ANAESTHETIC WORK

Dominion, Volume 36, Issue 32, 2 November 1942, Page 6

ANAESTHETIC WORK

Change Urged In Hospital Practice REPORT TO AUCKLAND BOARD ■ Dominion Special Service. AUCKLAND, October 31. The opinion that the use of visiting anaesthetists as practised at the Auckland Hospital for the past quarter ot a century was accompanied by a lack of co-operation involving a very serious break in the normal good care wlncli every patient should reasonably expect was expressed in a report to the Auckland Hospital Board by Dr. J. 8. Hudson, who was recently appointed to control the administration of anaesthetics. The bulk of anaesthetic work, stated the report, was done by visiting staff who were primarily engaged in general medical practice, including obstetrics. They bad taken up hospital anaesthesia as a side-line and it wap convenient for them to attend to it in the mornings 01113 ' Changed Conditions.

“In the past,” the report continued, “this lias been a workable arrangement, as anaesthesia involved little beyond the giving of chloroform and ether, preceded by the routine administration of morphia and atropine. Thus there was little need to see the patient before the operation, though at ail times this would have been a benefit to the patient, .in gaining his confidence, and a help to the anaesthetist, in gauging the difficulties of the case. “Now, however, there is a considerable choice in the type of anaesthetic, as well as numerous drugs Ms premedicating agents. Consequently there is now an imperative need ,for the anaesthetist to see the patient before operation, know his physical condition, and consult with the surgeon in charge or his resident as to the best type of anaesthetic and (lie pre medication.’’ Conflict of Interests. The best time for this work was the early hours of tlie evening, but visiting anaesthetists were then otherwise occupied. “Thus,” stated the report, “we have a major difficulty confronting us, brought about by the conflict between private practice and hospital work.”

At. night, many eases involving grave anaesthetic risks wore admitted which the resident medical staff could not be expected to handle, and the visiting anaesthetists were not conveniently available, if they were available at all. “As to the actual work done by our visiting anaesthetists,” stated the report, “we have to admit that on the whole it does not reach a high standard. This is no fault of theirs' for they are conscientious and able general practitioners. It is largely the fault of the system and due to the long years of neglect in the advancement. of anaesthesia.” After quoting the minimum requirements of the American College of Surgeons for a modern hospital department of anaesthesia, Dr. Hudson stated that visiting anaesthetists could not satisfactorily fit in. Material for Training.

“It has become imperative to reorganize completely the anaesthetic service as early as possible,” he continued. “It is extremely fortunate that we h;ive at hand a body of trained nurses from whose ranks may be obtained thoroughly satisfactory material for training as anaesthetists. This is a field of employment where nurses will excel and where we will get enthusiastic co-ojieration.” Important advantages in Dr. Hudson’s opinion wore their being at all times available, their youth and keenness assuring a high standard of work, the case with which they could cooperate with patients and surgeons and follow up operations, ease of control and discipline and more economical reimbursement. Resident Medical Anaesthetists. The report gave a scheme,of training and a plan of organization for a team of nurse-anaesthetists, working under a director, a medical anaesthetist, a senior resident medical officer anaesthetist ami two resident, medical anaesthetists. By this means it was considered that the anaesthetics department would reach a high standard of efficiency, not only in technical work, but also in the keeping of data and statistics, an important branch at present almost entirely neglected. The chairman, Mr. Allan J. Moody, describing the report as tt very important one, said it was a question whether the Director-General of Health would agree to certain of the proposals. He had asked Dr. Hudson to submit a further report, anil the two would require lo.'be carefully considered and submitted to the Health Department. The board received the report and decided to defer consideration.