Nurses as Anaesthetists

Kai Tiaki : the journal of the nurses of New Zealand, Volume XII, Issue 3, 1 July 1919, Page 117

Nurses as Anaesthetists

Anaesthesia has been truly termed an " art," for not only does it require skill and forethought, and an undivided interest m the subject, but one must have sufficient fineness of feeling to keep m touch with the patient's point of view, as consideration for that person's comfort and peace of mind are factors which should not be overlooked, if one wishes to have a satisfactory maintenance stage. And even as a successful anaesthetist, the more one learns about anaesthetics the more one realises what a wide scope one has for future possibilities and greater carefulness. On account of the shortage of doctors, sisters were trained m France m general anaesthesia for casualty clearing station work, where the enormous influx of wounded has to be dealt with as quickly as possible. I was one of several sisters who were fortunate enough to be trained m an American hospital, our instructor being a woman, who was a professional anaesthetist of 6 or 7 years' experience. She told me that m America a nurse, on finishing her hospital training, can take up general anaesthetics, as a post-graduate course, and at the end of six months receives a certificate and is entitled to practtise either m a general hospital, or, working with one surgeon, attend operations m a private hospital, or the patient's own home. Chemistry is also a post-graduate course •for hospital-trained nurses m America, for which the necessary certificate can be obtained.

Our training was a two months' course, with daily practical work, lectuies three times a week at which practical and theoretical questions weie asked, and a test examination at the end of the course. In the meantime one studied hard, reading anything and everything relative to anaesthesia , two of our most useful books being Gwathmey and Flagg. A much-used and very excellent apparatus for chloroform and ether was Shipway's, which, m the case of using ether alone, was an advantage, for by excluding all air and having the ether warmed up by passing through tubes m a thermos flask, the after effects of bronchial complications was reduced to a minimum,

One could, of course, induct with the Shipway, but one usually started with the open method, using a mixture of C and E, or ether only, as it was pleasanter for the patient. We were taught by the Americans that for the first five minutes an anaesthetic must be given slowly so that the mucous membranes of the throat got gradually accustomed to the more or less irritation of the fumes ; after that, one could :c speed up " m getting the patient " under." There is no advantage gained m pushing the anaesthetic m the initial stage, and a smooth' induction goes a long way towards an uninterrupted maintenance stage. We were also told that to have a stormy induction meant a badly given anaesthetic, and that the patient should skip the excitement period altogether. Very good advice! Of course m the case of a patient being addicted to alcohol, one cannot always expect him to behave properly when : ' going under," but, luckily, as we had to do with the soldiers, they were no trouble as a rule. The Americans use very little chloroform, and a great deal of nitrous oxide and oxygen which, when given with a good machine, is an entirely safe and efficient anaesthetic, lasting, when required, for as long as four or five hours, even for complicated abdominal cases. The patient is got under very quickly, and is awake and apparently none the worse for a long operation the minute the anaesthetic is discontinued. In cases of shock from severe injury or haemorrhage, it is an invalu-

able anaesthetic. Our patients were brought straight m from the ' line,' pale and cold, and practically pulseless for probably a major operation or extensive abdominal operation, and it was very necessary that not only should the operation be a success, but that they should be none the worse for having had it, or the anaesthetic. Boyle's nitrous-oxide oxygen machine was one of the best, as it was perfectly simple and most efficient. It was invented by an English surgeon, Mr. Boyle, on the staff of St. Bartholomew's Hospital, London.

One used to work on what was termed a "surgical team," i.e. a surgeon, anaesthetist, a sister who did instruments, and two

orderlies. Our hours were long, working all nights m tents lighted with acetylene gas, and usually till mid-day next day ; our table being only one of eight or ten tables m a large tent, and thc wounded coming m almost faster than one could cope with them. One lived m a constant state of ' moving on," and at one casualty dealing station we stayed 3.1 days, our admissions during that time being 3,600 casualties. At another place m ten days the admissions were 23,000. I found the work very interesting, and was most anxious to be a success at it, and am truly sorry that one cannot go on with it m this country ; however, it helped one to do ones ' bit," even if it was only a temporary war arrangement.

The English surgeons were perfectly splendid, working hour after hour, stooping own' the operating table and only stopping at long intervals for 10 or 15 minutes for a hurried meal. In cold weather the tents would be heated with oil stoves, using a double or treble-burner primus for boiling instruments, etc, and it was an advantage to have one or two oil stoves directly under the operating table, as most of our cases were icy cold, and more or less m a collapsed condition, and warmth is very stimulating. I gave anaesthetics for many English, Scotch, Irish, American and Canadian surgeons at various casualty clearing station), sometimes working for weeks with one surgeon, or being transferred to another team if he went sick, or to fill a gop if another anaesthetist was down.

We were frequently told by our surgeons that our work was more satisfactory than that of many a male anaesthetist, who was much more interested m watching the operation than m paying attention to the anaesthetic. At the same time one mist keep m touch with tho- various steps of the operation, so as to regulate the anaesthetic fco the surgeon's need. In addition to giving the anaesthetic, one used to fill m

the patient's field card from the surgeon' 8 dictation and copied that, with the patient's particulars (name, number, rank, unit, etc.) into the operation book, and this had to be done between stopping the anaesthetic, and having the next case upon the table ; .so every minute of time was precious. With Boyle's nitrous-oxide oxygen machine, one could give ether if one wished, as patients vary considerably and a machine of that description is a hundred times more accurate than any manual method. 1 thought when I first began that not having a doctor's knowledge and wisdom "at one's back," a& the saying goes, would be a tremendous handicap, but having such excellent supplies and appliances things " panned out r? very well. I believe the German chloroform was supposed to be very good ; I had some of what was captured but did not care to risk using it, knowing too well how very dishonourable the Hun really is. Latterly, the supplies of the best chloroform were running short, and what we had required "doping' to make it safe, but most of us used more nitrous-oxide and ether, excepting for heads and chests. In our training chloroform was considered less up-to-date and more dangerous, on account of its action on the heart, than other anaesthetics, and we certainly had no time to spare for artificial respiration. One can but admire the excellent methods of the Americans, who are progressive enough to go on seeking benefits for mankind, and are not content with using old methods if a new one proves more beneficial generally. One noticed their charming manners to their patients, which went a long way towards relieving the dread of hospitals that so many people have. The. same courtesy was extended to the "' Tommy" by English surgeons, who, m all that rush of work, found time for many a kindly word and glance for the poor wreck of humanity brought on to the table. — Anonymous.