• The anesthetic technique here recommended for intrathoracic surgery begins with premedication by 50 mg. of secobarbital given orally and 0.4 mg. of atropine sulfate hypodermically. For induction, 0.5 % solution of thiopental is given by intravenous drip until consciousness is lost. A drip of 0.2% solution of succinylcholine is then started and allowed to run until apnea occurs. Thereafter the anesthesia is maintained by giving a 50-50 mixture of nitrous oxide and oxygen by endotracheal tube. No more thiopental is given. The succinylcholine drip is resumed intermittently whenever it is needed to maintain the apnea; it is discontinued when the chest wall is being closed. The intermittent use of succinylcholine to keep the patient just apneic is called the "in and out of apnea technique" and has several advantages. This method of anesthesia has been used in 253 operations on the chest, including 115 mitral commissurotomies and 22 circumferential mitral sutures. The last-named group accounted for 8 of the 14 instances in which ventricular fibrillation developed. Defibrillation was accomplished in eight cases. The nitrous oxide affords good control of the degree of analgesia, and the succinylcholine helps to provide ideal operating conditions.
Schotz S, Bloom SS, Helmsworth FW. SUCCINYLCHOLINE AND INHALATION ANALGESIA FOR MAJOR CARDIAC AND PULMONIC SURGERY. JAMA. 1957;163(5):345–347. doi:10.1001/jama.1957.02970400017006
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