Nineteenth Century Medical Guide

Chapter 143 140. Safety of Anesthesia

Ether itself is a very good general anesthetic. As long as it is used properly, the effect is better than that of laughing gas, and the side effects are much less than that of chloroform commonly used at the same time.

But only if used properly.

With the medical level of the current era, no matter what kind of anesthetic is used, accidents are not uncommon.

If you think of anesthesia as a deep-sea dive that must reach a certain depth, then the anesthetic is the submersible for diving, and the patient is the passenger in the submersible.

Ether has its limitations as a submersible, that is, it can reach the depth required for surgery, but the range of action is very narrow.As a single anesthesia method, its sinking speed is very limited, and there will be a long period of unconscious excitement before anesthesia.

During the exciting period, there will be deep-sea sea monsters such as vomiting and coughing, which will increase the diving accidents.Once being attacked by such symptoms and causing aspiration, without corresponding treatment methods, diving into the sea will easily fail.

Secondly, there is still the problem of the depth of the dive. The operator of ether anesthesia has no concept of dosage at all.Once the amount is too much, that is, the dive is too deep, the submersible may be crushed by the pressure of the deep water, the patient's medulla is paralyzed, and the breathing and heartbeat stop one after another, which is equivalent to death after wandering in the sea.

The tuberculosis patients that Hills operated on before belonged to the former, that is, aspiration was caused during the dive, and Maldos belonged to the latter.

After the nurse noticed the patient's heart rate problem, Watman reacted immediately and started yelling: "Maldos, Maldos, wake up."

Mardos slumped on the operating chair amidst the shaking of the crowd, swinging his limbs wantonly.If you wake up, you will definitely not be able to wake up. Even if you do cardiopulmonary resuscitation now, it will be futile. The power of a large dose of ether cannot be changed by simple pressing.

Mardos was pronounced dead shortly after, with no other emergency medical support.

Just like Hills at the beginning, it was a pity that the patient died, but the operation was not over, nor could it be considered a failure.

"Anesthesia accidents are always inevitable. It may be that Mardos's special physique, which is different from others, cannot withstand the powerful effect of ether. In short, he failed to survive the anesthesia."

Watman first comforted the nurse, saying that it had nothing to do with her operation, and then took the assistants and nurses to say goodbye to the patient's body with deep apology: "Considering the patient's pursuit of beauty during his lifetime, I must clean up the body. With a heavy heart, I continue to complete this operation for him and comfort his lost soul."

The audience also mourned silently, and the sporadic applause expressed their respect for Watman's noble medical ethics.

The operation was able to continue in such a solemn environment.

Carvey had been here for two months, and accidents with anesthesia were not uncommon.

Since the last time Hills’s patient had a problem with the second anesthesia, he was limited to non-anesthesia majors, and he couldn’t immediately come up with a usable ether concentration dosage table, but he can summarize it according to an anesthesiologist named Gaidel in the 30s The stages of ether anesthesia identify the patient's physiological response in the ether safe zone. 【1】

It's a pity that this method of distinguishing the effect of anesthesia by relying on physical signs not only relies on strict physical examination, but also clinical experience.Most doctors do not understand why they do this and are skeptical about the results of this type of physical examination.

Having gone through that regular surgical meeting, Carvey also understood their stubbornness and persistence.

The job of a doctor is to save lives and heal the wounded, and to solve the sickness and pain of patients.They have a selfish side of improving technology, and at the same time it is difficult to accept the fact that "the past operations have caused thousands of patients to die".

So if you don't explain it's your own problem, if you don't listen to the explanation, that's their problem
At 9 p.m., Mardos tragically died in the operating chair.

At 9:35, Mardos' lower eyelid eversion (ptosis) repair was completed.

The successful maxillary resection just now did not leave much excitement on Waterman's face, but more of a look of desolation after losing the patient: "The operation was successful, but Mardos has left us forever .He is really a good boy, down-to-earth and capable, and full of curiosity about surgery.”

Before the dean could finish speaking, Carvey stood up first.

He did not refute the significance of continuing the operation after the death of the patient and the previous anesthesia methods in front of other audiences, but just looked at Watman with his eyes, hoping to seek a one-on-one postoperative conversation with this serious expression.

