GOOD AND BAD GAS

Without the technology changes in anesthesia in the two decades after WWII, none of the present day remarkable surgical triumphs would be possible. Operations such as, Organ transplants, extensive tumor removing procedures, separating Siamese Twins require long and stable anesthesia.

The available agents in 1946 were Chloroform, Nitrous oxide, Ether, and Ethyl chloride.

Ethyl Chloride was a volatile liquid which rapidly vaporized and could be used as an inhalant when sprayed on a nose mask. Although it produced rapid unconsciousness it was a very dangerous substance that could cause cardiac or respiratory arrest.

Chloroform was one of the oldest anesthetics. It too was a liquid which was inhaled when applied to a nose mask. It was non explosive and could be used where there was open flame. My earliest experience with it occurred in 1942 when as a 3rd year medical student I had a rotation for several weeks at the Kings Daughters Clinic in Norfolk, Va. They provided a home delivery service for the needy using a medical student and thank goodness a very capable nurse who would give whiffs of Chloroform if needed. And of more importance, advice to the nervous “doctor”.

Nitrous Oxide, know as Laughing Gas, was the first anesthetic discovered and had been in use for years. It was also the pot of its day and was used improperly to get high. It worked by displacing oxygen in the blood causing anoxia. It did not create a deep level of unconsciousness when properly used and if not watched could result in asphyxiation.

Ether was a very volatile and explosive agent. It was initially used by dropping small amounts on a nose cone or mask. By the time of WW II more efficient methods of administration had been developed. One was the Heidbrink machine. This was a single tube semi closed system that had a yoke that held two oxygen tanks on one side and two Nitrous Oxide tanks on the other, thus the gas flow could be regulated. The mixture was passed over an Ether container and through the hose to a mask over the patients nose and mouth. The mask had to be tight. There was a re breathing bag and a valve to relieve any excessive pressure into the air and of course into the Anesthetist’s face.

With the development of this machine major and prolong complicated operations were possible. However there were problems; induction to a deep enough level was slow. During the slow recovery patients would vomit so there was a danger of aspirating into the lungs. This could cause a fatal pneumonia, if not immediate asphyxiation.
Another problem of the times was one of carelessness. The yokes and fittings for the gas tanks were all the same size. It was possible to place the wrong tank on a yolk so if the anesthesiologist was not alert the patient could be receiving 100% Nitrous oxide and be asphyxiated.

In the early 50s, there was a great advancement. First with the development of the closed system two tube techniques and with the introduction of Cyclo-propane. With this gas induction was rapid, and recovery was equally fast. Nitrous Oxide was no longer required. The danger of aspiration was nearly eliminated. It was safer to now have anesthesia under emergency unprepared conditions.

However, Cyclopropane was a very volatile and explosive gas. There were frequent incidents of explosions. In a closed system, that could destroy the patient's lungs. Fortunately other safer inhalation gases with little risk of explosion shortly followed.

The use of intravenous drugs to produce an anesthetic state or make the induction by a respiratory gas easier is a postwar (that is WWII) blessing. Among the earliest were barbiturate drugs such as Pentothal. These were followed by great number of chemicals some of the antidepressants or anti psychotic drugs. Also the use of intravenous muscle relaxants derived from curare type drugs have made the surgeons life easier.

I must confess that I had a personal interest in anesthesia , having put the mothers of many of Plainfield's Baby Boomers to sleep during the late 40s and early 50s. Cyclopropane was the last agent I used. During that period we received from $5.00 to $15.00 per case and "ward" deliveries were pro bono. Oh for the good old days.