Anaesthesia in rectal surgery.

Twenty years ago the anaesthetics given at this hospital were with few exceptions of two sorts. For all the small cases such as haemorrhoids, fissures and fistulae a short deep anaesthetic was given. This was administered by means of a Clover's inhaler. For carcinoma of the rectum the routine treatment was a preliminary colostomy, followed two or three weeks later by a perineal excision. Open ether was given for the colostomy and for the perineal excision a spinal anaesthetic was used. The spinal solution used in those days was stovaine prepared according to Chaput's formula and consisted of IO per cent stovaine, io per cent sodium chloride and i c.c. of distilled water. This solution could be relied on to produce anaesthesia for about one hour after which its effects started to wear off. If the operation was not completed by this time a light general anaesthetic was given for the remaining period. Caudal block was occasionally used for some of the small cases but its effects were very variable. Sometimes it was slow in working and at other times it only produced a slight analgesia. The patients did not take kindly to it. With the arrival of low spinal anaesthesia general anaesthesia was largely abandoned for the small cases. An injection of 0 4 c.c. of the stovaine solution was injected with the patient in the sitting position and after remaining seated for a minute or two he was placed on his back and wheeled into the theatre. For several years this proved to be a very satisfactory procedure. With the appearance of nupercaine on the market stovaine was gradually abandoned and at the present time up to o.8 c.c. of the heavy nupercaine solution is used for all the cases requiring low spinal anaesthesia. Its action lasts for a minimum of two or three hours and thus it prolongs the time after operation when the patient may need the injection of an opiate. Of recent years local anaesthesia has been employed for numerous cases of fissure and haemorrhoids. The local anaesthetic solution is usually injected into the area by the surgeon himself and sometimes, as in the case of nervous patients, pentothal