RESPIRATORY AND CARDIAC CONTROL DURING ENDOTRACHEAL INTUBATION

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Abstract
It has been observed that sinus tachycardia and ventricular arrhythmias may be precipitated by the removal of the face-mask from hypercapnic patients anaesthetized with cyclopropane; the mechanism causing these cardiac disturbances appears to be vagal release following the escape of anæsthetic vapours from the lungs; during anaesthesia the arrhythmias are inhibited by stimulation of the pulmo-cardiac reflexes by irritant anaesthetic vapours in the lungs.The ventricular tachycardias associated with cyclopropane anaesthesia in the presence of hypercapnia may be abolished by the addition of ether to the inhaled gaseous mixture. Ether acts by stimulating the pulmo-cardiac reflexes and causing reflex inhibition of the ectopic cardiac contractions.An anæsthetic technique which facilitates rapid endotracheal intubation has been described. It incorporates the use of cyclopropane, oxygen, carbon dioxide, ether, and atropine. The prevention and the control of the cardiac arrhythmias which may be precipitated by the combination of the above drugs have been described.As the result of observations carried out during 2,000 endotracheal intubations it has been suggested that the cardiac arrhythmias which may follow intubation are due either to vagal release following the escape of anaesthetic agents from the lungs, or to partial asphyxia as the result of bronchospasm precipitated by the insertion of tubes into inadequately anæsthetized patients.It has been observed that it is possible to intubate a patient without causing any respiratory or cardiac upset if moderately deep cyclopropane anaesthesia is used; the use of an electro-cardiograph, with a visual screen, is necessary if cardiac control is to be accurate and safe. The advantages of cyclopropane are its rapid induction and speedy recovery.Some of the disadvantages associated with morphine premedication have been mentioned.The advantages of endotracheal anaesthesia have been described; these appear to be due to the abolition of the Kratschmer reflex by the presence of the endotracheal tube.

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