Ether itself is a very good general anesthetic. As long as it is used properly, the effect is better than laughing gas, and the side effects are much less than that of chloroform, which was commonly used at the same time.
But only if used properly.
With the current medical level, accidents are not uncommon no matter which anesthetic is used.
If you think of anesthesia as a deep-sea dive that must reach a certain depth, then the anesthetic is the submersible used 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 its range of action is very narrow. As a single method of anesthesia, its sinking speed is very limited, and there will be a long period of unconscious excitement before anesthesia.
During the excitement period, there will be deep sea monsters such as vomiting and choking, which increases the risk of diving accidents. Once you are attacked by such symptoms and cause aspiration, without corresponding treatment methods, diving into the sea will easily fail.
Secondly, the problem is the depth of diving. The operator under ether anesthesia has no concept of dosage. Once the amount is too high, that is, if the submersible is dived too deep, the submersible may be crushed by the pressure of the deep water. The patient's medulla will be paralyzed, and the breathing and heartbeat will stop one after another. It is equivalent to dying while wandering in the sea.
The tuberculosis patients that Hills operated on before fell into the former category, which meant they aspirated during the dive. Maldos fell into the latter category.
After the nurse discovered that there was a problem with the patient's heart rate, Waterman immediately responded and started shouting: "Maldos, Maldos, wake up..."
Maldos sat slumped on the operating chair while everyone was shaking, swinging his limbs wantonly. He would definitely not be able to wake up. Even if he tried to perform cardiopulmonary resuscitation now, it would be in vain. The power of a large dose of ether could not be changed by simply pressing.
Without the support of other emergency medications, Maldos was pronounced dead a short time later.
Just like Hills, it was a pity that the patient died, but the operation was not completed and could not be considered a failure.
"Anesthesia accidents are always inevitable. It may be that Maldos's special physique, which is different from other people, cannot tolerate the powerful effect of ether. In short, he failed to survive the anesthesia."
Waterman first comforted the nurse and frankly said that it had nothing to do with her operation. Then he deeply apologized and led the assistants and nurses to say a simple farewell to the patient's body: "Considering the patient's pursuit of beauty during his lifetime, I must clean up. With a heavy heart, I continue to complete this operation for him and comfort his lost soul."
The audience also observed a moment of silence, and sporadic applause expressed their respect for Waterman's noble medical ethics.
The operation was able to continue in such a solemn environment.
Kawei has been here for two months, and anesthesia accidents are common.
Since the last time Hills' patient had a problem with the second anesthesia, he was limited to a non-anaesthesia professional and could not immediately come up with a usable ether concentration dose table, but he could follow the summary of an anesthesiologist named Geidel in the 1930s. The stages of ether anesthesia identify the patient's physiological response when in the safe zone of ether. 【1】
Unfortunately, this method of judging the effect of anesthesia based on physical signs relies not only on strict physical examination, but also on clinical experience. Most doctors do not understand the reasons for this and are skeptical of the results of such physical examinations.
After experiencing that regular surgical meeting, Kawei also understood their stubbornness and persistence.
A doctor's job is to save lives and heal the wounded and resolve patients' illnesses and injuries. They have a selfish side of improving technology, and at the same time, it is difficult to accept the fact that "past operations have caused thousands of patients to die."
So if you don’t explain it, it’s your own problem. If you don’t listen after the explanation, it’s their problem...
At 9 p.m., Maldos unfortunately died in the operating chair.
At 9:35, Maldos’ lower eyelid ectropion (ptosis) repair surgery was completed.
The successful maxillectomy just now did not leave much excitement on Waterman's face, but more of a look of loneliness after losing the patient: "The operation was successful, but Maldos left us forever. . He is really a good boy, practical and capable, and full of curiosity about surgery..."
Before the dean could finish speaking, Kawei stood up first.
He did not refute the significance of continuing the operation after the patient died and the previous anesthesia method in front of other viewers. He just stared at Waterman, hoping to use this serious expression to seek one-on-one conversation after the operation.
Kawei wanted to reiterate the importance of the anesthesia dose, but Waterman did not agree: "You guys deal with his surgical incision. I need to go to his house to explain all this to the two old people, and I have to prepare for his death. "
After saying that, he turned and left the operating theater.
