WEBVTT

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This training film demonstrates a new anesthetic technique for oral surgery employing light

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fluothane.

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Oral surgery imposes anesthetic problems of ventilation, which we've solved by intubating

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both nasal passages.

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The resulting control of respiration provides a degree of safety lacking in the intravenous

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from arbitrate method.

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This new Saturn monitoring valve will show the patient's respiration and act as a non-rebreathing

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valve during assisted and controlled respiration.

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The portable fluothane draw over vaporizer at the right of the patient's head is a prototype

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unit called the FluAir.

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Until intubation, the upper airway will be maintained patent by hyperextended position

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with upward traction on the mandible.

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To begin induction, after pre-medication with 0.3 milligrams of atropine, the FluAir vaporizer

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is set to deliver 1% fluothane.

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This concentration is well tolerated by the conscious patient.

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The Saturn ball valve serves as a visual monitor of the patient's respiratory pattern.

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The right respirometer is attached to the exhalation tube and measures tidal volume.

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Each revolution of the small hand represents one liter of exhaled gas.

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Vital signs will continuously inform the anesthetist of the depth of fluothane anesthesia.

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The most important vital sign is blood pressure.

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The initial blood pressure is 110 over 60 millimeters of mercury.

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Assisting respiration at the patient's own rate delivers more oxygen and more fluothane

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to the patient's alveoli, thereby shortening induction time to three or four minutes.

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With antipotent agent, the pulse must be followed continuously.

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The temporal pulse is palpated and is 80 beats per minute.

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Blood pressure usually falls about 15% by the time satisfactory fluothane anesthesia is established.

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A reduction in blood pressure of 10 millimeters shows the early effect of fluothane.

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By now, the patient has lost consciousness.

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As he starts each inspiration, the Saturn ball moves to the right.

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This signal calls for the anesthetist to squeeze the bag and assist each breath with a maximal inflation.

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The right meter shows assisted tidal volume to be about one liter.

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Fluothane is being vaporized with room air.

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Blood pressure has fallen to 90 over 60 millimeters of mercury.

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The patient is ready for intubation.

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Induction is complete after four minutes.

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Nasopharyngeal airways will be used to provide a means of maintaining the airway despite an open mouth and pharyngeal pack.

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These tubes eliminate two-thirds of the previous dead space of the mask.

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Vigorous assisted inflations are used briefly.

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This hyperventilation should produce an apnea during the interval before intubation.

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The Robertasi tubes are lubricated and the patient is ready to go.

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Inserted.

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Connected to the Saturn valve.

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These tubes should rest beyond the tongue base with their tips just short of the vocal cords.

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Spontaneous tidal volumes are 350 cc's.

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Assisted tidal volumes are 800 cc's.

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The Robertasi all pharyngeal airways are tolerated during light fluothane anesthesia so the concentration of vapor is reduced.

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The tubes and connector are secured.

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At 7 tenths percent fluothane, the tidal volumes are at least 300 cc's.

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With the lower dead space provided by the nasopharyngeal tubes, these spontaneous tidal volumes are just adequate.

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Occasional inflations are conveniently managed to increase anesthetic depth and ventilation.

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The rise in systolic pressure to 100 indicates a lighter level of anesthesia.

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But fortunately, at this lighter plane, the jaw muscles remain as relaxed as necessary for easy access to the oral cavity.

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To hold the mouth open, the bite block is inserted.

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The gauze pack is placed deep in the oral pharynx without occluding the rubber airways.

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After packing, the jaw may need to be repositioned to ensure that good respirations are maintained, as indicated on the Saturn monitor or right meter.

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The method of airway management provides continuous, visible control of respiration, despite the fact that the open mouth allows for some air leakage.

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Fluothane is still being vaporized with room air.

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The adequacy of oxygenation will be determined by arterial blood analysis.

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While the pharynx was being packed, the patient's ventilation was not assisted for several minutes.

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Has the patient's oxygenation been adequate during this time?

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To answer this question, blood is drawn from the femoral artery in a preheparinized syringe

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and analyzed for oxygen saturation in the American Optical Oximeter.

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This sample shows 90% oxygen saturation, a safe but low normal value.

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Had ventilation been further reduced, room air alone would not have been sufficient, and ventilation should have been assisted more frequently.

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Another way to increase oxygenation is to vaporize fluothane with oxygen instead of air.

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After a period of ventilation with fluothane and oxygen, the patient's oxygenation is measured again.

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Another blood sample is drawn from the femoral artery.

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The blood pressure remains stable.

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Note the arterial pressure moving the plunger of the syringe, indicating that the needle is not in the adjacent femoral vein.

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Arterial saturation is over 99% after replacing air with oxygen in the vaporizer.

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During 20 minutes of anesthesia, the patient's blood pressure stabilized at 100 over 60 millimeters of mercury.

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Pulse remained around 80 per minute.

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As fluothane is turned off, emergence is accelerated by hyperventilation.

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During recovery, the blood pressure returns to the preoperative level.

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The nasal pharyngeal tubes are still well tolerated.

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The patient is breathing on his own now.

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The pharyngeal pack, bite block, and tubes are removed.

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By now, the patient's pharyngeal muscles have lost their flexibility and will not collapse to block the airway.

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However, to ensure an open airway, the jaw is extended.

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Oxygen by mask is available but is not necessary.

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One can feel his exhalation.

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Breathing remains adequate.

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His eyes now diverge, indicating lighter anesthesia, and he should awaken shortly.

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Within the next minute, the patient responds and now has the return of his protective reflexes.

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This technique is safe and efficient.

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Spontaneous ventilation is watched continually and assisted as needed.

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The anesthetic gear does not encumber the surgeon's field.

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With fluothane, the anesthetist maintains continuous control of the anesthetic level.

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Anesthesia need not be deep since no tracheal tube is used.

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Recovery time is rapid.

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Within a few minutes, the patient awakens without the confused sensorium seen after barbiturates.

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He is lucid, knows time and place, and can walk without help.

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Nausea or other complications have not been noted.

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Assisted fluothane anesthesia using compact, simple equipment and bilateral nasal pharyngeal tubes

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offers better, safer, and more physiologic anesthesia for oral surgery than the intravenous barbiturate

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and excludes the possibility of hypoxic brain damage.