Local Penicillin Therapy in Diseases of the Mouth. E. Stangl. Praxis, Sehweiz. RUI~~~~HII f. Mtd 30: 3, 194R.

.I:. 1’. P.

ANESTHESIOLOGY Preanesthetic Medication and Choice of Anesthetic Agent. Harold Carron. .T. JJloridn .tl.

I\. 37: 32, .rdJ-, 1949.

The aclministration of sedative mid ligmotic drugs prior to Dhe induction of anes- thesis hw long l~een a part of rant ine orllera prescrilw0l by the operating surgeon, l)ut in fact these 4lrllgs are actually a part of the whole ancwthet.ic procedure. Their in!luenw is exerted on the anesthetic awl not on the surgery. It is imperative, therefore, that the proper tlrugs lw prescribed for the type of nnestlirsia to lw twployc~l.

Proper prcanesthetic medication results in R cooperatire patient with anxiety re- lieve& met.nl~olic activity reduced. pain threshold heightened, and amnesia for t.he opera- tive 11rw~lurc5 and itnesthetie irltluot,ion, Intlividualieed nIt~di(~:ltion further eliminates respiratory irregularities during the induction of anesthcsin and vagd and carotid sinus reflexes. These desirable effects must, however2 be oldained withont depression of cirwla- tion: respiration, or compensatory mechanisnls.

The three main rlnssifiwtions of drugs uwtl ns pre:intWlwtic~ mcdkation are: (11 the narcot.ic*s (morphine and its su?ditutes), (2) the 11elIatlonna group (atropine trnrl scq~ol:mmine), and (3) the barl~iturates. Morphine has proved the most efficient of t.he narcotics for preme(lication. for its efFects are more consistent than those of Demerol. .Jt produces less cardiac and respiratory slowing than IMautlitl, an11 may be used in smaller doses than J?ant.opori. Jmproper timing of the administration of preanesthetic narcotics is most frcquenl.l~- responsible for excitement during induction, undue respiratory de- pression (Illring the iulestheai:L, ant1 l)rc)longetl postanestllcticd Ilepression. M:hen gi\,en SIIII-

cutanconsl?; the maximum optimal eBect of morphine is ol)t.ained in sixty to ninetv ntinutes, irlt.rnlllus~ularl~ in thirt!- to sixty minutes, and intravenously in approximately fifteen minutes. >lorphine atlministerecl prior to emergenc:y surgery sliould always I)e given intravenonsly (slowly) in ortler that. xde~pmte setlatitjn ma, Ibe obtained prior to the irltluction of anrsthesin.

Among the functions of the I~elladonna group of drugs arc the tlepression of IIIII~~IIS

secretions, the tleJ)ression of vagal reflexes, and respiratory stimulation to overcome the depressant elrocts of morphine. Scopolamine has the advantages over atropine in equivalent doses of producing amnesia, psyhic sedation, greater peripheral elferts on serre- tionr. and better respiratory et.imulation. These drugs are most etticwious when nsrtl iI1 the r:ttio of I:25 with rnorpliillc.

l\arl)iturutes as premeditation permit the use of impotent tknesthetie agents? in- crease the llypnotic en’cct, and protect against Che convulsive manifestations of cocaine nntl proanine poisoning.