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Frank E. Block

Blocking pain

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Dr. Frank E. Block Jr. says anesthesiology is for control freaks. It's also for people who like knowing how things work, who grew up putting together Heathkits - as he did - do-it-yourself ham radios and televisions and other electronic devices. While the surgeon is "wreaking havoc" with your body, Block says, the anesthesiologist "gets to play with really neat toys" to control your blood pressure and heart rate and blood oxygen. He makes sure you are feeling no pain. While you're under, he's on top of things - else you might not survive. Block, 54, really loves the "toys" of the OR. He spends a third of his time as a consultant, designing, for instance, monitors that are easy to use and how organ-specific alarm sounds might work. He studies the "man-machine interface" and what he calls "the human factor" - how doctors deal with their equipment, especially in emergencies. And when he's not playing the piano or figure skating or "locksmithing" - all revealed on his CV - Block is either in the operating room or teaching at the University of Arkansas for Medical Sciences, where he was awarded "Teacher of the Year" in 2002 by his department. He works among those who thrill to the "magic of putting goldfish to sleep" (a demonstration of some years back in which, during the course of a lecture, a goldfish swims, sleeps and wakes to cruise again, all by the hand of the anesthesiologist) and who like to keep up with all areas of medicine, since their patients "have every problem you can think of. … You have to keep up." Thanks to technological advances, Block and his colleagues in anesthesiology are doing a better job of helping us survive surgery. A generation ago, he said, 1 in 2,000 would die from anesthesia. Today, Block estimates, it's 1 in 20,000 - and "some would say one in 250,000." Among the most important advances in the field since Block started practicing medicine in the mid-'70s is the pulse oximeter, which clips on your finger and measures oxygen in your bloodstream. Anesthesia depresses breathing; before the development of the oximeter, a patient could be hypoxic "and we wouldn't know it," Block said. Another is the carbon dioxide monitor, which detects how well the body is metabolizing blood oxygen and making and removing CO2, keeping heart and lungs healthy. Invasive monitors can monitor blood pressure and help the doctor regulate fluids to protect the heart; tighter control over glucose levels is lowering infection rates. New anesthetics don't linger as long in the body; now we wake up faster and feel better. How does anesthesia work? "Nobody knows," Block answered. It's possible it has to do with cell membranes and the way they transmit pain signals. For example, Block said, "If you give Sodium Pentothal [a general anesthetic] to a rat and put it in a hyperbaric chamber, it will wake up." The pressure of the hyperbaric chamber is actually compressing the cells - so perhaps, Block suggests, the drug works by swelling the membranes and making them less able to signal pain. Drugs, people, diseases: The variables require the anesthetist to consider their interactions and tailor his treatment to the patient. In the OR, Block keeps his PDA in a fanny pack that so he can instantly get answers to questions that arise during surgery. He also consults other doctors. "At an earlier stage in my career," Block said, smiling, "I had to be right and know it all. [Today] another opinion doesn't offend me." Block, in his "human factor" studies, has observed how anesthesiologists react to surprises in the OR. The physician, using a "working diagnosis of a problem," will order lab work and other tests that might confirm the diagnosis. Then, as the results come in, the physician tends to "fit" them into the working diagnosis. Could the results point to another diagnosis? Or is the doctor "locked in a frame," as Block puts it, limiting his ability to see alternative diagnoses? "This is a real problem," Block said, among doctors. There is a time when "a new person needs to come in the room, to see the 'big picture' and make the right diagnosis," Block said. An example from his own career: At a hospital in another state, an anesthesiologist was having a difficult time "bagging" a patient - getting air into her lungs. The air was disappearing instantly, rather than inflating her lungs. Block was called in. He checked the machinery to make sure it was working [it has happened, according to another anesthesiologist, that a patient couldn't be ventilated because the machine wasn't plugged in]. He tried a simple oxygen tank and a manual bag-mask. Then it came to him: A tube supposed to be placed in the patient's stomach was actually in her trachea. It was sucking the air out as fast as it came in. Bizarre - and yet he saw it again, 10 years later, in another operation. The second time, he solved the problem instantly.

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