Regarding Awareness:
• Patients owe a lot to William Morton. If it weren’t
for him, they could tell the anesthesiologist when they are
still awake!
• There is a direct relationship between the number of
tattoos and the propofol dose.
• There is an inverse relationship between the number
of tattoos and the tolerance to regional anesthesia.
• Classical music isn’t as bad as it sounds (Berra-ism).
• Don’t be caught dead doing something you would
not be caught dead doing.
• There is an inverse relationship between a surgeon’s
ability and the frequency that he/she asks for more muscle
relaxant.
• There is no vital organ in the body that cannot be
reached with a two-inch needle.
• There is no condition that cannot be made worse by
surgery (and/or anesthesia).
• It’s easier to do it right the first time than
to do it over.
• It’s hard to predict the future because it hasn’t
happened yet. (Berra-ism)
• (Written on an old barn in Colorado) When on thin ice…dance.
• Beware of colleagues with no sense of humor —
they are not very bright and will blame you for their errors.
• Sick people die! (use in place of self-flagellation
when a negative outcome occurs).
• Every patient is a “preop” — it’s
just a matter of figuring out for what!
• The patient isn’t bleeding dopamine!
• Practice is the best of all instructors.
• Statistics will “prove” anything…even
the truth.
• Numbers are tools, not rules.
• Patients don’t die from their disease; they die
from the physiologic consequences of their disease (Osler).
• Levophed, or leave them dead.
• If you can feel a pulse, don’t panic.
• Pain has never been meaningless.
• Fibrillation is a sign of life.
• The better you are, the luckier you become.
• Be wary of patients whose risk exceeds their ejection
fraction.
• Treat the patient, not the monitor.
• Never trust a naked baby!
• We live a life of choice not chance.
• People respond to appreciation.
• Leadership by example works.
I received a note from Stephen J. Prevoznik, M.D., who
served for many years at the University of Pennsylvania
as the clinical director and vice-chair and was the mentor
for hundreds of anesthesiologists. As a teaching aid, he
composed a list of “laws” for practicing safe
anesthesia. These collected aphorisms are timeless and are
reprinted for you.
Prevoznik’s Laws of Anesthesia
• Never anesthetize a patient who isn’t there.
• The more effective the case, the more selective your
evaluation.
• Compromise, though not desirable, is permissible
with all but patient safety.
• Chance of survival drops precipitously as the BUN
exceeds the body weight.
• The more the ECG resembles the EEG, the sicker the
heart.
• Regarding open-heart surgery: If not on bypass by
the end of page 1, expect a long case. If not on bypass
by the end of page 2, survival odds drop.
• Death can be deferred but not defeated.
• Never block pain that isn’t there.
• It is much easier to add (drugs) then to subtract
(them).
• Never argue with success just because you can’t
explain it.
• No block ever fails, some just have to be supplemented
more than others.
• Fifteen minutes spent preoperatively with a patient
is worth 15 mg of morphine as a premedicant.
I would like to thank the following physicians for submitting
material to this column:
John S. Carson, M.D., Doris K. Cope, M.D.,
Kenneth R. DeVoe, M.D., Philip S. Gibbs, M.D., Stephen J.
Prevoznik, M.D., Hector A. Rodriguez, M.D., Myer H. Rosenthal,
M.D., Joseph L. Seltzer, M.D., Joseph F. Talarico, M.D.,
Peter M. Winter, M.D., Howard L. Zauder, M.D., and John
S. Zorab, M.D.
— M.J.L.
Editor’s Note: Please send your aphorisms, witticisms,
Berra-isms, oxymorons and dueling aphorisms to me for the
next “Aphorisms” installment.
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