Carvey wanted to reiterate the importance of the anesthesia dose, but Watman did not agree: "You guys deal with his surgical incision, I need to go to his house to explain everything to the two old people, and I have to prepare for his funeral. "

After speaking, he turned and left the operating theater.

I have no willingness to communicate, and Carvey does not force it. In this special era when "surgeons only talk about surgical techniques and don't care about anesthesia", it is difficult to quickly change the status quo regardless of theory or practice.

What he can do is to do his job well, and use one after another difficult operations that are easier to spread to slowly change the concept of doctors.

Of course, the anesthesia method itself also needs to be changed, and the safety of spinal anesthesia and local anesthesia is higher.

If general anesthesia is to throw the patient into a simple submersible for a deep-sea adventure, then spinal anesthesia is to put the patient on a VR device to watch a deep-sea diving movie, the experience is still an adventurous experience, and the mind is clear , There is no need for the body to take risks.

Simple local anesthesia is even easier, which is equivalent to turning the VR device into a flat video, and it is enough to achieve the effect of watching movies.

With theoretical knowledge, drugs still need to be explored. Carvey does not have the ability to prepare drugs, so he can only search for ready-made compounds that can be used by himself by groping through magazine literature.This method lasted for a month, and it was found that hydrogen peroxide was the biggest achievement, and other aspects still need time to slowly settle.

The most important thing now is the patient, and Carvey needs some "difficult" surgeries to prove his point.

However, limited by the singleness of diagnosis and treatment methods, the Municipal General Hospital has not received any troublesome patients recently.The appendix was arranged by Ignatz, and the cesarean section was almost done. Back at the hospital and looking through the medical records in the surgical ward, Carvey felt a faint sense of loss.

"Three simple inguinal hernias, five bladder stones, and eight cleft lip are all from Mr. Ignatz."

"One bed will undergo amputation of the right forearm, two beds will be resected for small tumors on the back epidermis, and nine beds will be resected by Mr. Heman."

"4 beds of circumcision, 7 beds of urethral dilatation, 10 beds of left foot amputation are mine."

Damirgang stood next to Kawei and finished the simple report work, and quickly explained: "It is also considering that you need to study in medical school and have a laboratory to take care of, so I finished allocating the patients."

Carvey had no objection. The reduction in the number of surgeries was agreed before. Firstly, it was to reduce the burden on himself, and secondly, it was to give more opportunities to other people in the hospital.Besides, there is no need to do these surgeries by yourself, these three should be able to complete them smoothly.

"Have you practiced preoperative anesthesia?"

"Ignatz specially took us to practice together, and he is already very familiar with it."

"That's good." Carvey looked at the ward again, and suddenly asked, "Has the patient named Fernan been here?"

After Damirgang disposed of the original clinic, he had no place to live and stayed in the hospital almost every day.After Carvey's standardized requirements, he has gradually become a resident doctor, and he knows the patients he has handled like the back of his hand:

"Just the patient with bilateral breast hyperplasia? When he was discharged from the hospital, I specifically told him to pay more attention to the changes in his body. If he has some of the symptoms you mentioned, he has to come back for a follow-up visit."

"So he still hasn't come."

Damirgang suddenly asked: "Will the breast hyperplasia disappear? Or there are signs of disappearing, so he didn't come."

Carvey also felt this way, but considering Fernan's age, I'm afraid things are not that simple: "If it is a younger child, because they are in puberty, this hyperplasia will indeed subside. But Fernan has already As an adult, hyperplasia is bound to be accompanied by other diseases, and there is a high probability that it will worsen."

"He was quite anxious at the beginning, and he wanted to get rid of the hyperplasia as soon as possible. If it got worse, he shouldn't have been silent all the time."

"never mind."

Carvey shook his head. In the absence of communication equipment, such things are inevitable.He also has no way to ask all patients to listen to him, and he has to let go when it's time to let go: "Besides him, there is also that young man named Amor, you pay attention recently."

"Is Amor a patient?" Damirgang wrote down the name, "I don't remember it."

"It's not a patient, it's a surgical assistant at Graze Hospital in the East." Carvey said, "He told me recently that he would come to see me, but he didn't say whether he was going to medical school or the hospital. Everything depends on letters. Too much trouble."

"Hehe, what do you rely on if you don't rely on letters?" Damirgang laughed and complained, "It doesn't necessarily depend on telegrams."

