740 ANESTH ANALG

1989;68:74&3

A Glossary of Anesthetic Jargon

Edmond I. Eger 11, MD

Key Words: PUBLICATIONS, ANESTHETIC JARGON. ing a technique to the whole patient, rather than the
appropriate part.

I. . . there arises from a bad and unapt formation Bag. 1 bagged the patient. (I ventilated the lungs of
of words a wonderful obstruction to the mind. the patient by hand [or manually].) To bag indicates
Sir Francis Bacon (1) ventilation produced by squeezing a reservoir bag;
we bag things (groceries, cement) or animals (a brace
of pheasants), not people.
The purpose of language is to transmit facts, ideas,
and feelings. As with scientific communication in
Block. The patient was blocked. (A nerve block was
general, clarity and conciseness advance communica-
used.) The error again lies in applying a technique to
tion in medicine. To convey information quickly, we
the whole patient, rather than a portion of the pa-
often resort to slang, jargon, acronyms, and other
tient. An additional problem is the arbitrary conver-
forms of stylistic shorthand, in the process perhaps
sion of a noun to a verb. Block may be appropri-
losing more than we gain.
ately used in brachial block but may be ambiguous
Why should we care how we communicate, so long
when used in spinal (or epidural) block. Spinal
as our meaning is clear? If our argot provides a
block may mean something quite different to our
compact and efficient expression of complex con-
neurologist colleagues who may get nervous when
cepts, isnt it a desirable and useful tool? Should not
patients have a spinal block. In addition, Greene
our professional language evolve and incorporate
has made a case for not using block at all, at least as
new forms of expression? These are valid arguments.
it is applied to the central nervous system ( 3 ) . He
The counter arguments are several. The language of
argues that we would be served better by substituting
anesthesia is not universally accepted and, thus, we
the word anesthesia when nerve transmission is
communicate best, sometimes only, to our confreres.
interrupted (e.g., spinal or epidural anesthesia with
Our jargon is not always clear or concise and some-
lidocaine,) or analgesia when only analgesia is
times sabotages the very attempt to be so. The use of
produced (e.g., with a narcotic placed in the epidural
slang or jargon may result in ambiguity, imprecision
or subarachnoid space.) Thus he would eschew the
of thought, and an unprofessional image.
use of block except where morphologic obstruction
The following glossary contains words and
occurs; and he would have us carefully distinguish
phrases overheard in conversations and conferences,
between the meaning of anesthesia and anal-
or read in our journals. Statements in parentheses or
gesia. His approach eliminates ambiguity and im-
brackets indicate a preferred usage. A similar glos-
sary was prepared by Tolmie and Birch (2). proves precision.

