"Counting Backwards"

An anesthesiologist once described the practice of his specialty as “hours of boredom, punctuated by moments of sheer terror.” In his book “Counting Backwards: A Doctor’s Notes on Anesthesia” pediatric anesthesiologist Henry Jay Przybylo, M.D. offers his take on this glib (and inaccurate) description of his practice. His observations are based on 30-plus years of experience and more than 30,000 anesthesia cases he personally managed.

Przybylo (who refers to himself as “Dr. Jay” throughout the book) opens by reviewing a brief history of anesthesia. Modern anesthesia practice dates from the mid-19th century.The discovery of ether, the first anesthetic gas, is first noted in the 1500s, although there is scant documentation of its use as an anesthetic agent in those years.

Przybylo admits that the basic gases used in anesthesia today differ little from the original chemical configuration of ether. What distinguishes current anesthetic practice from its relatively crude beginnings in the pre-Civil War era is the refinement of the inhaled gases that produce the deep sleep-like state necessary for the surgeon to proceed with the case, as well as the addition of adjunctive agents that permit a more comprehensive anesthetic experience.

Przybylo describes this experience as “the five As’” They are:

• Anxiolysis: The relief of stress brought on by an upcoming procedure,

• Amnesia: The prevention of memory formation during the procedure,

• Analgesia: The relief of pain both during and after the procedure,

• Akinesia: The prevention of patient movement during the procedure, and

• Areflexia: The stabilization of vital signs (heart rate, blood pressure, body temperature) during the procedure.

Przybylo describes how the anesthesiologist typically proceeds through a case, beginning with pre-anesthesia evaluation and patient counseling, preparation of equipment and medications, induction of anesthesia, intraoperative monitoring and correction of vital signs, reversal of anesthesia and post-operative management and counseling.

He then provides descriptions of clinical experiences, both routine and unusual, as illustrations of how quickly and easily cases can go awry and the importance of constant vigilance by the provider of anesthesia services.

In addition to his medical training, Przybylo has earned an MFA in creative non-fiction. His prose is straightforward and accessible to readers with no medical background.

It would have been helpful if the author had spent a few paragraphs answering the frequently asked question, “What is the difference between an anesthesiologist (a physician with specialty training in provision of anesthesia services) and an anesthetist (an RN with extensive training and experience in provision of the same services).”

Even with that minor omission, this slim volume will provide solid information for those who wonder what is going on in the seemingly lost time one is under anesthesia. It should also be useful in providing significant reassurance for those about to undergo anesthesia for the first time.