Carvey sighed: "Anyway, you help me keep an eye on it. If he wants to visit, let him see your pre-operative anesthesia physical examination. After he's done, let him go to the medical school to find me."

"Ok, no problem."

"I'm leaving first." Carvey glanced at the ward with some reluctance, and patted Damirgang on the shoulder, "If you have a patient who needs complicated surgery or a patient who cannot be diagnosed clearly, please let me know as soon as possible."

"must."

In the eyes of surgeons, anesthesia is a kind of preparatory work similar to disinfection of the body surface. Whether it is successful or not is determined by the ether, and whether it will kill or not is determined by the patient's physique.Suddenly telling them that the effect of ether anesthesia can be changed by relying on a whole set of inspections + dose regulation, it will naturally make them suspicious.

This is like the quality of the food is determined by the ingredients, the taste is determined by the chef's ability, and the diners are only responsible for eating.Now it is said that diners can adjust the taste and taste of the food they eat according to the way they lick their tongues, the strength of their teeth biting, and the speed of swallowing. Presumably everyone will find it weird.

Everyone, including Waterman, felt that way.

However, there will always be some "not so normal" people among the vast majority of normal people. The assistant who gave the second anesthesia to tuberculous peritonitis patients was one of them.

Although Hills has been emphasizing that the patient's death has nothing to do with Amor, the patient still died in his own hands after all.He agreed with Mr. Hills' judgment professionally, but he couldn't forgive himself personally.

After hearing that Carvey proposed a new concept of anesthesia, Amor secretly wrote a letter [2].

The content of the letter is not long, but it mainly expresses my determination to learn.But judging from the speed of replying, he seemed to have considered deeper factors, and still had a lot of concerns about this kind of cross-school study.

Kawei didn't force it either, the outer court didn't care, as long as it could ensure that Ignatz could listen to him.

After separating from his wife, the famous Austrian surgeon devoted all his energy to surgery.Carvey used a new cleft lip surgery to fix Ignatz last time, and this time he promised to fix him again with another updated cleft lip and palate repair procedure.

This is more or less suspected of "bribery", but in extraordinary times, some extraordinary means must be used.The new surgery can benefit many patients with cleft lip and palate, and the physical examination when adjusting the dose of anesthesia can save many surgical patients from misfortune.

Now that Ignatz didn't care about it, Carvey couldn't care less.

At 11 o'clock in the evening, there was a light rain in the sky, and Carvey got out of the carriage, ready to go home, take a bath, and read Dr. Lister's reply to himself.After writing the reply letter, I lay on the bed and continued to read the various magazines and documents I bought.

His life looks very monotonous to others, but it is very fulfilling in his own eyes.

"Doctor Carvey."

Just as the carriage drifted away and Carvey was about to open the downstairs door and enter the house, a voice not far away penetrated the rain curtain and got into Carvey's ears: "Huh? Who?"

"it's me."

A young man walked out of the dark alley next to the apartment building.

Through the gas lamp on the side of the street, Carvey could see that he was wrapped in a rough coat, his cheeks were covered with rain, and his whole body was wet: "Mr. Fernan?"

"I didn't expect Dr. Carvey to remember me." Fernan smiled, his entire facial muscles were a little stiff, "I've been waiting here all night, can you let me?"

Seeing him staring at the apartment building, Carvey nodded: "If you have anything to do, just come in and talk about it."

"Thank you."

Fernan's visit this time was naturally for the change of his condition.

As Carvey predicted before, the hyperplasia of mammary glands deteriorated further, directly evolving from the third degree to the fourth degree, showing a serious sagging state: "Doctor Carvey, can this be cured?"

"Yes, yes." Carvey lit the stove and let him take off his soaked clothes, "But you shouldn't be here just because of these two things."

Fernan was a little surprised at first, but soon turned embarrassing: "Nothing can escape your eyes. If it wasn't because it was too embarrassing, I wouldn't have come here to trouble you."

"Tell me, what's the swelling like?" Carvey did a simple exclusion method when he saw him, basically determined the cause of the disease, and asked, "If I'm not wrong, the place should be getting more and more It hurts."

Fernan tremblingly took off his pants: "You're right, it's really serious."

(End of this chapter)