Aspirate. The patient was aspirated. (Secretions were
aspirated.) Patients, lungs, and subarachnoid spaces
are not aspirated; blood, secretions, or cerebrospinal
fluid may be aspirated. The imprecision lies in apply-
Received from the Department of Anesthesia, University of
California, San Francisco, California. Accepted for publication
January 13, 1989.
Address correspondence to Dr. Eger, Department of Anesthe-
sia, University of California, Room -55, Third and Parnassus
Avenues, San Francisco, CA 94143-0464.
01989 by the International Anesthesia Research Society
Bolused. The man was bolused with 600 ml of fluid. (600
ml of fluid were given.) The problem (with this and
some subsequent words) again is the noun-to-a-verb
(bolused) conversion. Other examples are lesion to
lesioned, tracheostomy to tracheostomized, tracheotomy to
trached, shunt to shunted, dose to dosed, tachycardia to
taching, and bradycardia to bradied. (Also see block.)
Breathed. 1 breathed the patient 22 times a minute. (I
ventilated the lungs 12 times a minute.) Considered
A GLOSSARY OF ANESTHETIC JARGON
an alternative to ventilate, breathed unfortunately im-
plies inspiration by the anesthetist. Worse is the
statement: 1 breathed (or blew or gassed) tke patient
down. (I anesthetized the patient.)
Code. The patient was coded. (The patient had a car-
diac arrest; and we applied CPR.) The word code
derives from the now-universal use of code-blue
to announce the development of cardiac arrest and,
sometimes, treatment of the arrest.
Crashed (or blitzed). The patient was crashed. (We in-
duced anesthesia rapidly.) Crashed denotes the rapid
induction of anesthesia, usually with agents given
intravenously. The term also implies the rapid inser-
tion of an endotracheal tube.
Deep. 1 carried the patient deep throughout tke case. (I
maintained a deep level of anesthesia throughout the
surgical procedure.) Deep and light are so ingrained in
our vocabulary to indicate the level of anesthesia that
their use has become an accepted (and proper) part of
the language of our specialty. The problem is in their
application. Both are adjectives, not adverbs: both
describe a thing (deep blue sea) or state (deep level of
anesthesia) not an act (such a s jump or carry.) You
cannot carry deep, but you may maintain a deep
level of anesthesia.
Difficult airway. T h e patient was a difficult airzuay. (The
patients airway was difficult to maintain.) The prob-
lem here is an equivalence state that defies reality,
and the substitution of a whole for a part. Variants
include: He was a full stomach, (He had a full stomach.)
Or: He was a difficult intubation. (Intubation was dif-
ficult.)
Digitalized. We digitalized the patient. (The patient
was given digitalis.) The intent is to convey that
digitalis was administered, and this usage is becom-
ing accepted. However, ambiguity may result. We
digitalized the patient could imply a rectal examination,
or a binary transformation of the patient.
Down. We p u t the patient down. (We anesthetized the
patient.) The literal us. intended meaning of down
creates ambiguity. Another misuse: The patient bradied
d o w n , (The patient developed bradycardia.) Beyond
the metamorphosis of bradied (see bolused,) the context
makes down redundant. D o w n also has a spatial
connotation that leads to ambiguity (also see dropped,
fall, and rose.)
Dropped. She dropped her Paoz from 75 to 58. (Her Pao,
ANESTH ANALG 741
1989;68:74&3
decreased from 75 to 58.) It is unlikely that the patient
actively produced the decrease in Pao,. Dropped is
being used to indicate decreased. Only objects drop;
quantities decrease. A variant is cut: Then 1 cut her
down to 1%. (I then decreased the concentration to
l%.)
Estimate. Blood glucose concentrations were estimated.
(Blood glucose concentrations were measured.) Al-
though equated with measured, estimated implies that
the concentrations of glucose were guessed rather
than accurately determined.
Extubate. We extubated the patient. (We removed the
endotracheal tube.) Extubate is a perfectly good word,
but here it is applied to the whole patient. The
problem is doubled in the following: The patient
extubafed himself. (The patient removed his own en-
dotracheal tube.) Parenthetically, tracheal rather than
eizdotracheal might be used because one assumes that
no exotracheal tube exists. Variants on the removal
theme are: We pulled the tube. We sucked out the patient.
More compact, but ambiguous and incorrect is: We
aspirated the patient. (We aspirated secretions from the
trachea.)
Fall. The blood pressure fell, (The blood pressure
decreased.) Fell denotes downward movement in
space. Books fall to the floor and meteorites fall to
Earth. Physiologic variables do not fall. Blood pres-
sure and heart rate may decrease, but do not fall.
(Also see dropped and rose.)
Fast. The patient was fasted. (The patient fasted.) The
verb fast is intransitive. That is, it cannot carry action
from an agent (doer) to another agent or object
(receiver), as in 1 dropped the ball. I fast, you fast or
they fast, but we cannot fast another person. We may
starve them, however.
Gases. The misuses are several. Blood gases were
measured. (Blood gas partial pressures were measured.)
Blood gases were normal. This asserts that no abnormal
gases (e.g., xenon) were present. (Blood gas partial
pressures were normal .) Plasma electrolytes were normal
presents the same problem, unless one is searching
for an electrolyte not usually found in human blood.
(Electrolyte concentrations in plasma were normal.)
Another misuse: Blood gases were sampled from the
artery. (Arterial blood samples were obtained for
measurement of gas tensions.) Gases are not sampled
from an artery.
Induced. We induced the patient, This common expres-
742 ANESTH ANALG
1989;68:74&3
sion exemplifies the inaccuracy of verbal shorthand
and, in fact, is no shorter than the correct statement.
(We induced anesthesia.) Anesthesia was induced with
thiopental and succinylcholine. Succinylcholine does not
induce anesthesia. (Anesthesia was induced using