I have no desire to communicate, and Kawei does not force it. In this special era where "surgeons only talk about surgical techniques and have no concern for anesthesia," it is difficult to quickly change the status quo regardless of theory or practice.
All he can do is do his job well, and slowly change the minds of doctors with a series of difficult surgeries that are easier to spread.
Of course, the anesthesia method itself also needs to be changed. Spinal anesthesia and local anesthesia are safer.
If general anesthesia is like throwing the patient into a simple submersible to go on a deep-sea adventure where life or death is uncertain, then spinal anesthesia is like putting the patient on a VR device to watch a video of a deep-sea dive. The experience is still an adventurous experience, and the mind is clear. , there is no need to take risks with your body.
Simple local anesthesia is even simpler. It is equivalent to turning the VR device into a flat video, achieving the effect of watching movies.
Now that he has theoretical knowledge, he still needs to explore drugs. Kawei does not have the ability to prepare drugs, so he can only rely on groping through journals and literature to find ready-made compounds that can be used by himself. This method lasted for a month, and I found that hydrogen peroxide was the biggest result, and other aspects still needed time to settle.
The most important thing now is the patient, and Kavey needs some "difficult" surgeries to prove his point.
However, due to 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. When he returned to the hospital and looked through the medical records in the surgical ward, Kawei felt a faint sense of loss.
"Three cases of simple inguinal hernia, five cases of bladder lithotripsy, and eight cases of cleft lip were all treated by Mr. Ignatz."
"The first bed required amputation of the right forearm, the second bed required the removal of a small tumor on the epidermis of the back, and the ninth bed required hemorrhoid removal, which was done by Mr. Herman."
"The 4th bed for circumcision, the 7th bed for urethral dilatation, and the 10th bed for removal of the left foot sole are mine."
After Damirgaon stood next to Kavi and finished a simple report, he quickly explained: "It was also because you need to study in medical school and have a laboratory to take care of, so we assigned the patients."
Kawei had no objection. Reducing the number of surgeries was something we had agreed to do before. Firstly, it would reduce his own burden, and secondly, it would give other people in the hospital more opportunities. Besides, you don’t need to do these surgeries yourself, these three should be able to complete them successfully.
"Have you practiced anesthesia before surgery?"
"Ignatz specially brought us to practice together. We are already very familiar with it."
"That's good..." Kawei looked at the ward again and suddenly asked, "The patient named Fernan hasn't been here?"
After Damirgaon got rid of the original clinic, he had no place to live and stayed in the hospital almost every day. After passing Kawei's standardized requirements, he has gradually become like a resident doctor, and he knows the patients he has dealt with very well:
"As for the patient with bilateral breast hyperplasia? When he was discharged from the hospital, I specifically told him to pay more attention to his physical changes. If he develops some of the symptoms you mentioned, he must come back for follow-up consultation."
"So he still hasn't come."
Damirgang suddenly asked: "Is it possible that the breast hyperplasia has disappeared? Or maybe there are signs of disappearing, that's why he didn't come."
Kavi also feels this way, but considering Fernand's age, I'm afraid it's not that simple: "If it is a younger child, because they are in the period of puberty, this growth will indeed subside. But Fernand has already As adults, hyperplasia will inevitably be accompanied by other diseases, and it will most likely get worse."
"He was quite anxious at first and wanted to get rid of the growth as soon as possible. If it got worse, he shouldn't have been silent all the time."
"never mind."
Kawei shook his head. In the absence of communication equipment, this kind of thing is inevitable. He couldn't ask all patients to listen to him. He had to let go when it was time to let go: "Besides him, there is also a young man named Amor. Please pay attention recently."
"Amor...is he a patient?" Damirgang wrote down the name, "Why don't I remember it?"
"He's not a patient, he's a surgical assistant at East End Graz Hospital." Kawei said, "He recently told me that he would come to see me, and he didn't say whether he was going to medical school or the hospital... Oh, what? It’s too troublesome to have to rely on letters to communicate.”
small book booth
"Haha, what can we rely on if we don't rely on letters?" Damirgang complained with a smile, "I don't necessarily rely on telegrams."
