The Medical Curriculum

Eventually, after a latent period of nearly 20 years, it slowly dawned on me that if the patient was anaesthetized with nitrous oxide and oxygen, the novocain not only performed no useful function, but was actually a nuisance, in that its vasodilator effect counteracted the adrenaline. On omitting the novocain, the adrenaline can be reduced to I in 500,000 in normal saline. If this solution is used for infiltration at least 20 minutes before the surgeon makes his incision, a practically bloodless field results, and I have never seen either tachycardia or arrhythmias result. From the reasons given above I think it doubtful whether trichlorethylene itself caused fibrillation in this specific case, but at the same time our knowledge of the effects of the drug upon the cardiovascular system in man is far from complete and the publication of any additional data is valuable.I am, etc.,