麻 醉

第五十四章 麻 醉

1.The advent of anesthesia has made it so that any idiot can become a surgeon.

—— William Stewart Halsted, 1852——1922

【译文】麻醉一问世,白痴都能做外科医生了。

2.Anaesthetics have abolished the need for operative speed and they allow time for careful procedures.

—— Lord Lister, 1827——1912

【译文】麻醉剂的应用让手术变得不需要那么匆忙,为仔细的手术操作提供了足够的时间。

3.The good surgeon deserves a good anesthesiologist, who is indispensable for the bad surgeon!

—— Oleg Zverev (From Russian–Youry Vladimirovitch Plotnicov)

【译文】好外科医生值得有一个好麻醉医生,但一个不够优秀的外科医生更是离不开一个好麻醉医生!

4.The choice of an anesthetic is more often determined by the idiosyncrasy of the operator than by the necessity of the case.

—— Charles H.Mayo, 1856——1939

【译文】对麻醉剂的选择往往取决于术者的喜好,而非病情的需要。

【点评】 就现在麻醉学而言,必须是病情优先。大师这样说的原因在于早年很少有专业的麻醉医生,多数是由外科医生自己兼做麻醉,所以用什么麻醉剂只能根据其喜好而定。

5.All anesthetic agents are poisons –thus the fewer the number, the smaller the dose and the shorter the exposure, the better.

—— Mark M.Ravitch, 1910——1989

【译文】麻醉剂都是毒药,种类越少、剂量越小、暴露时间越短越好。

6.A surgeon is someone who likes to operate; an anaesthetist is someone who doesn't like to give anaesthetics.

—— David M.Dent

【译文】外科医生是一群喜欢做手术的人,麻醉师是一群不喜欢给麻药的人。

7.There is an inverse relationship between a surgeon's ability and the frequency he asks for more muscle relaxant.

【译文】外科医生的能力和他要求增加肌松剂的频度成反比。

8.Fifteen minutes spent preoperatively with a patient is worth 15mg of morphine as premedicant.

—— Stephen J.Prevoznik

【译文】术前和患者多聊15min的效果不亚于15mg的吗啡术前用药。

【点评】人什么时候最孤独?感到最恐怖?——陌生环境陌生人、无法预知的风险、清醒且有时间思考——患者从被推进手术室到麻醉诱导开始这段时间里这三个要素全具备了。已混熟的主诊医生(手术医生)还没进来,刚刚握别了至爱亲朋,被推进了有几分肃杀气的偌大的手术间,交给了一个完全陌生的麻醉医生和几个陌生的护士,这与噩梦中突然坠落到一个黑咕隆咚冷风嗖嗖的深渊有区别吗?此刻站立在患者头侧的伟大的麻醉医生的一举一动,一言一行都无不牵动着患者无比脆弱的心、无比紧张的神经。此刻的每一个抚摸,每一点的关怀都是患者巨大的依靠和安慰,所以此时麻醉医生与患者多聊15min岂止15mg吗啡能比?

9.The laryngoscope is a tool, not a weapon.

【译文】喉镜(插管)是救命的工具,而不是致命的武器。

【点评】 喉镜使用不当或插管准备不充分常会给患者带来严重伤害,让其成为“夺命喉镜”。

10.The patient who can't be intubate should be intubate.

【译文】难插管的患者更应该插管。

11.In America there exist professional anesthetists.This specialty is being praised in Germany.I cannot think of anything more dull.

—— August Bier, 1861——1949

【译文】美国有专业的麻醉医生。目前,这个专业在德国受到推崇。我想不出还有什么比这更无聊的了。

【点评】现在看来这是很有前瞻性的变革。随着手术越做越大,越做越复杂,麻醉学在临床医学中的重要性日渐跃升。21世纪以来,国内不仅将这个专业的学科分类提升到与内、外科这类一级分科并列,而且越来越多的医学院开设了麻醉学的本科专业。

12.Call me when you run out of blood and morphine.

