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    A Philosophical Approach to Anasthesia
    A Philosophical Approach to Anasthesia
    A Philosophical Approach to Anasthesia
    Ebook134 pages1 hour

    A Philosophical Approach to Anasthesia

    By John Schou

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    About this ebook

    Anaesthetist, you know what anaesthesia is?
    “YES” - You know too much. Read this book and see how little you knew.
    “NO, and I don't care”- A general problem, further analyzed here in order to explain how anaesthetists lost touch with their basic concepts.
    “NO, but I am interested” - A book for those who are not seeking simple answers to complex questions. This book is opening for neglected topics

    LanguageEnglish
    PublisherJohn Schou
    Release dateDec 14, 2012
    ISBN9781301733705
    A Philosophical Approach to Anasthesia
    Author

    John Schou

    John Schou was born 1951. He grew up in Denmark and graduated as a physician in Copenhagen in 1977. From 1982 did he work as a consultant anaesthetist in the county hospital in Lörrach, Germany (by Basel), where he still lives. 1994-97 he was Chairman of the prehospital committee, ITACCS. A severe disease forced him to retire from the medical career early in September 2001. He has published several medical articles and three books about emergency medicine and anaesthesiology. In later years, he has concentrated his authorship on other stories, some with but mostly without medical relevance.

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    Book preview

    A Philosophical Approach to Anasthesia - John Schou

    A Philosophical Approach to Anaesthesia

    John Schou

    J. Schou: A Philosophical Approach to Anaesthesia, 2nd Edition

    Originally published by

    Alix Publishing Group, 1994

    ISBN (10) 3-928811-05-3

    Library of Congress OL845171M

    Published by John Schou at Smashwords 2012

    ISBN 9781301733705

    This eBook is registered by Smashwords.com free of charge.

    Key words:

    Anaesthesia, techniques. Philosophy. Research, ethics & methods.

    To Natasha, Alexandra and Johannes

    General Opinion

    Index

    Preface and Acknowledgements

    Initial Considerations on Sleep During Anaesthesia

    The Philosophy of Anaesthesia

    The Double-Blind Anaesthetist

    From the Chair of Medical Dogmatics

    How the News Spread, Then and Now

    Changing Concepts in Anaesthesiology

    Approaching New Concepts

    Terminological Inconsistencies in Anaesthesia

    Some Philosophical Challenges of Intensive Care

    Epilogue

    Abbreviations

    Preface

    The contents of this book may appear negative, satiric and perhaps even offensive to modern anaesthesiological research and publications, and it is now difficult to understand that it all started rather innocently with a contribution to a congress on awareness in anaesthesia. I went to Glasgow in 1989 with a manuscript The Terminological Confusion in Anaesthesiology - certainly it is difficult for a Dane to criticize Anglo-Saxon terminology on British soil - and I started pondering on what anaesthesia is on a cerebral level. This led directly, with the courteous help of Prof. W. Lorenz of Marburg, to the publication, Changing Concepts of Anaesthesia in 1992. However, the reaction of my fellow anaesthetists was strangely muted. This was possibly caused by an idealised, though simple, vision of the mechanism of anaesthesia, in which the brain receives various stimuli at corresponding receptors while mental activity bypassed, except in bad anaesthesia.

    So what? Why upset them with a contradictory book, and why make myself unhappy with their (anticipated) negative reception of it? Leave the world in its pre-existing rotation and make no attempt to mould philosophers from anaesthetists. That would have been the easier route and I would have chosen it, had it not been for two disturbing matters: 1) the editor's attitude dissuading me from presenting some (predominantly prehospital) techniques which do not concur with the general opinion (actually the precondition for a novelty) and 2) I had (and still have) the feeling that it must be possible to advance further into an understanding of the nature of some kinds of anaesthesia (anyhow a polymorph condition). This demands leaving the narrow path of controlled studies with a broader view of the subject and pooling knowledge into this multidisciplinary field with other physicians dealing with conditions of impaired consciousness; such cooperation is still rare, if not totally non-existent.

