Info Request on Possible Awareness Case
 he
article
written by Karen B. Domino, M.D., in the March 2007
issue regarding a “Registry on Awareness under
Anesthesia” brought to mind an incident I encountered
a few years ago when serving as chair of a survey team
credentialing a surgery center for AAAHC.
An anesthesiologist at that center was attempting to
maximize the rate of return to postoperative consciousness
in the recovery room and subsequent early discharge
from the facility. The technique used was to administer
extremely small doses of propofol and miniscule doses
of short-acting narcotic, and simultaneously run a continuous
esmolol beta-blocker infusion to blunt the patient’s
cardiovascular response (tachycardia and hypertension).
As a surveyor reviewing charts from months prior, I
was unable to interview the patient regarding awareness
during anesthesia. It seems to me that such a technique
would increase the likelihood of awareness, and I am
wondering if there is any information pro or con regarding
this technique? Does Dr. Domino have any information
on this subject?
Clair S. Weenig, M.D.
Walnut Creek, California
Korean
War Vet Not So Well-Equipped
read with great interest and much humor the articles
in the March 2007 NEWSLETTER
on combat trauma. The pictures of the anesthesia setup
floored me! What equipment!
I was the anesthesiologist at Baker Medical Company,
1st Marine Division in the Korean War, operating within
one mile off the Main Line of Resistance (MLR) in
the last several months of the war, just south of
the Imgin River, 20 miles north of Seoul, when the
North Koreans were trying desperately to win back
territory.
My anesthesia setup consisted of two portable Heidbrink
anesthesia machines in “suitcases” about 15
x 15 x 24 inches, with a CO2 absorber,
a G cylinder of oxygen and a G cylinder of nitrous
oxide, plus several intravenous drugs. Two operating
tables were set up end to end, with one stool for
me in between so that I could handle two cases at
the same time. Thanks to terrific cooks, I ate all
my meals in the O.R. while operations were going on,
and I left the O.R. only to go to the head, while
a dentist covered for me. Every doctor carried sidearms,
i.e., .45 caliber automatics, because of the nearness
to the MLR and because an English medical company
had been overrun recently. All corpsmen stacked their
carbines along the O.R. wall for instant possible
use. The sterilizer was a Coleman-type, gas-pumped
heat source, with water obtained from a brook which
ran outside the medical setup. Thumbs became sore
from pumping the air compressor. The Army “supplied”
our drugs, and they were very meager, making our corpsmen
the greatest thieves in the world, getting the necessary
drugs by stealing them from the Army depot in Inchon,
25 miles away.
We were so close to the line and the chopper pilots
were so good, carrying two patients at a time
on the sled-like platforms on the sides of the small
choppers, we received our wounded Marines before
they had time to bleed much and certainly were
never in shock. We heard no big guns but heard plenty
of swishes of big stuff going above us.
In two battles, Berlin and East Berlin, in the mountains
just below the Imjin River: In the first battle, I
got 14 hours sleep; and in the second battle, I got
five hours sleep. That’s five hours in five
days! Every one of my patients went home! In so-called
“minor” surgery, the wounded were numerous,
and all wounds were handled with plenty of local anesthesia
with stretchers on boxes.
Two of the surgeons reported the largest series of
arterial grafts in the world at that time from the
1st Marine Division. With all the fancy equipment
the physicians use in Iraq, I wonder if their record
was as good as ours.
Ray T. Smith, M.D.
Ex-Lt, MC, USN
Longmeadow, Massachusetts
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