抄録
This paper deals with the painless delivery by means of the application of Hyaluronidase, in addition to the Demerol, for local anesthesia 46 cases were proved to be very satisfactory.
1) Demerol was administered for the preceding anesthesia, and for pudental nerve and for outer-pudendum. 5, 000 V. U. M. of Hyaluronidase and 100 cc of 1% novocain added with Bosmin were used for infiltration anesthesia.
2) Since Demerol affects higher synccptic conditions of fetus, its dose was limited within 105 mg and was injected into mother's upper arm. In this method, anesthesia continued about an hour and a half. Therefore, the said injection was conducted at the time of crowing for primpara or after opening of four finger with at the ostium of uterus in case of para, as a rule.
3) As for local anesthesia of pudendum, the said 1 % novocain was prepared in a 20 cc syringe with a 8 to 10cm intramuscular needle. Physician's first and middle fingers were inserted into vagina for searching of spina ischiadica, with the leading of the fingers, the said needle was placed into the inside of tuber ischiadicum, and 10 cc of the said preparation was injected into the nearest sourrounding tissues of spina ischiadica. Then the said needle was changed with hypodermic needle, and 20 cc of the said liquid was injected into labia minors, commissura posterior and perineum, for the infiltration anesthesia. An appropriate time for the injection is 30 to 40 minutes before the delivery.
4) 76% of the total cases was perfect anodynia, 13% was thankful slight anodynia delivery. Therefore, 85% of the total cases was of satisfactory in the decrease of pain.
5) No harmful reactions upon the use of demerol for mother were observed. Almost no influences were seen in blood pressure and pulse. Travail was generally restrained in its slightest restrait-action.
6) The most suitable dose of Demerol will be 135 mg and 70 mg was probably somewaht insufficient dose. However, because of individual difference, partial injection of smaller dose may be more desirable.
7) Even the amount of 105 mg of Demerol may sometimes cause respiratory troubles in born-baby. Therefore, oxygen inhaler and baby heater are always desirable in maternity room. The characteristics of syncope by Demerol was weak cring of baby for hours after recovery and continuation of slight cyanosis. For the prevention of syncope, injection of vitacampher into born-baby's head was effective. As the last resort, the said injection into heart shall be tried. Cyanosis and syncope of born-baby appeared in 15%, and 6%, respectively.
8) As for local anesthesia, hyaluronidase was administered to promote the absorption of the medicine and to reduce oedema. Moreover, pains in lateral incision and stitching of perineum were sufficiently prevented.
9) As for a deect of this method, it will take more than 20 minutes to reach satisfactory anesthesia. Therefore, in case of a rapid delivery, it may be of little use.
10) When the quantity of medicine and starting time of injection are carefully settled. This method will be very satisfactory one.
