Explosions in the operation theatre...
The patient- a child with vegetative foreign body swollen and soft in the bronchus. The patient was induced with ethyl chloride ether and taken deep in third stage, third plane and handed over to the surgeon as the procedure was expected to take longer than usual. The surgeon started and removed the foreign body bit by bit. O2 was added through the nozzle provided on the bronchoscope. In the middle of surgery there was a bang the surgeon face scalded and hair burnt and the child lay dead. Cause: Explosion due to over heated bulb and oxygen.
In another instance, the patient was induced in the induction room intubated and wheeled into the operation theatre. As soon as the anesthesiologist pressed the reservoir bag he was thrown away from the machine with burns on his hand and the patient lay dead. The reservoir bag was blown to pieces. Cause – Static electric spark causing explosion
During visit to Shrirampur for an ENT camp at the end of the day the doctors had some questions for both of us- the ENT surgeon and anesthesiologist over dinner. They presented me with a case which had resulted in death on the operation table. The incident had taken place during the hot summer days. Patient was male13-14 years old; symptoms were: high temperature 2-3 days, acute abdomen. The patient was induced with ethyl chloride ether after proper atropinization. The operation started after intubation and patient was connected to the Flagg’s can. The patient developed severe convulsions and died after couple of convulsive episodes. They wanted me to explain the cause. It was a typical case of ether convulsion with all conditions contributing to the fatality. High temperature summer days, ordinary operation theatre (not air-conditioned), good atropine action, toxaemia, deep ether anaesthesia good for laparotomy. All these were text book conditions for ether induced convulsions. They wanted to know the method for avoiding this complication. My answer was simple– cool the patient, use ether 2% after Thiopentone Scoline induction intubation and using muscle relaxant and IPPR. In case you can avoid ether use N2O--O2 IPPR with small supplements of pethidine.
Monday, May 10, 2010
Heat in Anesthesia: Reports of accidental deaths
Friday, June 6, 2008
Anesthesia on Demand
My idea of “Demand Anesthesia” is not liked by many senior anesthesiologists including my late teacher Dr. Bhojraj. Their objection to this technique is that the patient responds in between which is likely to result in adrenaline secretion and may result in hypertension, ventricular fibrillation and arrest. Demand anesthesia is a vigilant anesthetic technique which needs continuous watch of the depth of anesthesia by signs of light anesthesia like
When any one of the signs is exhibited you are supposed to administer additional dose of Thiopentone till the reflex is suppressed. Far too often appearance of signs of anesthesia means you have to give additional sedatives and analgesics like Diazepam and Pethidine or Pentazocin or even stronger pain relieving drugs. All one is supposed to do is the balance the quantity of drug given and reaction of the patient to the stimuli. People are really worried about the cumulative effect of drug in post op period. But the patients are comfortable. Their O2 saturation does not fall and if by any chance the effect of drug persists as trickle of O2 though the nasal catheters tides over. This technique has been tried in many nursing homes without Boyle’s apparatus to deliver Nitrous Oxide-Oxygen and inhalational anesthesia. In my practice I have extensively tried this technique especially in cystoscopic procedures and orthopedic procedures like major fractures in very aged patient. Surgeons are very happy with the procedures since they find their patients awake and comfortable in post-op period. Vital parameters (signs) are stable and well maintained. Though anesthesiologists do not believe in this technique, my advice to them is “to see and then believe”. Those who have seen this technique are converted and like the technique. In a difficult situation it comes in handy.
