Surgery: Under Pressure

Time was when a surgeon needed little more for an operation than his kit of instruments and an assistant to drip ether onto the gauze held over the patient’s nose and mouth. But since technology has taken over, today’s operating theaters contain surgical teams numbering a dozen or more specialists controlling batteries of instruments from heart-lung machines and artificial kidneys to monitoring devices recording every thing from pulse and breathing to brain waves.

But for all this equipment the major risks were nonetheless run by the man on the operating table. The newest branch of surgery is now going a step further and requiring the whole operating team to undergo the hazards along with the patient. This fast-developing technique requires that operations be conducted with both patient and surgical team isolated in a sealed chamber under pressure up to seven times the earth’s atmosphere. So successful have the results been to date that surgeons consider the risk worth taking—even for themselves—and already-crowded hospitals are now adding whole new combinations of hyperbaric chambers and spheres to make such under-pressure operations possible.

Staph & Clots. The surgeon who pioneered the new trend is Amsterdam’s Dr. Ite Boerema (TIME, Feb. 15, 1963), on hand last week to receive an honorary membership in the American College of Surgeons at its annual congress in Chicago. Dr. Boerema had begun by using high-pressure oxygen to combat gas gangrene. Reasoning that the microbes that cause gangrene are of types that thrive without oxygen, he succeeded in killing the microbes by flooding them with oxygen. Since then hyperbaric conditions in the operating room have proved a godsend when treating infants with congenital heart defects. Working in an old and relatively primitive Navy chamber, Harvard’s Dr. William F. Bernhard and his colleagues have now operated on 80 such infants and children, have had only one patient die during surgery.

Other researchers believe high-pressure oxygen may be useful in destroying lingering tetanus bacilli, and doctors at Maumee Vallery Hospital, Toledo, report that in some cases it is effective against oxygen-breathing microbes, including Staphylococcus aureus—”hospital staph.” There is even evidence that high-pressure oxygen may help to dispel massive blood clots in the lungs, help to reverse the effects of severe heart attacks, and enhance the effectiveness of certain drugs in the treatment of certain skin cancers (melanomas).

Martini Effect. As encouraging as the new hyperbaric technique has proven to be, it is still fraught with all the risks inseparable from working in abnormally high pressures. An expert in the field is Dr. Claude R. Hitchcock of the Hennepin County General Hospital in Minneapolis, first to open a large Government-supported unit in the U.S., which has been in operation since May 1 this year. Once inside the pressurized chambers, Dr. Hitchcock reported, the hospital staff and patient share all the dangers of the deep-sea diver. There is nitrogen narcosis, or Cousteau’s “raptures of the deep”—also known as “the martini effect”—caused by excess nitrogen; “oxygen ebullience,” a kind of euphoria resulting from excess oxygen; and finally, “the bends” or “caisson disease,” from too-rapid decompression.

To avoid the danger that someone inside might suffer from the “martini effect” all the controls are located on the outside and manned by highly skilled personnel breathing air at ordinary pressures. Elaborate instrumentation with a variety of fail-safe mechanisms delivers medical gases under extra pressure to the doctors inside. As a further safeguard, the four chambers at the Hennepin Hospital are all equipped with closed-circuit TV, so that monitors on the outside can watch everything that the operating team does on the inside, and sound an alert if normal operating procedures should be violated.