1247
the help of the bacteriologists to settle the matter, for
if they can show that pathogenic organisms are
destroyed by the ionisation of antiseptic chemicals
such as iodine, and are not sensibly affected by the
galvanic current alone, then the case is proved ; also
the biochemists might help us very considerably by
examining the body fluids.
GENERAL ANESTHESIA BY THE INTRA-
VENOUS INJECTION OF ETHYL
ALCOHOL.
BY JULIEN D. CONSTANTIN, M.R.C.S. ENG.,
TO THE MILLER GENERAL HOSPITAL, GREENWICH,
ANESTHETIST
AND THE FRENCH HOSPITAL, SHAFTESBURY AVENUE.
IN view of the premature and mostly inaccurate
publicity given to the method of anaesthesia advocated
by Dr. Miguel Garcia Marin, of the Military Hospital,
Mexico City, it seems desirable to. describe the method
in detail.
Intravenous anaesthesia is not a new thing, but the
use of ethyl alcohol intravenously had not, as far as I
know, been reported until Dr. Marins experiments
became known. The method consists in the administra-
tion, intravenously, of 96 per cent. pure ethyl alcohol
in a solution of glucose. Dr. Marin has been experi-
menting for over four years, during which time he
performed about 700 operations on animals before
applying his technique to operations on human
beings. Some 300 patients have now been anaes-
thetised successfully in this way for various operations.
Dr. Marin gives as his reason for using ethyl alcohol
that it " dissolves lipoids and penetrates by endos-
mosis the protoplasm of the nerve cells, hindering
their metabolism."
He claims that the adoption of the intravenous
route does away with any risk of initial syncope
through direct irritation of the mucous membrane.
Further advantages of intravenous anaesthesia are:
(a) No mask, or other appliances to the face or mouth,
need be used during any operation to the head or face,
which eliminates the possibility of infection from this
source and also leaves a clearer field of action to the
operator. (b) There is less danger of post-anaesthetic
pneumonic complications. (c) The risks of fire during
the use of thermocautery or diathermy are done away
with. (d) The possibility of injury to the eyes from
accidental contact with an irritating anaesthetic is
avoided. (e) Perfect control of administration obtained
(see below). (f) No material effect is noticeable on the
blood pressure. There is an initial rise, but this is of
short duration, and the blood pressure soon falls to
normal again and remains normal.
It is claimed that, since ethyl alcohol is 137 times less
toxic than chloroform, and since surgical anaesthesia
can be obtained with a dose three to four times smaller
than the lethal one, there must be a large margin of
safety.
Technique.
The usual aseptic and antiseptic precautions, as
for any other intravenous administration, should be
taken. An ingenious apparatus has been devised
by Dr. Rooul Ortiz, of Mexico, a collaborator of
Dr. Marin, but a convenient, if not ideal, substitute
may be found in the old Army 606 outfit, interposing a
two-way stop-cock at the junction of the two outlet
tubes.
Two sterile solutions are used, one in each container.
They are : (a) an isotonic solution of glucose, and
(b) a solution of pure ethyl alcohol and glucose-viz.,
30 c.cin. of 96 per cent. ethyl alcohol in 70 c.cm. of a
25 per cent. solution of glucose. Any vein may be
selected to suit the convenience of the anaesthetist or
the surgeon. Once the needle is ascertained to be well
inside the lumen of the vein, solution (a) is allowed to
flow and a few cubic centimetres are injected ; then had a tendency to be perhaps too shallow, but there
the two-way tap is turned over to allow solution (b) was immediately a distinct improvement whenever
to flow at a rate of not more than 10 c.cm. in 30 seconds. the tap was switched over to the isotonic glucose
1 Thesis presented to the National University of Mexico, 1929. control is available during administration.
This rate is more or less maintained until anaesthesia.
has been induced. When anaesthesia, is considered
sufficiently deep, the tap can be turned off ; or at the
discretion of the anaesthetist more anaesthetic or
isotonic solution can be given. The needle may be
held in position during the administration by pieces
or sticking plaster. The dosage is estimated from the
body-weight of the patient (2 to 3 c.cm. of the 96 per
cent. pure alcohol per kg. of weight), but one is
seldom called upon to make use of the maximum
allowance.
Results.
Induction may take from 2 to 15 minutes. There is
no initial stage of excitement such as may occur with
inhalation anaesthesia. Perfect relaxation is said to be
a chief feature, the breathing being very quiet ; and
naturally this is of great assistance to the surgeon in
all abdominal cases. The method should not be
employed for infants or in cases of advanced pulmonary
tuberculosis, but the 300 cases already operated on
have included patients with definite cardiac lesions
and also diabetics. Brights disease is said not to be
a contra-indication. One curious contention is made-
namely, that alcoholics require a dose even smaller
than the average temperate subject.
Surgical anaesthesia is reckoned to last an hour and a
half, but may be prolonged, by giving more anaesthetic,
up to four hours. The recovery is peaceful and there
are no ill-effects, such as vomiting. The patient may
even be fed if the nature of the operation so permits.
There is a period of post-anaesthetic analgesia that may
last three to four hours or more. During the experi-
mental stage there were instances of haemoglobinuria,
but this trouble was soon eliminated when isotonic
solutions of glucose were employed and the correct
dilution of alcohol was adopted, thereby ensuring
proper diuresis.
My acquaintance with this type of anaesthesia is so
far limited to two cases, but I was greatly impressed
by the results obtained. a
The first case was that of a woman, aged 58, with a slight
cardiac arrhythmia, who walked into the hospital a few
moments before the operation for onychogryphosis, and,
therefore, had had none of the preparation one would expect
before an anaesthetic. Her weight was a little over 9 st.
and it was reckoned that her allowance would be about
150 c.cm. of 96 per cent. ethyl alcohol. The induction took
13 minutes and was very peaceful, the anaesthesia being
gradual and uneventful. The corneal reflex was slow in
disappearing. Although the surgical part of the operation
was relatively a small one, I had the opportunity of testing
the relaxation of the abdominal walls by pressure, and
everything seemed apparently as it should be, though I
should hesitate to say whether the patient would have
reacted to incision of the parietal peritoneum at that stage.
The systolic blood pressure, taken just before the anees-
thetic, was 130, and when anaesthesia had been induced it
was still the same. The patient, seen two hours after the
anaesthesia, although conscious to a certain degree, was
somewhat inclined to be " fidgety" with her arms and
incoherent in her speech ; otherwise she seemed to be quite
comfortable. She suffered from incontinence of urine once,
three hours after the operation.
The second case was that of a man of between 50 and 60
years of age, who had an excision of an epithelioma of the
"
upper lip with the diathermy knife. The same solution
as in the first case was again employed, and the total
quantity of alcohol administered was 176 c.cm. The time
of induction here was also 13 minutes, and again there was
no excitement, the man being inclined to be talkative and
apparently experiencing no distress or discomfort. In my
opinion the operation was painlessly performed, and
except for a few twitchings of the facial muscles, due to
direct electrical stimulation, there was no movement of the
body. The patient was conscious almost immediately after
the operation, and an hour and a half afterwards he was
sitting up in bed taking nourishment. He had not vomited,
and he said he did not feel any nausea ; he talked sensibly,
but seemed to be somewhat " merry and bright," as after
a mild potation.
I observed that in these two cases the respiration
solution only. I point this out to show that great