[Anesthesia in thoracic surgery].

Premedication must now be considered. It is desirable that the patient should be drowsy before the operation, but full basal narcosis is not always to be recommended, since it is important that the coughing reflex should have returned immediately after the operation, and, indeed, the patient should as a rule be able to cough voluntarily before leaving the table. If local analgesia only is contemplated, full basal narcosis is definitely unwise since reflex movements might occur and as the patient is non-cooperative he may become uncontrollable. For these reasons, it is the writer's practice to give a preliminary hypnotic such as morphine (or omnopon or opoidine) and scopolamine about i hour before the operation. These drugs are usefully combined with atropin in the "Hyoscine Compounds 'A' and 'B' ", the former being suitable for the average female and the latter for a male. If a patient is known to react badly to morphia, two or three capsules (3 to 41 grains) of nembutal are substituted. In children, rectal paraldehyde in doses of about 50 minims per stone body weight in a Io per cent. solution in water is useful. If for any reason a full basal narcosis is considered essential, intravenous sodium evipan should be used, as its rapid elimination usually leaves the patient with intact reflexes after operation.