Anaesthesia in difficult situations. 3. General anaesthesia-technique

An Anesthesiologist's Perspective on the History of Basic Airway Management: The "Modern" Era, 1960 to Present

This fourth and last installment of my history of basic airway management discusses the current (i.e., "modern") era of anesthesia and resuscitation, from 1960 to the present. These years were notable for the implementation of intermittent positive pressure ventilation inside and outside the operating room. Basic airway management in cardiopulmonary resuscitation (i.e., expired air ventilation) was de-emphasized, as the "A-B-C" (airway-breathing-circulation) protocol was replaced with the "C-A-B" (circulation-airway-breathing) intervention sequence. Basic airway management in the operating room (i.e., face-mask ventilation) lost its predominant position to advanced airway management, as balanced anesthesia replaced inhalation anesthesia. The one-hand, generic face-mask ventilation technique was inherited from the progressive era. In the new context of providing intermittent positive pressure ventilation, the generic technique generated an underpowered grip with a less effective seal and an unspecified airway maneuver. The significant advancement that had been made in understanding the pathophysiology of upper airway obstruction was thus poorly translated into practice. In contrast to consistent progress in advanced airway management, progress in basic airway techniques and devices stagnated.

Paediatric anaesthesia in a developing country

A suitable anaesthetic technique was needed for oral surgery in infants in a developing country. As an air compressor was present, and oxygen accessible, a continuous flow technique was chosen. Two Boyle's machines--useless due to lack of soda lime and nitrous oxide--were converted without increasing susceptibility to technical and supplemental deficiencies. The challenge to simplify techniques without reducing patient safety is discussed, and the solutions in an Ethiopian hospital are presented.

Inhalational anaesthesia in developing countries. Part II. Review of existing apparatus

We have reviewed the availability of apparatus which permits the maximum use to be made of available supplies and services in developing countries. In particular we have stressed the use of electrically operated air compressors and oxygen concentrators to drive sophisticated anaesthetic apparatus which is not dependent on supplies of compressed gases in cylinders.

Inhalational anaesthesia in developing countries. Part I. The problems and a proposed solution

We have examined the requirements for inhalational anaesthesia in the developing countries with particular reference to the problems posed by difficulties in the supply of compressed gases. A scheme is proposed to circumvent these difficulties without loss of the quality of anaesthesia other than foregoing the use of nitrous oxide.

A simple vaporizer improvised from a carbon dioxide absorber canister

An empty British Oxygen Company (B.O.C.) Mk. 4 carbon dioxide absorption cannister was modified for use as a vaporizer by placing a layer of flannelette bandage over the horizontal perforated septum and adding a base plate with an exit port for anaesthetic vapour. Aliquots of liquid anaesthetic were injected from a syringe through the top of the cannister and vaporised by air drawn through the cannister. Laboratory testing showed that this could be a useful way of administering inhalational anaesthesia in the absence of compressed gas supply.