Anesthetic gases

[Jeff Root]

Funny how one can come up with a completely new
explanation of something experienced 44 years ago!

-- Jeff, in Minneapolis

[primummobile]

I just read primummobile's post immediately before
mine. When he said that the anesthesiologist walked up
to his *bed* (rather than the operating table) it reminded
me that I had been given something before I was taken to
the operating room. Some sort of preliminary anaesthetic.
But I don't remember how it was administered or by whom,
or that it had a noticeable effect. It makes me wonder
how many different steps there were. First this preliminary
anaesthetic, given to me in the room I would spend the
next two days in, then the taps from the penlike thing,
then the IV, and possibly gas after that?

-- Jeff, in Minneapolis

iirc, I was already in the operating room when this happened. But I don't remember moving from my bed to the table.

ETA: Actually, I moved from my bed to a gurney they brought to my room. So I don't remember leaving the gurney.

[Van Rijn]

I've never encountered an anaesthetic gas or vapour I would describe as "sickly sweet" - I've always imagined that description was made up by novelists who didn't know any better, and who were trying to evoke something both appealing and threatening.

Suggestion might be an issue too. I believe I only once had anesthetic gas (some other times with IV stuff, generally "conscious sedation," once deep enough where they used supplemental oxygen, but I believe that was still with an IV anesthetic). I remember when I was very young, around '65, when I was in the hospital for a tonsillectomy. I remember a strong odor when they put a rubber mask on my face. I have a memory that I thought I was smelling the rubber mask, but with your descriptions of the anesthetic gases, I doubt it. Anyway, if someone suggested it was "sickly sweet" it's been long enough I might accept that.

By the way, nice to see you posting again, Grant.

[Tom Mazanec]

I had a dentist remove a tooth once and had that mask with the sickly sweet odor. Next thing my whole body felt supernumb, and then I experienced a dream where I was an astronaut on a barren planet, with a huge spiral galaxy overhed, and a caterpillar like alien began attacking me in the mouth. I think the "galaxy" was the light, and the alien was the dentist.
Years later, I had a polyp removed, and the anestetic injection was like, one second I'm getting it, and the next second it is a hour later...

[Ara Pacis]

Hmm, I don't recall anything about my surgery. I'm told that it took longer than expected, but no one told me why, it was just what family said. They said I was also in Recovery longer than expected. Makes me wonder if any weirdness happened or if the doc was just late getting in. They had delayed it a couple hours because of that and I don't recall him being there yet when they prepped me and knocked me out. I don't know if they EEGed me or not, but I'd be worried that it wouldn't work. I had an EEG a few years ago after a head injury and the doc told me to wake up when it was done because she thought I had been sleeping, but I had been conscious the whole time but was just daydreaming.

[DonM435]

Suggestion might be an issue too. I believe I only once had anesthetic gas (some other times with IV stuff, generally "conscious sedation," once deep enough where they used supplemental oxygen, but I believe that was still with an IV anesthetic). I remember when I was very young, around '65, when I was in the hospital for a tonsillectomy. I remember a strong odor when they put a rubber mask on my face. I have a memory that I thought I was smelling the rubber mask, but with your descriptions of the anesthetic gasses, I doubt it. Anyway, if someone suggested it was "sickly sweet" it's been long enough I might accept that.

By the way, nice to see you posting again, Grant.

That's the way that I remember that childhood anesthesia -- fresh rubber (like a new automobile) intensified.

[Ara Pacis]

Could that smell have something to do with the tubes and other gas gear?

[grant hutchison]

Could that smell have something to do with the tubes and other gas gear?

Up to about twenty-five years ago, masks and tubing were generally made from reusable antistatic rubber. All the vapours were soluble in rubber to some extent, so the circuits ended up with a rubber+solvent sort of smell. With the elimination of potentially explosive anaesthetic agents (and the associated need for antistatic precautions), that's all been replaced with light plastic disposable products, so modern circuits and masks now tend not to smell of anything very much, unless the masks have been deliberately scented. If they are scented, the smell (vanilla, mint, something fruity) is very mild - obviously, making the masks smell strong enough to be "sickly" would be counterproductive. I've anyway never found scented masks to be much of an improvement on the unscented ones - if you don't like a mask on your face, a whiff of misplaced strawberry just isn't going to change that.
A lot of the experiences reported on this thread date from the days of rubber circuits, so people are going to have smelled the rubber and a whiff of anaesthetic vapour, even if they were just receiving oxygen through the mask while an IV anaesthetic was administered.

