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August 18, 1928


JAMA. 1928;91(7):514. doi:10.1001/jama.1928.02700070074024

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To the Editor:  —In The Journal, July 21, page 192, is an answer to the Bessesen Clinic relative to "Statistics of Spinal Anesthesia." I disagree with the following statements: "A Trendelenburg position may be employed but only after the anesthesia in the lower extremity has appeared, indicating that the drug is fixed to the lumbar segments.Patients must be placed in the Trendelenburg position immediately after the injection has been made. Subarachnoid block causes circulatory changes inherent to the method, and all the other symptoms associated with it are chiefly subordinate to these changes. Respiratory failure following the injection of an anesthetic solution into the subarachnoid space is the result of acute anemia of the brain. Anemia of the brain is induced by unnecessarily keeping the patient too long in the erect position or head up, with the intention of avoiding gravitation or diffusion of the drug to the brain

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