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New type apparatus for giving intravenous anesthesia
NEW TYPE APPARATUS
FOR GIVING INTRAVENOUS
ANESTHESIA ALVIN
Y.
WELLS,
Winfield,
S
intravenous apparatuses have been described in the Iiterature but none have offered the compIeteIy cIosed system with the compactness, ease of operation and contro1 as the one herein described. WhiIe the author was acting as anesthestist during the war, he deveIoped the apparatus herein described. It has been used over a period of three years and has been found very satisfactory. PentothaI sodium was the drug used in every instance. The apparatus* as shown in Figure I is essentiaIIy an instrument of simpIe construction which is a very great aid in administering intravenous pentotha1 sodium anesthesia. The body (R) is made of cast aIuminum and clamped flat on the arm board by means of a bracket (S) which is aIso constructed to hold the reservoir bottle (F). It is distinctive in its sinipIicity and compactness, being so smaII that it does not project up into the way of any of the operating equipment. Furthermore, the feeder screw (A) which operates through the sIiding pIunger head hoIder (D) gives more accurate contro1 of the syringe pIunger (E) with Iess friction. The rotary type syringe barreI cIamps (J) are efficient and easiIy operated. The bracket which cIamps the apparatus to the tabIe is so constructed that it may easily be transferred to the opposite side EVERAL
* The apparatus is manufactured and distributed by the Kansas City AssembIage Company, Kansas City, MO. 526
M.D.
Kansas
by mereIy Ioosening a thumb screw (Q). Since the bracket aIso holds the reservoir container the Iatter may be put on the side where it wiI1 be most convenient. The accessory equipment consists of a small wide mouthed bottIe (F) 2 inches in diameter and ~$6 to 3 inches high, two 8-inch pieces of g-inch inside bore rubber tubing (L), one three-way vaIve (K), a rubber stopper (G) containing two hoIes, one smaI1 gIass observation needIe adapter (N), one 20 cc. Becton, Dickinson syringe (I), a so-gauge r +$inch hypodermic needIe (M) and two pieces of gIass tubing connected with the stopper. A stand is provided so that the apparatus may be assembIed, the syringe, tubing and bottIe fiIIed with pentotha1 soIution and a11 set aside convenientIy until the anesthetist is ready to start anesthesia. When the entire apparatus is set up as shown in Figure I and connected with the vein in the arm, it occupies so Iittle space that sterile operating sheets may be thrown over it aI1. Operation of the equipment beneath the sheets is very easy and a measure of safety to both surgeon and anesthetist is added. TECHNIC
The tubing with three-way vaIve and gIass adapter, two 20 cc. syringes, two drug glasses, two zo-gauge ~>+inch needIes, the reservoir bottIe (with the rubber stopper) and some gauze sponges are wrapped and steriIized in an individua1 kit. The syringe pIungers are coated with a IittIe glycerine
Vm.LXXV,No.3
WelIs-Apparatus
for Anesthesia
American
~~~~~~~ of surgery
$27
FIG. I. A, feeder screw; B, set screw; c, I. D. threaded bushing; D, syringe plunger head holder; E, syringe plunger; F, reservoir bottle; G, rubber stopper; H, air vent tube; I, syringe barrel; J, rotary syringe clamp; K, three-way valve; L, rubber tube from syringe to supply bottle; &I, hypodermic needle; N, glass adapter; o, holder for needle and tube when not in use. (The other cut opposite side of apparatus.) P, sliding arm of bracket. (The other cut opposite side of apparatus.) Q, thumb set screw to hold bracket in place. (The other cut opposite side of apparatus.) K, main body of hoIder; s, bracket for holding bottIe and also for clamping apparatus to table.