Grant Hutchison

[captain swoop]

Threads like this are why I like this place.

[DonM435]

Threads like this are why I like this place.

Yep, there's some numbing erudition going on here.

[Jens]

Personally, I find this all quite sedate.

I have a textbook of dental anaesthesia from that time which (paraphrasing from memory) says: 100% nitrous oxide should be administered until the lips are blue and the pulse begins to fade. At that point a single breath of air should be administered, and extractions may commence.*
The footnote reads *If the child fails to breathe at this point, it is advisable to assist ventilation.

That's insane! I'm surprised they didn't recommend leeches!

[grant hutchison]

That's insane! I'm surprised they didn't recommend leeches!

Yes, the past is indeed another country. A clear violation of Hutchison's First Law, "Never breathe anything that contains no oxygen."

But we're still using leeches medically, of course: bdellotherapy or hirudotherapy, depending on whether you think of "therapy" as coming from Classical Greek or Modern Latin. (And on how comfortable you are pronouncing "bd"!)
Here (3-page pdf) is a current patient-information leaflet on leeches.

Grant Hutchison

[Tobin Dax]

Up to about twenty-five years ago, masks and tubing were generally made from reusable antistatic rubber. All the vapours were soluble in rubber to some extent, so the circuits ended up with a rubber+solvent sort of smell. With the elimination of potentially explosive anaesthetic agents (and the associated need for antistatic precautions), that's all been replaced with light plastic disposable products, so modern circuits and masks now tend not to smell of anything very much, unless the masks have been deliberately scented. If they are scented, the smell (vanilla, mint, something fruity) is very mild - obviously, making the masks smell strong enough to be "sickly" would be counterproductive. I've anyway never found scented masks to be much of an improvement on the unscented ones - if you don't like a mask on your face, a whiff of misplaced strawberry just isn't going to change that.
A lot of the experiences reported on this thread date from the days of rubber circuits, so people are going to have smelled the rubber and a whiff of anaesthetic vapour, even if they were just receiving oxygen through the mask while an IV anaesthetic was administered.

Grant Hutchison

That roughly fits the time frame I'm thinking of. I know that the masks used in my surgeries in the early-to-mid '90s were different than those used earlier. Now I'm trying to recall more about the surgeries I had around '88-'89 and whether the rubber circuit masks were used then. I was too young to really remember the round of surgeries before that, but it's possible that I dislike the masks from when I first experienced them in the mid-'80s.

ETA: Forgot to say thanks to Grant. I'm glad you popped in.

[ShinAce]

What's wrong with leeches? I'm pretty sure they can be used when reattaching digits to assist blood circulation into the nearly dead tissue. Like nature's little capillary blood pumps. Next I'll see people say that using maggots is not medical, when in fact it is. Maggots and leeches, baby!

I've been knocked out twice, and both times was with fentanyl. Likely laced with another drug to seal the deal. Second time was to have a metal plate screwed into my arm and that went well. Except for the rookie resident anesthesiologist who missed the vein at least 4 times in a row. It was the 5th or 6th time when I told him to stop being an amateur. The senior anesthesiologist got it first try like a boss. Woke up an hour later to crazy pain in my arm. Apparently the human body doesn't like new hardware that much.

First time was to get my wisdom teeth taken out. The nurse was administering and doing it slowly. So slow that I had time to bad trip and lose blood pressure. When it feels like you've had 8 shots of tequila injected in 10 seconds, you start wondering what the next 10 seconds are going to be like. Enter 10 minutes of purple lips bad tripping. That time I woke up 30 minutes after being put out, with no pain for the next hour and a half. Was even able to walk home on my own power. Only a slight buzz.

Good times!

[grant hutchison]

What's wrong with leeches? I'm pretty sure they can be used when reattaching digits to assist blood circulation into the nearly dead tissue.

