First Findings of BAH Anesthesia

I was pleased to find 2 functioning anesthesia systems. One continuous flow system (a Japanese machine: Acoma complete with non-functioning ventilator, and one year old soda lime), and the second system, a draw over set-up with a... with uh... well what do you know!? A good-‘ol OMV (Oxford Miniature Vaporizer)! How very quaint ☺

I couldn’t believe it! I’d seen drawings of them in books, but here was the real deal! And *I* was going to get to use it! But then, suddenly, I recognized a group of letters, printed all caps on the top of the dial, next to the word “Halothane.” They struck terror in my little American heart... PENLON.

Say it isn’t so! I hung my head for a few moments, there in the darkness of the humid OR, all alone, and sighed out loud. You see, back in the states, about 2 years ago, our department made the mistake of purchasing 5 new anesthesia machines made by Penlon to replace some of our older Drager machines. We started having serious problems right away... like the ventilator stopping for no reason in the middle of a case, the CO2 absorbant container leaking like it had more holes than Swiss cheese, complete re-breathing of all CO2, etc. We had a “wall of shame” in the faculty office with modified Far Side cartoons that poked fun at the Penlons and our experience with them. It was like I’d come to the ends of the earth, and yet I STILL couldn’t escape this British company’s freaky-fickle equipment. I thought, “Well, the thing looks like it’s a good 50 years old. If it’s lasted this long, maybe it’ll make it another week or so and I can get outta' here without any repeat offences.”

Room 2 was their minor sugery room, and the graveyard for donated equipment. There was a Drager 2A and a Drager AVE (I've never heard of that model). Both had seen better days, and those days were before I was born. I was told that neither worked. And even if they did, I knew that they’d need high flow, compressed oxygen to make them work. Still, it’d be nice to have at least one machine in the hospital that had a ventilator, and could serve as a back up should the Acoma fail (which was likely at some point, given its age and working condition. The Penlon, as much as I hated to admit it, was nearly fool proof and maintenance free. It had only one working part (excluding the screw cap that came off to fill the vaporizer), required no electricity, and could be operated using only room air. A mission hospital’s dream machine, really. At least it would be as long as they LEAVE the OR, and THEN use ether to dissolve the thymol residue that tends to build up as the halothane is vaporized. What I didn't want to hear later was that they opened up a can of ether RIGHT IN THE OR where electricity was flowing through a varied array of frayed wires and cables. If they can remember to take that precaution, then the hospital won’t literally be blown to kingdom come as the ether (a very explosive chemical) drifts down to the sockets, power strips and cables at floor level.

Here at Blantyre Adventist Hospital there are 2 anesthetists. They typically run one OR at a time, and either tag team doing the cases, or more often than not, help each other do the same case. It actually does take 2 anesthetists to do 1 case... one to start doing anesthesia, the other to trouble shoot all the problems that arise while the other one keeps trying to care for the patient. They do not intubate here, and there is no ventilator, so one person has to hold the mask while the patient breathes on their own. So, examples I’ve seen of second person anesthesia responsibilities are: setting up suction after a patient has already vomited, getting drugs drawn up to inject for the treatment of low blood pressure, getting the pulse oximeter to keep work, putting on the blood pressure cuff after induction of anesthesia with halothane... and cycling it once or twice, filling up the halothane because it’s almost gone, adjusting the ceiling lights for the sugeon (no sterile handles for them to do it themselves), going off somewhere to find an oral airway. No, I'm not kidding.

The anesthetist I helped out today barehanded the Tylenol suppository into this kid’s butt, THEN put on gloves to hold the mask again for continuing anesthesia. Good grief. What am I supposed to say to that? Don’t some things go without saying?! I just shook my head and wondered if I really could help this guy learn.