AW: [HSF] Deairing the heart

[Rwmfglycar at aol.com]

Dear Ani,
Thank you for a gracious reply to my curmudgeonly criticism. I agree  with 
you totally that we need to be aware at all times that we may not have  evidence 
for the routines that we practice. The problem with air is that we know  it 
can be harmful, that it is hard to know exactly how much air we are seeing  and 
very hard to detect how much harm it may be doing. Given that, we must take  
the view that we will clear the air on every case and use all the tricks to 
find  its hiding places and get rid of it. There is a way air can get into the  
descending aorta after induction has started. We showed many years ago and, 
our  anesthesiologist published it, that air introduced into the Pulm Art can 
pass  through the lungs. No reason why air that has gone through the lungs 
should not  be seen in the aorta. If you watch the outlets of various central lines 
during a  case you will see plenty of air emerging from them during 
manipulations on the  other side of the screen.
Part of the reason for my sharp response is that I am very concerned  that 
trainees do not get the wrong message from some of our comments. 
Finally as we perform our rituals we must be continually aware  of  alternate 
possibilities. George Orwell and I think also Scott  Fitzgerald called it 
holding two conflicting ideas in our heads at the same  time.
Bob
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