thiopental; and muscle relaxation was provided with
succinylcholine.)
Intubate. W e intubafed her. Or worse: W e tubed the
patient. (We intubated the trachea. Or: We inserted an
endotracheal tube.) The incorrect statements could
mean that the patient was placed in a tube, or was
made into a tube, or that a tube was placed in a
convenient cavity. Sometimes, it is not the patient
who is intubated: W e did a fiberoptic intubation. The
statement literally indicates that the fiberoptic instru-
ment was intubated. (We used a fiberoptic broncho-
scope to facilitate intubation.)
Lined. He was lined to get an avterial trace. (We inserted
an intra-arterial catheter to obtain arterial blood pres-
sure.) The patient who has intravenous or intra-
arterial catheters inserted is not lined. Lined suggests
an artistic tone. Zauder has cleverly detailed the case
against lines (4).
Mask induction. Mask iizduction was begun. Was the
mask to be anesthetized? (We induced anesthesia via
a mask.) This beauty contains two errors: W e masked
the patient down. (We induced anesthesia via a mask.)
Mask ventilate (or delivered gas X.) W e mask ventilated.
Or: 1gave her mask halotham. One hopes that the mask
itself wasnt ventilated. (We ventilated via a mask.
Or: I administered halothane via a mask.) Similar to
mask induction, the usage is intended to indicate
ventilation or administration of an anesthetic via a
mask, but the literal meaning is that the mask was
ventilated or was the type of halothane. A variant of
mask ventilating (or bngginX) is hand ventilate. 1 hand
ventilated. (I ventilated the patients lungs by hand.)
Most of us would not ventilate a hand.
Nauseous. Patients become nauseous after anesthesia.
(Patients become nauseated after anesthesia.) They
do not, by and large, become nauseous, i.e., cause
nausea in others.
On. The patient was put on a ventilator. Clearly, this
would be an uncomfortable position for the patient.
(The patients lungs were mechanically ventilated.)
He was breathing spontaneously on isoflurane. (He ven-
tilated spontaneously while breathing isoflurane.) O n
is widely used to indicate the application of some
EGER
management. The potential for misapplication is
enormous. O n nasal prongs is a particularly egregious
variant: W e put the patient on 5 liters of nasal prongs. (We
gave 5 liters of oxygen via nasal prongs.) He was put
UIZ drug X . (He was given drug X.)
Post- and Pre-. Post- and Pre- are prefixes used
before adjectives, not nouns, e.g., post-operative, not
post-operation. One should not use post-halothane
or post-epidural. Similarly, pre-operative, not pre-
operation medication. What ever happened to before
and after?
Pure. W e gave pure oxygen. (We gave oxygen.) If we
give pure oxygen, does this imply that others might
not? Do we use pure because we desire to appear
virtuous? It also is not usually necessary to say: W e
gave 10070 oxygen. (We gave oxygen.)
Pushed. W e pushed the Pentothal. (We administered
Pentothal. Better yet: We administered thiopental.)
Pushed connotes administration of drugs or fluids,
often in amounts that are greater than those usually
given.
Reversed. W e reversed the pancuronium (or fentanyl or
hepariiz, etc.) (We antagonized the effect of the pancu-
ronium.) The intent is to indicate antagonism or
reversal of an effect. The error is sometimes com-
pounded by applying the term to the patient rather
than the drug: W e reversed the patient. (We antago-
nized the paralysis.)
Rose. The blood pressure rose. (The blood pressure
increased.) The past tense of raise, rose denotes
upward movement in space. The smoke rose, but the
blood pressure increased. (Also see dropped and fal/.)
Spiked. The patient spiked a temperature. (The patient
had a temperature spike.) The original statement
implies that the temperature was nailed by the pa-
tient.
Stabilized. The patient wus stabilized in the ICU. (The
patients cardiovascular condition was supported-or
stabilized-in the ICU.) The term is applied, incor-
rectly, to the whole patient rather than a specific
condition or system. A variant is: The patierit was
stabilized out.
Started (or stopped.) W e started the halothane. (We
started the administration of halothane.) Started (or
stopped) indicates initiation (or termination) of some
therapy. Usually we start a process, not an object.
A GLOSSARY OF ANESTHETIC JARGON
(in) Trendelenburg. W e put the patient in Trendelen-
burg. Alas, poor Freidrich. (We put the patient in the
Trendelenburg position.)
With. She was exchanging well with a nasal airway. Was
the conversation recorded? (She ventilated easily
through a nasal airway. Or: Insertion of a nasal
airway permitted adequate ventilation.) This is a
variant of on. However, I rather like the image of a
patient holding a conversation with a nasal airway.
The trachea was intubated with succinylcholine. (Admin-
istration of succinylcholine facilitated intubation of
the trachea.) A tube, not succinylcholine, was placed
in the trachea.
Anesthesiologists do use jargon in their writing,
and use it still more when they speak. Surely, we do
not wish our surgical and internist colleagues to
believe that a function of an anesthesiologist is to bag
patients. Being attentive to common errors might
ANESTH ANALG 743
1989;68:740-3
abolish these inappropriate uses of language. Other-
wise, . . . words . . . [may] . . . throw everything
into confusion, and lead mankind into vain and
innumerable controversies and fallicies (1).
The author gratefully acknowledges the suggestions made by
Drs. William K. Hamilton, Arthur S. Keats, M. Jerome Strong, and
Leroy D. Vandam, and Ms. Winifred von Ehrenburg.
References
Sir Francis Bacon. The new organon and related writings.
Anderson FH ed. New York: Liberal Arts Press, 1960.
Tolmie JD, Birch AA. Anesthesia for the uninterested. Second
Edition. Rockville, MD: Aspen Publishers, 1986:247-56.
Greene NM. Another tower of Babel? Schmerz-Pain-Douleur.
1987;3:89-91.
Zauder HL. Medical jargon-A few lines about lines. Anes-
thesiology 1980;53:271.