surgical anwsthesia could be produced by hypnosis.l But this method is not likely to play a large part in the practical administration of anaesthetics, though Dr. Hollander was of the opinion that in certain circumstances hypnosis might replace the preliminary drugs used to procure calm and banish apprehension, and that it might be employed alone or as an aid to induction. One of the elements in the fear induced by the prospect of an anaesthetic, apart altogether from that due to the operation itself, is the fear of the unknown: this is an instinctive fear. Throughout the ages the race has had to be afraid of the unfamiliar and approach it with caution, and in the nervous individual this fear is very much accentuated. In their book, "Outwitting Our Nerves,"2 Jackson and Salisbury quote from Crile (Origin and Nature of the Emotions) : "We fear not in our viscera alone, fear influences every organ and tissue. . . . Nature has one means of response to fear, and whatever