Medicine: Conscious Under the Knife

In Operating Room D of Manhattan’s New York Hospital, Surgeon-in-Chief Frank Glenn held a razor-sharp scalpel over the patient’s chest and asked, “How is she?” Replied Chief Anesthesiologist Joseph Francis Artusio Jr.: “She’s fine.” Then Artusio addressed the patient: “Edna, can you hear me talking to you now?” She opened her eyes. “Edna, look over this way.” She turned her head toward the sound of Dr. Artusio’s voice.

Without more ado, Surgeon Glenn cut into the chest of Edna, 37, a housewife who had had rheumatic fever at 18 and was now suffering from scarring and narrowing of the mitral valve in her heart. As the scalpel made swift but precise cuts and laid bare a rib, Dr. Artusio asked: “Can you nod your head?” Edna nodded. Dr. Glenn lifted a pair of shears and snipped out the rib. Then he cut deeper, through the layers of the heart sac, until the pulsing organ itself was laid bare. He plunged his gloved finger into it and wiggled his fingertip, so that it tore some of the scar tissue and enlarged the opening in the mitral valve in order to let more blood flow from the left auricle to the left ventricle. Throughout the delicate operation, Edna was conscious. As the incision was being sewed up again, Dr. Artusio told her: “Put your tongue out at me.” She did.

Although conscious. Edna did not feel anything. Five days later, on her way to a good recovery (after years of semi-invalidism and constant fear that her heart might fail completely), she remembered nothing about the operation. And she was politely shocked at the idea that she had stuck out her tongue at anybody.

In most operations it has been thought best to have the patient totally anesthetized and unconscious. But this can be dangerous for the “poor-risk” patient with a failing heart, because the circulation may collapse entirely. To get around this hazard, Drs. Glenn and Artusio went back to a 100-year-old medical observation that had never been put to practical use, i.e., the fact that when the ether of ordinary anesthesia is wearing off, surgery can still go on, because for a while the patient feels no pain.

To bring about this painless state, or analgesia, which involves the entire body,* Dr. Artusio puts patients through all the usual sequence of anesthetics (barbiturates, thiopental sodium, nitrous oxide, oxygen, ether) until they lose consciousness. Then he gives more oxygen and less ether, so that they edge back across the threshold into consciousness, and holds them at this level. Edna’s case, filmed in color by E. R. Squibb & Sons for hospitals and professional groups, was typical of 120 mitral valve repairs on which Drs. Glenn and Artusio have worked—enough, they feel, to establish that ether analgesia is just what the surgeon needs for many hard-pressed patients.

*As distinct from local anesthesia, which is impractical for major chest surgery.