Complexity, Technology Seen as Possible Problems

C. Stanley Jones Worcester, C.P.

To the Editor

I enjoy reading the issues of the APSF Newsletter which have been (so far) reaching me with unfailing regularity. But the general tenor disturbs me because the remedies espoused seem invariably to involve the use of more complex instrumentation, more rigid codes of practice, and escalating expenditure of time, energy, and money. These factors militate against universal acceptance and, hence, success in the objectives sought.

Here I draw a parallel between human behavior and the AIDS epidemic. Universal self-discipline at the sexual level might well have prevented the epidemic and could perhaps control it. However, at the moment, the only reasonably effective way of containing the spread of the virus seems to be the use of a condom when personal self-discipline is wanting. The condom is cheap and it most certainly is not a modern invention.

Anesthetic mortality (and morbidity a vast iceberg, the invisible part of which is as yet largely unexplored) is not new and much of it is due to our failure to understand that anesthesia clinicians cannot totally control the physiology and responses of their patients.

Anesthesiologists who think that they have all the answers to their patients’ problems are kidding themselves and potentially killing those patients!

But if anesthesiologists will admit that any action they take may have randomly-occuring, unwanted, and sometimes dangerous or fatal outcomes, then they can make use of statistical mathematical aids which can point the safest way through an anesthetic maze. Also, this way will usually he the simplest and the least expensive dollar-wise! What is needed to promote patient-safety is not a proliferation of fallible artificial monitors, but the development of simpler and safer basic procedures!

For example, I reported in 1961 that disregarding our forefathers’ dictum. “Don’t give a muscle relaxant until your endotracheal tube is in the correct place!” had led to the death of four and the permanent disability of two patients.

In 1976 and again in 1982 and 1984, 1 drew attention to the demand-feed anesthetic technique which was pioneered by McKesson in 19 10 and which dispenses a pre-selected anesthetic atmosphere, by-passing the need for trying to monitor the composition of the mixture that the patient is inhaling. It also prevents any carbon dioxide accumulation either in the circuit (by voiding all exhaled gases to atmosphere) or in the patient (by assisting respiratory efforts or taking them over).

The evidence that our specialty needs to alter radically its present approach to the mechanics of inhalational anesthesia is all them But the will to re-think present practices seem to be paralyzed. We seem to be hypnotized by a belief in our own wisdom. According to Al Koran, no folly is greater than this.

Dr. C. Stanley Jones Worcester, C.P.

Republic of South Africa