Changing Anesthesia Machines

[Dr.Madhav]

Hello everybody,
Many of us are still using the old and outdated boyle's machine for delivering general anaesthesia.As a result we are compromising on the patient's safety and our own safety medico legally.Every Boyle's machine is treated as junk after 15 years and if not serviced regularly.The vaporisers in these old machines are meant for ether and trilene.Goldman vaporiser is used for halothane.It is shocking to note that Halothane which is banned in USA and UK and several countries is still being used in India.
This problem can be solved if we instruct the nursing home owners to go in for the newer machines with vaporisers for isoflurane and sevoflurane.In anesthesia,the dictum"old is gold" does not hold true.When surgeons are going in for newer techniques and instruments,why is it that we anesthesiologists are afraid to open our mouths and demand for newer things?
A gynaecologist in India has spent around Rs.50 lakhs for interrior decoration of his house with an inbuilt swimming pool,but in his own OT,fish tank is used for delivering oxygen to the patient!!!!
I would like all viewers of gasbag to read this article and send in their vciews,opinions and experiences.   

[jafo1964]

Totally agree with you
But we are partly responsible for this situation because we have no unity amongst us
If I say "No" to a case some other anaesthetist will do it
There are places where if I ask for ECG monitoring for a spinal anaesthetic they laugh at me
At another place the regular anaesthetist put on a pulse oximeter only if the case has problems or he does not use it
Anaesthetists do  brachial plexus blocks ( with potential for complications) in the recovery room without any monitors
Neurolytic blocks and pain releif is done without C-arms and adequate documentation
A huge number of us still do laproscopic surgery without ETCO2
You must go to our district hospitals and see how our young anaesthetists are forced to give anaesthesia for tubectomy . It is a national programme. No monitors , No Boyles , Only Ambu bag

Is there any point in then failing our PGs if they dont answer questions in the exams because finally they will work only with appalling standards.

What have I done

I and the team I work with,  refuse cases that are out of the capability of our anaesthetic skills or hospital backup facility
We ensure that the place we work in have a minimum standard maintained
In the few places we go,  we work with Oxygen failure safety Boyles, Sevoflurane, Selectatec,all monitors including Etco2, temp and invasive if needed
All these places have all emergency drugs even rarely used ones and definitive airway rescue devices like COOks cricothyrotomy set, mini trach set, bougie, levering blade and stuff like that

The point I am making is if you have the vision and perseverance to convince a surgeon who basically  cares about his patients we can acheive it

I have compromised quantity for quality and we need to make these changes , we owe it to our juniors and hopefully they will take it forward

regds

[Dr.Madhav]

I am happy to read your reply.Whatever you have written is 100% true.We are made to compromise on the working conditions,patients safety and our paltry remuneration.No wonder,many of the anaesthesiologists are ending with CABG(including myself in 2005).
I feel we should blame our forefathers for the present state of our branch.They should have drilled the idea into their student's head that they are qualified dignigied doctors and should behave like one.Instead we were led to believe that we are bonded labourers and be satisfied with whatever is thrown at us.
The word UNITY never exists among the anaesthesiologists.I have been fighting for the anaesthesiologists for the last 30 years but have not fully succeeded.
I have been labelled as an aggressive anaesthesiologist!!!!

[yogenbhatt1]

Cool it man! . Do not be so aggressive. You may not get another CABG.
Let us go back to where we started. 30 yrs back it was only Ether in India. Now atleast, we talk in terms of Sevo. Things change over a generation. Sow the seeds and things will grow. I am very optimistic as I have seen the change and relished it too. Western countries are 2 dacades ahead of us. We too will reach there in next 10 yrs.
Be happy. Same scene was there too.

[Dr.Madhav]

yogen, i already had CABG as you are aware of it.I think we are very slow in going in for any change.See the municipal hospitals where the OT conditions are pathetic.Of course you always say"I have my juniors working there"so you may not feel the pinch.I still go to municip[al maternity homes and i know the problems!!!
There is only an outdated Boyle's machine with everything missing.You try giving full fledged GA and You had it.
payments are made after ages.
Madhav