    It is impossible to begin this journey without first considering what led to anaesthetists becoming so narrow-minded and visionless. A first attack on this subject appeared as the Guidelines for the Use of Guidelines, in 1992 (in German) and in 1993 (in English). A second strike failed with the manuscript to The Double-Blind Anaesthetist, which was submitted to only one magazine. I am most grateful for the critical comments of the anonymous reviewers, who improved this difficult and probably somewhat unjust attack on traditional scientific anaesthetic methods. Since it was impossible to connect this article to the philosophical aspects of anaesthesia, it seemed a waste of time to proceed with this on its own. This left me no other way than to proceed with the complex matter in a monograph, including various published and unpublished material in a larger consensus while rewriting the manuscripts and filling the gaps between them. Certainly, I realized that I am incompetent to produce A Philosophical Approach to Anaesthesia but it seems that everybody is, so why not still give it a try, even an approach?

    This book can merely be one step on a stony way to make us aware of the largely neglected philosophical aspects of anaesthesia. Unfortunately, I remain pessimistic in thinking that the matter will not be given more attention in the anaesthesiological literature hereafter. More on this theme is presented in the epilogue.

    Acknowledgements

    This book studies anaesthetists rather than patients and I am, therefore, grateful to the subjects of this study, my colleagues in- and outside our own county hospitals, and for all the discussions over the years. Particularly, I want to thank my co-authors in the cited own publications and Prof. Lorenz for his great help for two articles, published in Theoretical Surgery. Additional suggestions were provided by Dr. J. Kübler, Dr. M. Jerger, Dr. J. Deklerk, Dr. K. Wagner and Dr. B. Jemec.

    It was, of course, necessary that friends of Anglo-Saxon origin performed extensive and repetitive editing. For this I am most grateful to Mrs. C. Lama, Dr. H. R. C. McSorley and Dr. M. Berry.

    Lörrach, Germany, February 1994

    John Schou

    Preface to 2nd Edition

    After almost 20 years, little has changed in the subjects dealt with in this book. Personally, I have changed my scope of interest to fiction, where I have also dealt with the difficult distinction between unresponsiveness and unconsciousness in the stories ‘Rudolph Rednose’ and ‘Dysthanasia’ in the collection ‘The Tunnel and the Cave.’ This new edition was borne through the desire to make the book freely available and it is in principle unchanged from the first edition.

    Lörrach, November 2012

    John Schou

    Initial Considerations on

    Sleep during Anaesthesia

    THIS PATIENT ISN'T ASLEAP! the surgeon roared, as muscular relaxation was lost temporarily, not for the first time. The anaesthetist, for some time lost in personal reflection, awoke and administered the relaxant. Independent of what appears to be logical, blood pressure and heart rate normalized, muscular tonus waned and even the surgeon seemed less tense. But shouldn't you deepen the anaesthesia, rather than paralyzing a patient who isn't asleep? the nurse, the colleague, the visitor or whoever it was today, asked. A waste of time to explain the basis of this anaesthesia to the colleagues, they would not accept it anyway, and soon they forgot the issue as the surgeon found what looked like a metastasis and started discussing the prognosis, soon to be interrupted by the anaesthetist with you shouldn't discuss these matters here! Why not here? the surgeon asked, surprised. Because, as you rightly mentioned, the patient is not sleeping or say, perhaps he is, but he is not unconscious.

    Heavy stuff for cutting colleagues, but apparently no less weighty for gasmen and -women, dedicated to producing the state of anaesthesia (whatever that is). Not even an appropriate topic for double-blinded scientists to consider, who open their eyes only to mathematical considerations and disregard anything which is impossible to measure and evaluate statistically.

    It is now evident, however, that awareness may occur frequently during anaesthesia. Another question is, whether this is acceptable (when concealed postoperatively by amnesia) or conversely reflects a false anaesthetic technique. You have probably formed an opinion on this matter and, if belonging to the majority of humans, physicians or even anaesthetists, probably adhere to the latter conclusion. Our expectations necessarily influence choice and dosage of anaesthetics but we do not strictly know, whether we use the drugs in unnecessarily high or problematically low dosage, in either case possibly associated with adverse effects to the patient. This problem, therefore, deserves continued attention, even if you may never know the precise answer.

    It is difficult to employ other sophisticated theories on altered consciousness when seeing this only from the anaesthetist’s point of view. To make a short comparison between sleep and anaesthesia, partly elaborated in subsequent

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