Yep, the link I gave in post #42 gives more detail.
The problem with reimplantations and free-flap grafts is that thick-walled arteries are easier for surgeons to find and stitch together than thin-walled veins are. So a lot of reimplantations and grafts start off with better arterial supply than venous drainage. So the grafted tissue swells, the swelling impairs microcirculation, and the graft can die. Veins are distensible, however, and the veins that are plumbed in will dilate over a few days to take the load, provided the reimplanted or grafted tissue survives until that happens. Leeches feeding from the grafted tissue help restore the microcirculation, both by reducing swelling and by injecting a local anticoagulant which prevents the slowly moving blood from clotting in the vessels. They buy time for the graft's venous drainage to improve.

Grant Hutchison

[HenrikOlsen]

I've had general anesthesia twice that I can remember (I have no memories from the time in infancy when I got my appendectomy),
First time I remember was a bit less that 40 years ago, an adenoidectomy done in the doctor's practice where anesthesia was achieved with with some sort of cloth or mesh mask which the doctor poured a liquid on, I'm guessing perhaps one of the ether's (I'm not sure when use of chloroform stopped but I think it was before this), this was one where I had to count and at the time I guess that was to keep me breathing it though I didn't like the smell. I can't remember what the smell was with any certainty, very vaguely recall that it reminded me of my dad's pain thinner from when he cleaned brushes but whether turpentine or acetone I wouldn't be able to say now.
Second time was in a hospital 5-10 years later with the anesthetic administered through a vein on my left hand while breathing through a mask.

Incidentally, I would actually describe the smell of acetone as sickly sweet, that's how it appears to me.

[grant hutchison]

Incidentally, I would actually describe the smell of acetone as sickly sweet, that's how it appears to me.

I likewise find some of the short-chain ketones to be sweet-smelling, and sickly in high concentrations, perhaps because of the association with rotten fruit.

Grant Hutchison

[swampyankee]

No but it is potentially highly reactive. If you are telling me that it has anaesthetic effects, perhaps those effects are down to toxicity rather than true anaesthesia. So it's only an anaesthetic in the same sense that carbon monoxide is an anaesthetic ? Personally I wouldn't go inhaling cyclopropene without doing some careful checks first.

Ara Pacis wrote:
Not all anesthetics are gases tho, I recall getting something through an IV, but is the mechanism of action be similar or different?

They usually give you some serious drugs to make you really calm (or put you to sleep) before they gas you. But it's the gas that is classed as the anaesthetic.

Or it's just plain false that they all smell sickly sweet

Ether and chloroform could be described as sweet smells. With modern anaesthetic gases I am guessing the sweet smell comes either from an additive or from products used to clean the mask. If it smells nice it can't scare you can it?

Cyclopropene was a typo; I should have written cyclopropane, which was used as an anesthetic until they decided its toxicity and reactivity made it impractical.

[grant hutchison]

Cyclopropene was a typo; I should have written cyclopropane, which was used as an anesthetic until they decided its toxicity and reactivity made it impractical.

Yes, cyclopropane was a fine drug in some ways, and we didn't properly fill the gap it left until xenon came along. It was so insoluble in blood, and so non-irritant, that you could take one deep breath of a suitable cyclo/oxygen mixture and become unconscious. It was great stuff for putting a wriggling, crying baby off to sleep. If only it hadn't had that pesky tendency to detonate.
(Another of my old textbooks of anaesthesia has a very long chapter entitled Combustion, Deflagration and Explosion ... happy days!)

Grant Hutchison

[swampyankee]

Yes, cyclopropane was a fine drug in some ways, and we didn't properly fill the gap it left until xenon came along. It was so insoluble in blood, and so non-irritant, that you could take one deep breath of a suitable cyclo/oxygen mixture and become unconscious. It was great stuff for putting a wriggling, crying baby off to sleep. If only it hadn't had that pesky tendency to detonate.
(Another of my old textbooks of anaesthesia has a very long chapter entitled Combustion, Deflagration and Explosion ... happy days!)

Grant Hutchison

I'm sure many fire departments and insurance companies are very happy that the combination of oxygen and cyclopropane or oxygen and ether are obsolete.