—— Ario Hermreck

【译文】血和吗啡用完了就打电话给我。

【点评】这种麻醉医生也太可怕了。(https://www.daowen.com)

13.There is no such thing as a "little anesthesia ".

【译文】不存在有所谓的“小麻醉”。

14.It is usually a bad sign if the anesthesiologist is asking you if you are losing a lot of blood during a case especially when you're not.It is usually a bad sign if there are three or more anesthesiologists in the operating room at the same time and none of them is reading the newspaper.

—— Michael Hoffman

【译文】手术室出现以下两个场景时,通常就大事不妙了:在并无大出血的情况下,麻醉医生问你手术是否正在大出血;有三个或更多的麻醉医生聚集在同一间手术室,且没人在看报纸。

15.Three natural anesthetics: sleep, fainting, death.

—— Oliver Wendell Holmes, 1809——1894

【译文】三种自然“麻醉”:睡着了、昏厥和死亡。

16.Mr.Anesthetist, if the patient can keep awake, surely you can.

—— Wilfred Trotter, 1872——1939

【译文】麻醉师先生:如果让患者保持清醒,你一定能做到。

【点评】我经常调侃麻醉医生:该麻醉时没麻,不该麻醉时却醒不来是一流麻醉;该麻醉时麻醉了,不该麻醉时也醒不来是二流麻醉;该麻醉时麻醉了,不该麻醉时立刻能清醒的就是三流麻醉。以此标准,让患者保持清醒一定是超水平麻醉。

17.Blood brain barrier (BBB): the screen between the surgeons and anesthetists.

【译文】血脑屏障:外科医生与麻醉医生之间的屏障。

【点评】外科医生只在意麻醉效果,而麻醉医生还要顾及麻醉的后果。

18.If you can feel pulse, don't panic.

【译文】如果你能感觉到脉搏,不要惊慌。

19.What's blue & white anesthesia? The patient blue, the anesthetist white (blue and white are colors of the Israeli flag).

—— Danny Rosin

【译文】什么是“蓝白”麻醉?患者蓝色,麻醉医生白色(蓝色和白色是以色列国旗的颜色)。

【点评】患者蓝色是因为缺氧所导致的发绀,白色是麻醉医生被吓得面色苍白。

20.General anesthesia is like air travel: disasters usually occur during take off or landing.

—— Max M.Simon

【译文】全身麻醉就像是乘飞机,灾难多发生在起飞或降落时。

【点评】还有比这更贴切的比喻吗?

21.Then causes of anaesthetic death are all too often mundane and obvious and rarely require much, if any, scientific investigations to establish them, provided a truthful account of the facts can be obtained.

—— Robert Macintosh, 1897——1989

【译文】麻醉致死的原因通常都是普通而明显的,只要能提供对事实的真实描述,就很少需要太多的科学调查(如果有的话)来确定它们的原因。

【点评】说明大多数麻醉意外都是低级错误所导致的吗?

22.Nearly all drips set up at the start of an operation are not merely unnecessary, but harmful.At least half of the drips set up afterwards are an automatic routine or an assurance against worry, rather than a considered form of therapy.

—— William Henege Ogilvie, 1887——1971

【译文】几乎所有在手术开始时进行的静滴不仅是多余的,而且是有害的。之后的点滴治疗至少有一半是例行程序,或者只是图个安心,而不是一种经过深思熟虑的治疗方式。

【点评】不能完全认同,有些血容量不足或者有可能发生大出血的患者就是需要提前“预充”,既能稀释血液,也能防止意外大出血来不及补充。

23.The anaesthetist is there to look after the mother: the paediatrician is there to look after the baby; the obstetrician is there to look after himself.

—— Barbara Morgan

【译文】麻醉医生在那照顾母亲;儿科医生负责照顾宝宝;产科医生在那自己照顾自己。

【点评】调侃无痛分娩过程中貌似无所事事的产科医生。