Monday, October 26, 2020

TILIF #16: From behind the ether screen

A surgeon observing a case today asked if it would be okay if he peered over the blood brain barrier. This was a tongue in cheek reference to the cloth drape that separates the sterile surgical field ("blood") from the head ("brain") of the patient, behind which the anesthesiology provider monitors the airway. The double meaning, is that the surgeons our glorified mechanics that deal with blood and the anesthesiologists are "the brains," doing a lot of physics, physiology and pharmacology, to keep the patient alive despite the surgeons best efforts to the contrary.

TILIF that the original name for this dividing drape was the "ether screen." The first widely used anesthetic was ether, a clear volatile liquid that quickly turns to a gas when not in an enclosed bottle. This is also the substance that you see depicted on TV and film by splashing a bottle onto a rag before holding the rag to a unsuspecting victim's face before they promptly fall asleep*.

So, back before we had well-controlled anesthesia techniques and form-fitting plastic facial masks, the ABSOLUTELY BONKERS standard of care was called "open drop" ether anesthesia. The anesthesiologist would simple drip ether slowly from a bottle onto a rag that was placed on the patient's face. As the liquid evaporated, the patient would breath it in and lose feeling/consciousness. You titrated the dose by... dripping it from the bottle faster or slower. But recall that there aren't any masks or tubes involved, which means that this gas is free to spread anywhere, including to the surgeons who may be quite close to the patient's face. To limit the intoxicating effects on the people with the knives, anesthesiologists started putting up a barrier to keep this heavier than air gas from wafting down the body. Interestingly, the anesthesiologists did not have any such protections,

*This would actually be pretty dangerous, as an overdose would cause the patient not just to pass out, but to stop breathing, likely for long enough to cause serious hypoxic injury.

2 comments:

  1. Those calculations are pretty basic.... enjoy these immensely!

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  2. I was given either when I was a child, on two separate occasions. It was so scary, I felt so helpless, still conscious for what seemed like a long period of time. I could hear the Doctor and those assisting talking. I experienced red devils swirling around me each time.

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