[grant hutchison]

I'm sure many fire departments and insurance companies are very happy that the combination of oxygen and cyclopropane or oxygen and ether are obsolete.

In clinical use, ether was much less of a combustion risk than cyclopropane. (Diethyl) ether was commonly given using a Schimmelbusch mask (the cloth-and-wire thing Henrik recalls), and the patient breathed air - this was possible because people breathe quite deeply even when well-anaesthetized with ether. But cyclopropane was notorious for inhibiting breathing, so was almost always given in oxygen. Ether is flammable in air over a limited range of concentrations, but it's not explosive; whereas cyclopropane detonates in oxygen over a very broad range of concentrations.
So there are stories of ether anaesthetics being administered in rooms heated by fires burning in open fireplaces; blue flames would intermittently flickering across the floorboards when the dense ether accumulated into a layer concentrated enough to briefly support a travelling flame. And of the anaesthetist who demonstrated the safety of ether anaesthesia by anaesthetizing a baboon using ether in air, and then holding a lighted match to the baboon's lips. Because of that deep breathing which characterizes ether anaesthesia, all that happened was that the baboon kept blowing out the matches.

Grant Hutchison

[selden]

The assistant anesthesiologist was one of the more memorable parts of the heart surgery I underwent back in 2005. I have to believe that they intentionally picked the most beautiful doctor on their staff to distract male patients who were about to undergo major surgery.

The fact that they used some kind of glue instead of thread or staples to close all of the external incisions was a surprise, too.

[grant hutchison]

The assistant anesthesiologist was one of the more memorable parts of the heart surgery I underwent back in 2005. I have to believe that they intentionally picked the most beautiful doctor on their staff to distract male patients who were about to undergo major surgery.

Ah, the old "Gorgeous Assistant Trick". Works almost as well as the "Tap With The Magic Pen Trick" they used on Jeff.
Of course, the skill is in knowing which trick to use on which patient.

Grant Hutchison

[Ara Pacis]

I feel left out now. I don't recall any gorgeous people in my OR. I mean, there were nurses in scrubs and they were all pretty because I live in an area with a lot of pretty swedish types, but no one was intentionally trying to distract me from anything. That's okay though, my mind was on a specific nurse I had developed a crush on from my previous ER visit and sure enough, she was my nurse again. Unfortunately she was pregnant so all the flirty teasing back and forth was for naught.

[publiusr]

I wonder how these gases might be used in suspended animation. Prehoda did a book on the subject--and I think he mentioned xenon. Oxygen both cures and kils. You need it for immediate respiration--but over time its effects eat away at you. I think a recent sci am article talked about removing oxygen from a subject in suspended animation was vital--then flooding everything with oxygen--but quickly to get everything up and around again--but don't let it linger.

I know this is O/T--but bear with me--in that the topic you are all discussing might be relevant down the road.

Now we all know of the fictional ice nine--and its properties--however--according to the wiki: The ice-nine phenomenon has, in fact, occurred with a few other kinds of crystals, called "disappearing polymorphs". In these cases, a new variant of a crystal has been introduced into an environment, replacing many of the older form crystals with its own form. One example is the anti-AIDS medicine ritonavir, where the newer version destroyed the effectiveness of the drug[2] until improved manufacturing and distribution was developed.

http://en.wikipedia.org/wiki/Ice-nine

So here is my question: Could an anesthetic be designed similarly so as to break down at once so as to allow oxygen to quickly flood the body--and vice versa?

[NEOWatcher]

I feel left out now. I don't recall any gorgeous people in my OR.

I don't ever recall a gorgeous person anytime I ended up in an OR. They must have all been ugly if they had to hide under a mask.

[Ara Pacis]

I don't ever recall a gorgeous person anytime I ended up in an OR. They must have all been ugly if they had to hide under a mask.

I do recall a friendly cutie running the CT scanner on my ER visit, but I forgot about her once I got to a room and met my nurse. *sigh* At first, I did think I was going to develop a crush on the CT tech cause I saw her beaming at me from the control room and I felt this glowing warmth spread across my body... and then I realized it was just the iodine contrast. (That's my story and I'm sticking to it.)