Kawei sighed: "Anyway, keep an eye on it for me. If he comes and wants to visit, let him see your pre-operative anesthesia physical examination. After that, let him go to the medical school to find me."
"Ok, no problem."
"I'm leaving first." Kawei glanced at the ward with some reluctance and patted Damirgang on the shoulder. "If there are patients who need complicated surgeries or patients whose diagnosis is unclear, be sure to tell me as soon as possible."
"must."
In the eyes of surgeons, anesthesia is a kind of preparation work similar to body surface disinfection. Whether it is successful or not depends on the ether, and whether it dies or not depends on the patient's constitution. Suddenly telling them that the effect of ether anesthesia can be changed by relying on a complete set of examinations and dosage adjustments will naturally make them suspicious.
This is just like the ingredients have the final say on the quality of the food, and the chef has the final say on the taste. The diners are only responsible for eating. Nowadays, it is said that diners can adjust the texture and taste of the food they eat based on the licking method of their tongue, the strength of their teeth, and the speed of swallowing. I think everyone will find it strange.
Everyone, including Waterman, feels that way.
However, among the vast majority of normal people there are always some "not so normal" people, and the assistant who gave secondary anesthesia to patients with tuberculous peritonitis was one of them.
Although Hills has been emphasizing that the patient's death had nothing to do with Amor, the patient still died in his own hands after all. He agreed with Mr. Hills's judgment professionally, but emotionally he could not forgive himself.
Ever since he heard that Carvey proposed a new concept of anesthesia, Armor secretly wrote a letter [2].
The content of the letter is not long, but it mainly expresses your determination to learn. But judging from the speed of replying to the letter, it seems that he has taken into account deeper factors and still has many concerns about this kind of cross-campus learning.
Kawei didn't force it, the outer court had nothing to do with it, as long as he could ensure that Ignaz would listen to him.
After separating from his wife, the famous Austrian surgeon focused all his energy on surgery. Last time, Kawei used a new cleft lip surgery method to treat Ignatz, and this time he promised to use another newer cleft lip and palate repair method to treat him again.
This is more or less suspected of "bribery", but in extraordinary times, extraordinary means must be used. The new surgery can benefit many cleft lip and palate patients, and the physical examination when adjusting the anesthesia dose has saved many surgical patients from misfortune.
Since Ignatz doesn't care about it, Kawei won't care even less.
...
At 11 o'clock in the evening, it started to rain lightly in the sky. Kawei got out of the carriage and planned to go home, take a bath and read Dr. Lister's reply to him. After writing the reply, I lay on the bed and continued reading the various magazines and documents I bought.
His life may seem very monotonous to others, but in my eyes it is very fulfilling.
"Dr. Kavey..."
Just as the carriage was fading away and Kawei was about to open the door downstairs and enter the house, a voice not far away penetrated the rain curtain and penetrated into Kawei's ears: "Huh? Who?"
"it's me."
A young man walked out of the dark alley next to the apartment building.
Through the gas light on the street, Kawei could see that he was wrapped in a coarse cloth coat, his cheeks were covered with rainwater, and his whole body was wet: "Mr. Fernand?"
"I didn't expect Dr. Kawei to still remember me." Fernand smiled, and the muscles on his face were a little stiff. "I have been waiting here all night. Can you let me..."
Seeing him looking at the apartment building, Kawei nodded: "If you have anything to do, just come in and talk."
"Thanks."
Fernand's visit this time was naturally due to a change in his condition.
Just as Kawei had predicted before, the breast hyperplasia worsened further, evolving directly from the third degree to the fourth degree, showing a state of severe sagging: "Dr. Kawei, can this be cured?"
"Yes, yes." Kawei lit the stove and asked him to take off his soaked clothes, "But you should not be here just because of these two things."
Fernan was a little surprised at first, but soon became embarrassed: "It's true that nothing can escape your eyes. If it wasn't because I was too embarrassed, I wouldn't have come here to trouble you."
"Tell me, what's the swelling like?" When Kawei saw him, he did a simple elimination method, basically determined the cause of the disease, and asked, "If I guessed correctly, that place should be getting worse and worse recently. It hurts."
Fernan took off his pants tremblingly: "You are absolutely right, it is indeed serious..."
