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too far under. If you keep the patient in this state, you need not worry that you are giving your patient too much or too little ether. In regard to the administration, I start oft' with a few drops of a fifty per cent, solution of menthol in alcohol. This buy synthroid will eliminate some of the un- pleasantness of the odor and also act as a soothing agent to the mucous membrane of the respiratory organs. I then give my ether drop by drop on a single layer of gauze, very slowly and giving plenty of room on top for the admittance of air. I gradu- ally increase the number of drops and add another layer of gauze. My patient is now accustomed to the odor and has not experienced any of the un- pleasantness of which his friends have told him, and he breathes in a normal and natural manner. I steadily increase the number of drops and gradu- ally increase the number of layers of gauze, and in from three to five minutes the patient passes through the primary stage without suffocation or synthroid mg choking sensations. In this stage you will find the respirations accelerated, the blood pressure slightly increased, the pulse full and bounding, the color re- flex heightened, and the order synthroid online pupils dilated. The special senses are disturbed, though in what order I cannot say. If in this stage you administer the anesthetic in too concentrated a form, you will find that your patient has difficulty in breathing, complains of a feeling of suffocation, coughs, and turns his head from side to side. As the second stage, or what is commonly called the stage of excitement, and incorrectly so, comes on, the number of drops and the layers of gauze are increased. Never try to hasten this stage, but keep on administering your ether drop by drop. Rarely do I see any excitement, struggling, holding of breath, or cyanosis during this stage, the patient passing through it gradually and quietly, with a very slight stiffening of the bodv. The pupils order synthroid continue to be dilated and mobile, mucus and saliva are freely secreted — the excess should be wiped away — the face is flushed, and perspiration appears on the face and other parts of the body. The pulse is still accelerated, full, and bounding. In this stage apnea may occur, but this phenomenon disappears as the patient becomes more and more deeply anesthetized. As the patient passes into the third stage, the respir- atory muscles become more flaccid and there is synthroid mcg no longer any danger of respiratory interference. As we pass into the third stage, the respirations are now full, regular, and generally audible. A soft stertor may be considered normal, but if breath- ing buy cheap synthroid becomes strongly stertorous, it is an indication of some obstruction in the airway. I consider the respirations the princijial synthroid buy online guide to the depth of nar- cosis. When the regular, automatic respiratory action is obtained, it should be maintained, bearing in mind slight variations in different patients and the field in which the surgeon is operating. Cy- anosis should at all times be considered a dan- gerous symptom. We find the pulse in this stage slightly accelerated, full, and bounding, but regular. The face is usually flushed. Blood pressure, as a rule, remains constant. The pupils, when no pre- liminary medication has been given, will be found to be slightly dilated or normal and to react to light. The eyeballs may be fixed, but sometimes may be rolling, a condition I have found in a number of cases. I have briefly gone over the different stages cost of synthroid of ether anesthesia and told what occurs in the dif- ferent stages when ether synthroid tablets is properly given. The patient is now ready for the surgeon. From now on, it is the duty of the anesthetist to keep his pa- tient in a state of narcosis to such an extent that the reflexes synthroid levothyroxine will not be interfered with ; he should not have his patient too far under the influence of the ether nor should he have his generic synthroid patient half anes- thetized. You will find that if you use your ether carefully and drop by drop, you require very little ether to keep your patient in this happy price of synthroid condition. In a series of forty-five cases of operations in the upper abdomen, in which the combined method of ether and the anociassociation technic of Crile were used, I found that the amount of shock and the amount of ether were greatly diminished in all. The cases were of such a nature that a great amount of shock would be expected, such as draining of the gallbladder, removal of where to buy synthroid the gallbladder, gastro- enterostomies, and the breaking up of adhesions in the upper abdomen. In several cases the nitrous oxide, ether, oxygen method, in association with the method of Crile, was used with even better re- sults than when ether alone was used. In the consideration of the anociassociation, we are brought to a question of trauma. We know that no pain is felt during a surgical operation in which the patient was anesthetized, say, with synthroid cost ether, but we know that while some of the brain cells are anesthetized, all of them are not for the simple reason that if they were, we should kill our patient. Now the question is asked. What eft'ect purchase synthroid online has trauma under surgical anesthesia upon the cells of the brain which are not. as you might say, anes- thetized but wide awake? Again, if under surgical anesthesia the traumatic impulses cause an excita- synthroid cheap tion of the wide awake cells, what influence, if anv. June 5, iqisJ BAKER: PROGRESS IN CHILD HYGIENE. purchase synthroid 1 169 has it upon the anesthetized cells? Whether the anesthetized cells are influenced synthroid online must be synthroid price determined by noting the physiological functions after anes-

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