before sterilizing. The syringe should be tested in the hoIder to be sure it fits before sterilizing. When it is desired to give an intravenous anesthetic, the apparatus is assembIed after checking al1 parts carefuhy. It is especiaIIy important to manipmate the three-way valve severa times to be sure it works easiIy. Otherwise, the shank of the syringe may be broken off in the process. The Becton, Dickinson Luer-Iok type syringe is safer to use and is included in the set. Next, the pentotha1 powder is put into the medicine glass and sufficient steriIized distihed water (40 cc. per Gm.) added to make a 246 per cent solution. When compIeteIy dissolved, the syringe and tubing are fihed with soIution, being sure to eIiminate a11 air bubbIes. The excess soIution is put into the reservoir bottIe and the stopper snugly appIied. The reservoir bottle is Iitted with a No. 6 stopper containing two holes. In one hoIe a gIass tube connects the rubber tubing and syringe to the bottom of the jar for deIivering the reserve suppIy of anesthetic solution. Into the other hoIe of the stopper a gIass tube is placed to act as an air vent (H). In the
Iatter tube is an enIarged chamber into which is pIaced some cotton to fiber the air going to and from the jar. When the unit has been assembled and fiIIed with anesthetic soIution, the syringe and bottIe are fitted into the apparatus for cIamping on the tabIe. An aIcoho1 sponge may be put on the needle before putting it into the cIamp (0) on the apparatus. The entire apparatus is now set aside on the stand unti1 the anesthetist is ready to start anesthesia. When ready to start the anesthesia, the anesthetist cIamps the apparatus on the armboard beside the patient’s arm; the needle is inserted through the skin and the feeder screw reversed one-fourth turn to produce a back pressure so that the bIood wiI1 immediately appear in the gIass adapter as the needIe punctures the vein. The Iatter procedure wiI1 obviate the use of a syringe unti1 the vein is found as is necessary in some obese patients. In fact, this works better than a syringe because the back pressure is maintained unti1 the vein is punctured. This is a great advantage over other methods.
528
A m&can
Journd of Surgery
WeIIs-Apparatus
The anesthetic material is now injected sIowIy into the vein unti1 the desired amount is given. A shght turn of the feeder screw may be made at intervaIs, if necessary, to keep bIood from coaguIating in the needIe. When the patient is at the desired depth of anesthesia, the anesthetist’s hands will be free to do other things. It is a great advantage to the anesthetist to have perfect contro1 of the anesthesia and at the same time to be free to work with the patient at a11 times. When the .syringe is empty, one may change the three-way vaIve and reverse the feeder screw to refiI1 from the jar. The valve is again changed and the anesthetic solution forced into the vein by a few turns of the feeder screw as needed. If the pIunger seems to stick, give it a turn with the fingers and smooth operation wiI1 foIIow. However, ‘6jiggIing” the feeder screw back and forth sIightIy may be a11 that is needed. The reservoir wiI1 hoId enough soIution for two or three patients and by merely changing the needIe and tubing that deIivess the pentotha1 from the syringe to the vein, one may give several anesthetics with perfect safety. Additiona pentothal
for Anesthesia
MARCH. 1948
soIution may be added to the reservoir bottIe whenever desired. If, at times, one does not wish to use the feeder screw, it may be Ieft in the extreme distal position and the syringe plunger manipuIated with the fingers. The apparatus stiI1 wiI1 be found usefu1 to hoId the syringe and its supply of pentotha1 soIution. Since some things made of gIass vary considerabIy in their dimensions, it is sometimes heIpfu1 to turn the syringe in the apparatus to find the position that wiI1 give the smoothest operation. The apparatus is made to take a standard Becton, Dickinson 20 cc. syringe aIthough others may be used. It is beIieved that if one wiI1 famiIiarize himseIf with the mechanisms and use the apparatus a few times, he wiI1 not care to give intravenous pentotha1 without it. SUMMARY
A new type apparatus for administering intravenous anesthesia is described. 2. The apparatus is compact, easy to operate and provides a safe means of giving intravenous pentotha1 sodium. 3. The administration of the anesthetic is compIeteIy under control at a11times. I.
