Vital Times 2021 - 95

The paravertebral catheter remains in place at
home, and a slow continuous infusion of local
anesthetic through it allows the patient to sleep
comfortably in her own bed. Pain and nausea
are absent.
The following morning, a nurse from the
preoperative clinic calls her to check on her status.
She has no complaints. She is advised to resume
a light diet and to visit the clinic for removal of the
catheter on the third postoperative day. After the
paravertebral catheter is removed, she requires only
over-the-counter NSAIDs for pain relief.
Conclusion
Two hundred years ago, even a minor operation like
a simple mastectomy was a gruesome experience.
Without anesthesia, all operations were horribly
painful. The surgeon had to work quickly because
bleeding could not be controlled. Gastric aspiration
was common, and, without antibiotics, even if the
patient survived the actual procedure, the risk of
dying from postoperative surgical site infection or
aspiration pneumonitis was great.
One hundred years later, the surgical experience
was still traumatic, but significantly less so than
in 1822. Ether, chloroform, nitrous oxide, and a few
other agents could provide general anesthesia.
However, ether was flammable, and electrocautery
to control bleeding was not yet available, so tedious
suture ligature of blood vessels was routine.
Antibiotics were unknown, so postoperative
surgical site infections were still common.
The patient's airway was not protected, so and
aspiration remained a major risk.
From 1922 to 2022, we have made tremendous
advances in the anesthetic and perioperative
management of the surgical patient.
Non-flammable agents allow the surgeon to use
electrocautery to control intraoperative bleeding,
so surgery no longer needs to be rushed. Regional
anesthetic techniques, alone or as a supplement to
general anesthesia, provide outstanding analgesia
with less nausea or other adverse effects. Today,
modern anesthesia allows an operation like a
simple mastectomy, which could be fatal in 1822
and even 1922, to be performed as a routine
outpatient procedure with little or no risk to
the patient.
Annual Publication 2021 | 95

Vital Times 2021

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