0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

ANALGESIA WITH NITROUS OXIDE-OXYGEN-CURARE FOR MAJOR SURGERY IN THE POOR-RISK PATIENT

Morris L. Heller, M.D.; T. Richard Watson Jr., M.D.; Robert C. Storrs, M.D.
JAMA. 1956;161(16):1534-1542. doi:10.1001/jama.1956.02970160014004.
Text Size: A A A
Published online

• Experience with more than 200 patients, most of them between the ages of 70 and 95, showed that anesthesia with nitrous oxide, oxygen, and a relaxant of the curare group gave excellent results in major surgery, provided certain precautions were observed. Premedication consisted of secobarbital sodium, scopolamine hydrobromide, and either morphine or meperidine hydrochloride. The type of gas machine is important because of the superiority of the demand-flow, fractional, or nonrebreathing technique. The induction must allow a period of 15 to 30 minutes for denitrogenation, during which the patient settles down to an equilibrium that can be maintained, in some patients, with an oxygen percentage of 30 to 50%. The relaxants used were gallamine triethiodide, succinylcholine chloride, or tubocurarine, the last named being avoided in patients with pulmonary fibrosis, emphysema, or bronchial asthma. The relaxant was administered only when denitrogenation was believed to be complete.

The anesthesia was kept light, so that the electroencephalograms resembled the records from the wakeful state. Several experiences here described convinced the authors that deep anesthesia greatly increases the danger of hypotension and that changing from ether to nitrous oxide obviated the need for vasoconstrictor drugs. The fact that nitrous oxide does not depress the respiratory center, does not irritate the respiratory epithelium, and does give adequate alveolar ventilation was shown by detailed biochemical studies in 13 patients. It is believed that this type of anesthesia permitted more deliberate, extensive, and definitive operations in poor-risk patients.

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Tables

References

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();