FOR GIVING INTRAVENOUS
ANESTHESIA ALVIN
Y.
WELLS,
Winfield,
S
intravenous apparatuses have been described in the Iiterature but none have offered the compIeteIy cIosed system with the compactness, ease of operation and contro1 as the one herein described. WhiIe the author was acting as anesthestist during the war, he deveIoped the apparatus herein described. It has been used over a period of three years and has been found very satisfactory. PentothaI sodium was the drug used in every instance. The apparatus* as shown in Figure I is essentiaIIy an instrument of simpIe construction which is a very great aid in administering intravenous pentotha1 sodium anesthesia. The body (R) is made of cast aIuminum and clamped flat on the arm board by means of a bracket (S) which is aIso constructed to hold the reservoir bottle (F). It is distinctive in its sinipIicity and compactness, being so smaII that it does not project up into the way of any of the operating equipment. Furthermore, the feeder screw (A) which operates through the sIiding pIunger head hoIder (D) gives more accurate contro1 of the syringe pIunger (E) with Iess friction. The rotary type syringe barreI cIamps (J) are efficient and easiIy operated. The bracket which cIamps the apparatus to the tabIe is so constructed that it may easily be transferred to the opposite side EVERAL
* The apparatus is manufactured and distributed by the Kansas City AssembIage Company, Kansas City, MO. 526
M.D.
Kansas
by mereIy Ioosening a thumb screw (Q). Since the bracket aIso holds the reservoir container the Iatter may be put on the side where it wiI1 be most convenient. The accessory equipment consists of a small wide mouthed bottIe (F) 2 inches in diameter and ~$6 to 3 inches high, two 8-inch pieces of g-inch inside bore rubber tubing (L), one three-way vaIve (K), a rubber stopper (G) containing two hoIes, one smaI1 gIass observation needIe adapter (N), one 20 cc. Becton, Dickinson syringe (I), a so-gauge r +$inch hypodermic needIe (M) and two pieces of gIass tubing connected with the stopper. A stand is provided so that the apparatus may be assembIed, the syringe, tubing and bottIe fiIIed with pentotha1 soIution and a11 set aside convenientIy until the anesthetist is ready to start anesthesia. When the entire apparatus is set up as shown in Figure I and connected with the vein in the arm, it occupies so Iittle space that sterile operating sheets may be thrown over it aI1. Operation of the equipment beneath the sheets is very easy and a measure of safety to both surgeon and anesthetist is added. TECHNIC
The tubing with three-way vaIve and gIass adapter, two 20 cc. syringes, two drug glasses, two zo-gauge ~>+inch needIes, the reservoir bottIe (with the rubber stopper) and some gauze sponges are wrapped and steriIized in an individua1 kit. The syringe pIungers are coated with a IittIe glycerine
Vm.LXXV,No.3
WelIs-Apparatus
for Anesthesia
American
~~~~~~~ of surgery
$27
FIG. I. A, feeder screw; B, set screw; c, I. D. threaded bushing; D, syringe plunger head holder; E, syringe plunger; F, reservoir bottle; G, rubber stopper; H, air vent tube; I, syringe barrel; J, rotary syringe clamp; K, three-way valve; L, rubber tube from syringe to supply bottle; &I, hypodermic needle; N, glass adapter; o, holder for needle and tube when not in use. (The other cut opposite side of apparatus.) P, sliding arm of bracket. (The other cut opposite side of apparatus.) Q, thumb set screw to hold bracket in place. (The other cut opposite side of apparatus.) K, main body of hoIder; s, bracket for holding bottIe and also for clamping apparatus to table.
