My first Anaesthesia
MY FIRST ANAESTHESIA AND PRIVATE PRACTICE
During my PG study at SCB Medical College,way back in eighties, I was staying in hostel but used to come home often at 4,Gautam Nagar, Bhubaneswar, that was my fathers official residence.
During that time Dr S N Mohanty who was 2 years senior to us but finished MBBS and internship along with us had started a nursing home, Sunder Nursing Home probably the 1st Nursing home of Capital city , Bhubaneswar. A very small one compared to many at present with just 6-7 cabins, a reception, an OT, two doctors chamber.
Prof A M Naik FRCS, a renouned surgeon of that time used to operate in the nursing home. We being friendly during undergraduate Medical college, used to visit the nursing home occasionally.
One-day he asked me, “Prasanna, why do not you give anaesthesia here”, by that time I had finished my Post Graduation in Anaesthesia theory exam and about to appear my , oral and practical examination.
“OK, what is the case, ?”
“ A 12 year old boy with cystic hygroma in neck”. “Sir will do it tomorrow evening” He added.
“I am sure you can do it”.
I agreed. During that time Ether, rather open ether Anaesthesia was widely practised. Boyle’s Anaesthesia machine was available only in Medical colleges. Practising Anaesthesiologists at Cuttack used an Air ether apparatus. A simple device with provision of air flowing in one direction only with an exhalation valve. I did not had one.
“Open ether will be Ok with Sir “ I asked.
“No problem with sir, as you decide”, he replied.
Nextday while returning from SCB Medical college, I purchased a tea strainer from Ranihat, a bottle of ether. Reached Nursing home, much before time. Saw the boy and checked if he has any cough and cold. Saw a medium size swelling in the neck right side. Auscultated his heart and lungs. No ECG, No evaluation and clearance by cardiologist. We have our own tests to evaluate a normal cardiac status. I do not remember what kind of blood tests were done. But surely a stool and urine test. Probably a DC and Hb was enough.
Everything looked normal. The parents were more anxious than the boy. Prof Naik was supposed to reach around 5.30 pm. 30 mins before I gave an injection of atropine 1 amp ingluteus muscle in his room. When Prof Naik arrived in his car the boy was called into OT room. I do not remember if We had started an IV drip or not.
Hesitantly he came into the room. With a little coaxing he was made to sit on the table eagerly looking all around. All new faces and covered with a white mask. He was made to sleep on the table with a little force. By that time I had cut the plastic handle of the tea strainer , it became a rounded mask and I covered it with 4 layers of gaudge piece. When I brought in the face mask towards the face the pungent odour made him move his head away. I had to fix his head as well as put ether drops on the mask at a rate of approximately 100 drops / min.There were 2-3 assistants who restrained his legs and hands.It was not a easy job. He held his breath for some time then cried out. Initially one needs high concentration. He cried and pleaded to leave him, the more he cried more ether vapour he inhaled. I could feel the strong ether vapour coming out during his expiration. I continued my act like an expert knowing my job fully well.Within a minute the boy was motionless and breathing spontaneously without any fight. An I.V line was placed on his forarm and a bottle of Glucose saline was started. There was no venous cannula during that time. Glucose saline flowed drop by drop through a needle that was fixed into the vein. Some one was assigned to hold that hand , probably tied to the table.
I poured more ether drops to continue and reach a surgical stage, that was known from the pattern of respiration. There was no ECG monitor or SpO2 probe. In between we checked the radial pulse or near the head superficial temporal artery pulsation.
Prof Naik who was ready by that time with Surgeons glove and dress came to table applied antiseptic on the part and covered the site with sterile clothes.In those times the clothes were autoclaved but the instrument is were boiled in water for 30-40 mins. That was a little discomfort as we shared the head end of the patient to work. Before he put incision he looked at me, I had added more ether to suppress the reaction to incision. I nodded my head in positive,though I was a bit anxious as well. The incision was painless and there was no movement, I silently breathed heavily.
