Points from Letters: Asthma and the Inhaler

Abstract

On Dec. 18, 1944, a man aged 68 underwent partial cystectomy under light spinal " nupercaine " and light general anaesthesia. While the abdominal wound was being closed the anaesthetist reported that the patient had stopped breathing. On examination his was a typical case of white asphyxia. By the time cardiac massage was started through an upper abdominal incision three to four minutes must have elapsed. He was given nikethamide, and artificial respiration was commenced at the same time. Cardiac massage had been carried out for about two minutes when the heart started beating again. Some adrenaline was injected into the heart muscle. The patient was returned to the ward, andl by slow drip one pint (568 ml.) of blood was given, along with an intramuscular injection of suprarenal cortex extract. The patient was still in deep coma at 9 p.m. The night nurse reported: " Patient seems to be semiconscious , but is very dazed." In the morning to my great surprise he was semiconscious and irrational. He was restless for a few days, and from Jan. 1, 1945, his condition improved. On Jan. 3 he was fully conscious, but on the 4th he again became restless, and was not able to pass urine. Two stitches were removed from the suprapubic wound and a large blood clot taken away. Next day, as he did not improve, the suprapubic wound was reopened under local analgesia and intravenous " pentothal," a blood clot removed, the bladder washed out, and a suprapubic drain put in. Progress was satisfactory until Jan. 12, when the upper abdominal wound burst open, with protrusion of omentum. Under local and regional analgesia the abdominal wall was resutured. Progress was uneventful, and he was discharged fit, passing urine normally. He was sent to see Dr. F. M. R. Walshe and Dr. Parkinson. Both reported no organic changes as a result of the asphyxia. When last seen he was fit and active.