before sterilizing. The syringe should be tested in the hoIder to be sure it fits before sterilizing. When it is desired to give an intravenous anesthetic, the apparatus is assembIed after checking al1 parts carefuhy. It is especiaIIy important to manipmate the three-way valve severa times to be sure it works easiIy. Otherwise, the shank of the syringe may be broken off in the process. The Becton, Dickinson Luer-Iok type syringe is safer to use and is included in the set. Next, the pentotha1 powder is put into the medicine glass and sufficient steriIized distihed water (40 cc. per Gm.) added to make a 246 per cent solution. When compIeteIy dissolved, the syringe and tubing are fihed with soIution, being sure to eIiminate a11 air bubbIes. The excess soIution is put into the reservoir bottIe and the stopper snugly appIied. The reservoir bottle is Iitted with a No. 6 stopper containing two holes. In one hoIe a gIass tube connects the rubber tubing and syringe to the bottom of the jar for deIivering the reserve suppIy of anesthetic solution. Into the other hoIe of the stopper a gIass tube is placed to act as an air vent (H). In the
Iatter tube is an enIarged chamber into which is pIaced some cotton to fiber the air going to and from the jar. When the unit has been assembled and fiIIed with anesthetic soIution, the syringe and bottIe are fitted into the apparatus for cIamping on the tabIe. An aIcoho1 sponge may be put on the needle before putting it into the cIamp (0) on the apparatus. The entire apparatus is now set aside on the stand unti1 the anesthetist is ready to start anesthesia. When ready to start the anesthesia, the anesthetist cIamps the apparatus on the armboard beside the patient’s arm; the needle is inserted through the skin and the feeder screw reversed one-fourth turn to produce a back pressure so that the bIood wiI1 immediately appear in the gIass adapter as the needIe punctures the vein. The Iatter procedure wiI1 obviate the use of a syringe unti1 the vein is found as is necessary in some obese patients. In fact, this works better than a syringe because the back pressure is maintained unti1 the vein is punctured. This is a great advantage over other methods.
528
A m&can
Journd of Surgery
WeIIs-Apparatus
The anesthetic material is now injected sIowIy into the vein unti1 the desired amount is given. A shght turn of the feeder screw may be made at intervaIs, if necessary, to keep bIood from coaguIating in the needIe. When the patient is at the desired depth of anesthesia, the anesthetist’s hands will be free to do other things. It is a great advantage to the anesthetist to have perfect contro1 of the anesthesia and at the same time to be free to work with the patient at a11 times. When the .syringe is empty, one may change the three-way vaIve and reverse the feeder screw to refiI1 from the jar. The valve is again changed and the anesthetic solution forced into the vein by a few turns of the feeder screw as needed. If the pIunger seems to stick, give it a turn with the fingers and smooth operation wiI1 foIIow. However, ‘6jiggIing” the feeder screw back and forth sIightIy may be a11 that is needed. The reservoir wiI1 hoId enough soIution for two or three patients and by merely changing the needIe and tubing that deIivess the pentotha1 from the syringe to the vein, one may give several anesthetics with perfect safety. Additiona pentothal
for Anesthesia
MARCH. 1948
soIution may be added to the reservoir bottIe whenever desired. If, at times, one does not wish to use the feeder screw, it may be Ieft in the extreme distal position and the syringe plunger manipuIated with the fingers. The apparatus stiI1 wiI1 be found usefu1 to hoId the syringe and its supply of pentotha1 soIution. Since some things made of gIass vary considerabIy in their dimensions, it is sometimes heIpfu1 to turn the syringe in the apparatus to find the position that wiI1 give the smoothest operation. The apparatus is made to take a standard Becton, Dickinson 20 cc. syringe aIthough others may be used. It is beIieved that if one wiI1 famiIiarize himseIf with the mechanisms and use the apparatus a few times, he wiI1 not care to give intravenous pentotha1 without it. SUMMARY
A new type apparatus for administering intravenous anesthesia is described. 2. The apparatus is compact, easy to operate and provides a safe means of giving intravenous pentotha1 sodium. 3. The administration of the anesthetic is compIeteIy under control at a11times. I.