Continuous Spinal Anesthesia in Colon Surgery

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PATIENTS requiring surgery of the large bowel are frequently poor operative risks because of age and degenerative vascular disease. The depleting effects of chronic or acute obstruction, large infected ulcerating cancers, and the ravages of ulcerative colitis also increase operative risk. Under such conditions impairment of the nutritional status and deficiencies in the circulating blood volume are found.

It has seemed wrong to us to subject such patients to the depressing and otherwise deleterious effects of anesthesia by ether and other inhalation agents. Single injection spinal anesthesia has the disadvantage of adding hypotension to the already depleted circulating volume. In the past three years we have used continuous spinal anesthesia administered in fractional doses. This type of anesthesia has several outstanding advantages. (1) The anesthetic can be confined to the area to be operated upon. (2) The total dose can be “controlled” and is minimal as compared to single injection technics. (3) Hypotension can be avoided or minimized by fractional doses. (4) Operative procedures of any magnitude may be carried out with little worry over time consumption since the anesthesia may be prolonged by added injections.

Since January 1950 we have used continuous spinal anesthesia to perform 505 resections of the colon with nine deaths; a hospital mortality of 1.7 per cent. There can be little doubt that the lowered mortality or morbidity in colon surgery is partially due to safer anesthetic methods.

Continuous spinal anesthesia administered in fractional doses with the ureteral type catheter causes minimal disturbance to the . . .



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