The problem of anaesthesia for thoracoplasty.

In the earlier years of the operation of thoracoplasty speed was the primary aim of the surgeon in order that shock and poisoning by toxic general anaesthetics should be kept to a minimum. Presently there was a revolt against this outlook and the operation came to be conducted in more leisurely fashion under local anaesthesia. This change made accurate dissection possible and produced a genuine reduction both in mortality and in the frequency of extension of the disease in the immediate post-operative period. It did not, however, abolish these accidents, nor did they disappear even when operations were carried out on patients to whom streptomycin was being given.23 Further, unless sedatives were given in so great doses that the cough reflex was abolished for long perIods the performance of the operation under local anaesthesia involved the infliction of a considerable amount of pain and discomfort on the patients. Since the other advantages of local anaesthesia for thoracoplasty, viz., quiet respiration and an avascular field, can readily be produced by modern methods of general anaesthesia it will be seen that the sole justification for the retention of relatively barbarous techniques of anaesthesia for thoracoplasty must lie in their influence on mortality and spread rate, and it is primarily with these that the present paper is concerned.