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Counting Backwards: A Doctor’s Notes on Anesthesia 波士顿诗人、医生、同时也是教授的 Oliver Wendell Holmes爵士在写给 Morton 的信中首次使用了希腊文中表示“没有知觉”的“麻醉（anesthesia）”这个词，此后“Anesthesia”这个词被保留了下来。  AMANDA’S MOTHER, UNAWARE OF anesthesia’s history and unconvinced by the description of my process, remained dubious that I could induce a chemical coma in Amanda in a minute or less. She insisted on accompanying her daughter to the OR. Amanda的母亲并不知道麻醉的历史，对于我使用药物几分钟就能让Amanda昏睡这个说法，她将信将疑。她坚持陪女儿到手术室。 The gas I would use to anesthetize Amanda, sevoflurane, differs remarkably little from the ether used in 1846. Today’s gas has the same chemical backbone: fourC’s (carbon) anchored by an O (oxygen). Instead of ten H’s (hydrogen), seven are replaced by jumping two letters to the left in the alphabet, to F (fluorine). In the 160 intervening years between ether and sevoflurane, many different gases were introduced, all with one or another undesirable trait and left to remain in historical context only. Sevoflurane is nonflammable, much less odorous than ether, and—most important—dramatically decreases the time until loss of consciousness. Two other volatile gases are commercially available—desflurane and isoflurane—but the properties of sevoflurane led to its popularity. (It appears we’ve reached the end of the line with volatile anesthetic gases; the ones inuse today were all discovered decades ago and no new agents are forthcoming.) 我将用于麻醉Amanda的气体，七氟烷，和1846年人们使用的乙醚并没有太大的不同。 现代吸入麻醉药有相同的化学主体结构:1个氧原子O锚定4个碳原子C。10个氢H中的7个被换掉，取2个字母放在氟F（Fluorine）的左侧。从乙醚被发现到现在使用七氟烷，这160年里，大量的吸入麻醉药涌现，又因为各自不同的特点而不宜用于麻醉最终被淘汰。七氟烷不易燃，相较乙醚味道很小，最重要的是，可以更快的让患者失去意识。市面上还有另外两种挥发性气体，地氟烷和异氟烷，但只有七氟烷因性能卓越得到广泛使用。看来关于挥发性麻醉药，我们已经做了足够多的研究，现在我们使用的药物仍然是几十年前就已经发现的那些，短时间内也不会有新药问世。
Nitrous oxide, although not potent enough to use alone, is added because it provides a boost to the loss of sensation, and it does so without an unpleasant odor. I planned to start Amanda’s anesthetic experience by having her breathe nitrous oxide at fifty percent of the inhaled gas. Amanda would be shown a mask and asked to choose a scent—bubblegum, cherry, strawberry, or orange—which would be rubbed on the inside of the mask to cover the scent of the sevoflurane she would breathe. And she would have little to no recall for the odor of induction of anesthesia if I could convince her to breathe the nitrous oxide for thirty or so seconds before I added the potent sevoflurane. 氧化亚氮，尽管因药效弱不被单独使用，但可以加速意识消失，无刺激气味，常用于混合气体吸入麻醉。我打算用含有50%氧化亚氮的麻醉气体开启Amanda的麻醉之旅。在她看到面罩的那一刻，我会让她选一种喜欢的气味，她喜欢的泡泡糖，樱桃，草莓或者橘子的味道会被抹在面罩内侧以掩盖七氟烷的味道。 如果我让她吸入氧化亚氮30秒以上再加入强效的七氟烷，她几乎会忘记在麻醉诱导阶段闻过的气味。 The state of anesthesia is far different from sleep, but every day I find myself commenting to my patients and families on the process of “going to sleep.” During the induction of anesthesia, I advise patients: “Pick out agood dream. Do you have a happy place? Go there.” But there are no dreams underthe influence of anesthesia. 麻醉状态和睡眠状态有着天壤之别，然而我每天都告诉我的病人和家属，开始麻醉时就可以“入睡”了。诱导麻醉时，我会让建议他们: “做个好梦。梦中去个喜欢的地方吧！” 但其实人是不会在麻醉作用下做梦的。 Since I am not especially religious, it was decades after entering medicine before I suddenly saw a connection between the Bible and anesthesia. Genesis 2:21: “And Yahweh caused a deep sleep to fall upon Adam, and He took one of his ribs, and closed up the flesh.” Did Adam receive anesthesia for his rib resection? 我没有虔诚的信仰，因此在入行几十年后我才突然发现圣经和麻醉之间的联系。《创世纪》2:21中写到，“耶和华让亚当陷入沉睡后，取走他的一根肋骨，缝合他的血肉。” 亚当的肋骨切除术也是在麻醉下完成的吗？
To calmly anesthetize a child requires a skill set different from that needed to anesthetize an adult. An adult in the holding area will volunteer an arm, remain cooperative as the tourniquet tightens, and not flinch as the needle pierces the skin and enters a vein. Then, after a relaxing injection, it’s off to the procedure room for the countdown in reverse. I make it a little more challenging. As the intravenous anesthetic agent flows in, I suggest to start at 100 and count backward by 7’s. Making it to 93 is tough. 比起麻醉一个成年人，让一个孩子平静的接受麻醉需要不同的技巧。大人会配合的伸出手臂，被绑上压脉带打针的时候不会害怕躲闪。然后，他们会在镇静下来到手术间开始倒数。我会给他们的倒数增加一点挑战:当静脉麻醉药流进他们的血管，我建议他们7秒内倒数100下。能数到93就很难了。 With a child in the holding room, just mention a shot and a struggle ensues. 但是对于孩子来说，告诉他们要打一针就足够让他们闹腾了。 I spoke to Amanda on the trip to the OR. Amanda’s mother followed. I pointed out the bees, butterflies, and birds painted on the walls and talked about her favorite colors. In the operating room, I continued to talk about breathing bubblegum, the scent she had chosen for the mask. 我和Amanda一路聊着天走向手术室，她的妈妈在后面跟着。我把墙上画着的蜜蜂，蝴蝶和小鸟指给她看，我们还聊了她最喜欢的颜色。在手术间，我们聊她最喜欢的泡泡糖甜味，那也是她选择的面罩香味。 As long as Amanda could remain calm, havingher take several breaths of the gas that had failed Wells, nitrous oxide, would likely prevent her from remembering the odor of the potent anesthesia gas. Then we talked about apretend trip to the zoo and smelling piggies. 尽管氧化亚氮让Wells的手术演示失败了，只要Amanda可以冷静的吸上几口，它足以让这个女孩忘记强效麻醉气体浓烈的味道。接着我们想象一起去动物园，去看微笑的小猪仔。 “How many piggies do you smell? “你能闻到几只小猪仔呢？” ”“Five piggies,” she said as she drifted into a state of anesthesia quickly and quietly. “五只，”在回答的时候，Amanda已经快速安静地进入了麻醉状态。 I turned to her mother and said: “She’s asleep.” 我转身对她母亲说:“她已经睡着了。”
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来自： 麻花慧慧子 > 《counting backwards》