Ether is a volatile anaesthetic, it quickly evaporates at room temperature. From the face mask the patient breathes in this vapour and anaesthetised. While exhaling the same vapors fill the room air but gets diluted and does not ffect us unless one puts his head close the the face mask. Many a times ice is formed in between the layers of gauze , as the moisture from expired gas becomes wet and ice forms and obstructs the flow of air. Like an expert I knew when to change these layers and put new ones.
In between I had to check his pulse and look at his pupil to estimate the depth of Anaesthesia along with type of respiration, that guides us when to stop or add more of ether drops on to the mask to maintain optimum anaesthesia state for the surgery. More importantly there is a trick to hold the mask so that he breaths easily, as in an unconscious patient the tongue falls and one can not breath properly. That also strains my left hand. I do not remember applying an airway ,( a metallic curved device placed in side mouth that prevents fall of tongue, we use these days often a plastic one)
Luckily for me this patient needed lesser depth than a surgery in Abdomen. This adminstartion of ether vapour is a continuous process that needs balance , and this one lasted for about 30 mins. Prof Naik was a great surgeon no doubt.He did his job precisely and removed the liquid filled tumour along with its walls from the neck,He was assisted by only one nurse.The bleeding vessels were tied with cat gut almost obsolete these days. Also application hot tetra ( 4 layers of gauge stitchedtogether,size of a handkerchief) .Finally the skin which was cut for about 4 to 5 fingers long was closed with skin stitch with simple cotton thread sterilised by puting it in boiled water for 10-15 mins.
Towards the end of stitch before applying a skin ointment and surgical dressing, I stopped and removed the mask from his face and felt his breath clearly as as lifted this chin and head a bit for unobstructed breathing. About 15 mins later his breathing pattern also changed slightly, When I pinched his ear lobule he responded with movement of hands after a while the boy cried a kind of soft moan. In another 5 mins he cried. Thats when I gave a sigh of relief. My patient is OK, and I remembered the age old dictum, “Patient cries ,Anaesthetist Laughs” .
Prof Naik who by that time had removed his OT dress and gloves, came in looked at the patient then looked up at me, said with his style of a smile “That was a good going, very good”. He felt his pulse , “How long it will be for recovery?”.
“May be 15-20 mins, we will shift him to his room”, I responded. “OK then”, he said
I asked the patient to be shifted to the cabin, Parents were happy to see their boy but still a little gloomy as the boy was still sleeping .We put him to one side (lateral position), to have a better breathing as well as prevent any aspiration if there is vomiting. Vomiting is very common after ether Anaesthesia. We also told the parents and watching sister that this happens during recovery of Anaesthesia. The parents had a lot of querries in their eyes, when the surgeon came in. He felt his radial pulse and checked his bandage.
He declared, “The operation has gone well, There is no bleeding, everything is fine”.
Wheather he addressed to all medical staff or to the patients attendants difficult to say. The father bent to touch the feet of the surgeon. After Prof Naik left the father appeared to be satisfied.
I also confirmed,” Do not worry everything is fine”.
I advised, to give an injection of Pethidine and Phenergan intra muscular after complete recovery. IV fluids and Antibiotics were domain of surgeon.
"He will sleep for next 6 hours with these", I told the parents.
I left the room and came to doctors chamber along with Dr Mohanty. Soon a cup of tea was served which I finished in two three gulps as it was nearly cold now. While chit chatting on some other things Dr Mohanty unlocked and opened his drawer , brought out a fifty rupees note as my professional fees. That was my first professional earning, which I put it in my pocket happily and carefully. I thanked Dr Mohanty.
Even though I had adminstered anaesth to patients being operated by many other professors in Medical College, at Cuttack , independently, that was a different experience for me, not because of the money I earned but administered anaesthesia to a patient operated by Prof Naik outside the Govt hospital. Prof Naik was a different and respected surgeon all over Odisha. Dr Morton the inventor of Anaesthesia must have felt like that in October 1846, a victory.
Note: Some names changed. Now I understand after a visit to USA hospital, sometimes an anaesthetist fees are more than the surgeons.
