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Canadian Journal of Anesthesia, Vol 7, 379-398, Copyright © 1960 by Canadian Anesthesiologists' Society

A Study of Chloroform Anaesthesia in a Precision System: II. The Effect on Circulatory Dynamics and Anaesthetic Morbidity

ALLEN B. DOBKIN M.D.1, LESLIE C. SKINNER M.B.1, and HUGH J. JOHNSTON M.D.1

1 Department of Anaesthesia, University of Saskatchewan College of Medicine and University Hospital, Saskatoon, Sask.

Chloroform with nitrous oxide and oxygen was administered to 154 patients during major operations, employing a precision noh-rebreathing system with a calibrated vaporizer. Artificial respiration was provided with a pressure regulated ventilator designed by Takaoka, and pulmonary ventilation was set to the requirements of the individual patient. Smooth maintenance of anaesthesia was accomplished in this system with 0.5 to 1 per cent chloroform, 65 per cent nitrous oxide, and small supplements of muscle relaxant drugs. This method sufficed to produce satisfactory operating conditions without inducing cardiovascular depression. Dimethyl d'tubocurariue was preferred to gallamine as the muscle relaxant, because the latter sometimes caused prolonged tachycardia.

The only alteration in the vital signs that was frequently observed was a slowing of the pulse rate. This was effectively treated with atropine. A moderate reduction in the estimated stroke volume and cardiac output was also observed, but this was of the same degree as was seen with the Fluothane–diethyl ether azeotrope. Cardiac arrhythmias in these cases were significant by their absence even in those patients with serious cardiovascular disease.

Postoperative recovery from anaesthesia was not significantly slower than that observed after Fluothane. The incidence of postoperative nausea and vomiting was somewhat higher than average, but was similar to that seen with other anaesthetics for the particular operations in which it was used. Postoperatively serious cardiovascular depression attributable to the anaesthetic agent alone was not seen. The incidence of postoperative jaundice was regarded prominently because it was expected to occur, more often after chloroform than after other anaesthetics, but this was not evident when the data of this study were reviewed, Surgical mortality was not higher after chloroform anaesthesia than after other anaesthetics for similar operations by the same surgeons.

This study shows that chloroform has, in fact, been inordinately maligned as an anaesthetic for major operations. When used with the same care and precision as are expected for other potent agents, it undoubtedly has a place in clinical practice along with the other halogenatecl anaesthetic vapours.

Note:

Read at the Second World Congress of Anesthesiologists, Sept. 4–10, 1960, Toronto, Ont.






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Copyright © 1960 by the Canadian Anesthesiologists' Society.