Intravenous anaesthesia (part one). No. 6.

Date:
1944
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Credit

Intravenous anaesthesia (part one). No. 6. Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Source: Wellcome Collection.

About this work

Description

A technical film (part of a series) apparently aimed at the inexperienced anaesthetist. The opening sequence with scrolling text explains why barbiturates are the preferred agent for intravenous anaesthesia as they are quickly absorbed into the blood stream. Three barbiturates are referred to and it is the third, Pentothal, which is demonstrated in this film. Case studies which illustrate good practice in the application of intravenous anaesthesia and the monitoring of patients as well as trouble-shooting potential problems are also shown. 5 segments

Publication/Creation

UK, 1944.

Physical description

1 encoded moving image (28:35 mins) : sound, black and white.

Duration

00:28:35

Copyright note

ICI

Terms of use

Unrestricted
CC-BY-NC
Creative Commons Attribution-Non-Commercial 2.0 UK: England & Wales

Language note

In English.

Creator/production credits

Directed by Yvonne Fletcher, Photography by A. E. Jeakins. Produced by Realist Film Unit. Made with the co-operation of the Department of Anaesthetics, Westminister Hospital, London.

Contents

Segment 1 Opening credits. Rolling intertitle contextualising the use of quick-acting barbiturates for intravenous anaesthesia. A narrator explains the barbiturates in common use and the medical vials such as Venesetic (clearly labelled with the word Poison), Evipan and Pentothal are displayed. It is noted that the latter is the most efficient and the demonstration to follow will use this. Intertitle: Apparatus. Equipment is laid out left to right on a bench; sterile syringes of different sizes, wide bore needle (cannula), hypodermic needle for the injection, ether or sterile water in a bowl, swabs etc. There is also an oxygen cylinder and anaesthetic equipment. In the operating theatre there is an arm rest for the patient attached to the operating table as well as wrist straps. The ampoules are opened and the anaesthetist washes his hands. The syringe and cannula are rinsed. The syringe is charged, then placed on a sterile surface and it can be used up to 24 hours later. Time start: 00:00:00:00 Time end: 00:04:56:05 Length: 00:04:56:05
Segment 2 Intertitle: Technique of Venepuncture. An operation is about to start; the narrator explains that the patient's veins should be inspected. If they are fatty, warm compresses should be applied to make them more obvious (not shown). The patient's arm is manually compressed and a simple rubber tourniquet applied. This patient also opens and closes his fist to aid the identification of a suitable vein. Several veins are pointed out before one is selected on the back of the hand. The anaesthetist once more washes his hands. The needle to be used is then shown in medium close-up (MCU), it is very sharp and hooked on one side. It is further sharpened with a sterile hone. The skin is swabbed clean. The angle of the needle as it enters the arm is demonstrated and the injection commences. Then a situation is shown where the needle is incorrectly positoned and the patient complains of pain. The injection is re-sited. The needle is fixed in position with adhesive tape. The arm has to be secured. Time start: 00:04:56:05 Time end: 00:09:55:00 Length: 00:04:49:05
Segment 3 Intertitle: Course of anaesthesia. A case study is then shown featuring a healthy woman of 23 who is about to undergo an inguinal herniorrhaphy. She has been given premedication which reduces the amount of anaesthesia required. The notes with the exact premedication are shown. Variations in the dosage are mentioned but not shown. The patient has some gauze atttached to her nose as her breathing will be very quiet and the medication will depress her respiration. The anaesthetist washes his hands and then administers the injection (there is no standard dose). A short rapid injection of 3 cubic cms is given; the time is noted and then the patient is observed. The patient's airway must be kept clear. The patient rouses slightly and so is given more barbiturate. In this case, a further 3 cubic cms. At the point the patient reaches deepest anaesthesia, a signal is given to the surgeon to commence. The patient is topped up from time to time. A patient undergoing an orthopaedic operation is then shown; deeper breathing is a signal for further medication. The commentary explains why the eye reflexes are not observed; this is an unreliable indicator when using barbiturates. Time start: 00:09:55:00 Time end: 00:17:14:00 Length: 00:07:21:02
Segment 4 Intertitle: Dangers of Pentothal anaesthesia. A male patient is shown. Pentothal depresses the breathing and so the anaesthesist is seen observing the patient. Next, breathing is shown with the aid of a breathing bag. An operation is in progress; the patient has a breathing tube in place and laryngeal spasm is noted. A female patient having spasms is shown and the operation has to be halted. The airway is partially removed, followed by artificial respiration by oxygen under pressure. When cyanosis ceases, an injection of stimulant drugs such as Cardiazol or Coramine (product shots are shown) can be given. A male patient is shown who has ceased breathing and his heart has also stopped. A male patient who has received an overdose of bariturate is then shown, artifical respiration is commenced with oxygen. Then both his colour and breathing improve. A chart is shown indicating the blood pressure of the patient when Pentothal has been given. Other charts are shown with normal and high blood pressure. The ensuing scenario shows how a situation when the anaesthetist has to swap over to an inhalation method (nitrous oxide and oxygen). Time start: 00:17:14:00 Time end: 00:23:57:00 Length: 00:06:43:00
Segment 5 Next a surgeon is seen single-handedly trying to anaesthetise a young woman prior to surgery - this is considered poor practice except in emergencies. A number of general surgical scenes are shown. Abdominal surgery is shown reminding the viewer that due to the use of muscle relaxants, respiration will be depressed and that it is the role of the anaesthetist to monitor the patient. Intertitle: Indications. An anaesthetist is shown reading a patient's notes. One of the occasions when the patient should not be given Pentothal is when there is already cyanosis, the patient in the example has just had a tracheotomy. In cases of trauma to the airways, Pentothal should be avoided. An endotrachael tube must be used. Penthothal should be used with care; other cases are shown, including a young child, the dose has to be given to suit the patient. Intertitle: Post-operative. Pentothal is described as a "delightful" anaesthetic as the patient goes under quickly and then rouses with ease without nausea or vomiting. The patient is seen recovering in bed. RFU The End. Time start: 00:23:57:00 Time end: 00:28:35:00 Length: 00:04:38:00

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