To the Editor
I believe that there are areas in the USA and certainly many, many areas elsewhere in the world where the ASA (and other) Standards and Guidelines are, because of financial constraints, difficult or impossible to comply with.
In South Africa, one of the unwanted outcomes of Guidelines is the automatic assumption by legal authorities that failure to observe them is ipso facto evidence of negligence. In this country, such assumptions by the courts will lead automatically to disciplinary proceedings. But about half of our medical staff work in state-funded facilities and cannot always purchase what they wish to use. This is a disadvantage which is in no way due to their own negligence although they may suffer considerably as a consequence of the failure to adhere to Guidelines or Standards promulgated by our own Society of Anesthesiologists.
I don’t want to debate that issue in the Newsletter, but I do think that it is appropriate to draw attention to inexpensive and reliable alternatives to some of the gadgetry which the Guidelines emphasize and which, I believe, could well be incorporated AS ALTERNATIVES WHEN CIRCUMSTANCES DICTATE, even in the ASA Standards. We overlook many of the gifts with which Nature has endowed us and that could be called a cardinal sin. To me it is certainly negligence.
So I do hope that you will be able to publish my small contribution.
Professor Ross Holland’s report of a ‘Wrong Gas” incident prompts me to remind readers of a very old, very reliable, very simple and very cheap method of making certain that such accidents do not occur.
In the distant past, before technology provided oxygen and carbon dioxide analyzers, it was routine practice for the anesthesiologist to use-his own nose and lungs to test the nature of the gases delivered by the machine and the integrity of the anesthetic circuit.
The anesthesiologist’s ear and lungs can also be used to determine rapidly and accurately the precise placement of an endotracheal tube. One can use the ear if the patient is breathing spontaneously or the lungs if he/she is apneic. It is quite surprising how sensitive and how reliable are the chemo and baro-receptors of the human respiratory tract. The human ear is less reliable, but the pinna can feel air movement even if the cochlea is not functioning.
To those who fear the alleged deleterious effects of traces of anesthetic gases and vapours I can only say: firstly, that I have used the manoeuvres outlined above for an ongoing period of 50 years; secondly, that I had to submit to vasectomy to limit the fertility of myself and my wife; and thirdly (but, I believe, most importantly) that OR staff is daily exposed to the vapours of biocidal solutions which are used for cleaning and sterilizing environment and instruments. By definition these agents are lethal to living organisms. I am surprised that they were not first excluded as being possibly noxious to OR staff, before rushing to incriminate agents which our patients receive in high concentrations and for long periods without any very obvious deleterious effects. (I exclude accidents.)
So far, I have not been able to discover ANY study of the effects of biocidal agents on the virility, fertility and general health of anesthesiologists or nurses. Should such evidence exist, I would greatly appreciate a brief note citing the reference. Thank you.
Cecil Stanley Jones, F.F.A.R.A.C.S. Sangrove, Rondebosch
Republic of South Africa
- Holland R: Foreign Correspondence: Another ‘Wrong Gas’ Incident in Hong Kong. APSF Newsletter 1991;6:9