The Lioness, The Dentist and the BBC

"What do you think Mike? Deep or light?" whispered John, the Anaesthetist after he clambered round the patient, over the wires, cables and general paraphernalia that filled the small cage we were working in.

I was going to ask you exactly the same I replied.

We had both just checked the vital signs, respiration rate, depth, palpebral reflex, and a quick look at the monitor said the patient, a Lioness at Chessington Zoo was sound asleep. The Pulse Oximeter, confirmed the mucous membranes, nicely pink. The Capnograph agreed on depth and rate of breathing, the blood pressure nicely normal, the ECG just doing its thing.

Peter Kertesz, the specialist dentist, said everything was fine as he worked away in the lions mouth headlight illuminating his way. Not that Peter needed the headlight today, because not only were we sharing the space with Peters dental nurse, Sam, the head keeper, a sound recordist, camera man but a lighting man complete with monstrous great "portable" television studio style lights.

I'm blaming the distraction of the BBC, filming with us for the day for a news item later that night, for the fact that neither of us had tracked the anaesthetic perhaps as closely as we might. It is often said, incorrectly in my opinion that, anaesthesia is 99% boredom, 1% terror but we weren't sure if we were approaching that 1%. Another difficulty with wild animals, even those in captivity, is that whilst there are recipes of drugs that can be used, by definition there aren't thousands of cases available to build a cast iron anaesthetic by and there are always individual differences in how patients react to drugs. This was demonstrated spectacularly on another occasion with The Bengal and the missing dart.

So there we were...6 people too many in a small cramped cage with a female lion, was she deep or was she light, the only call to make in this situation is to call a halt, Peter said he needed a few more minutes...no problem and everyone else..."time to leave". John and I made ourselves as useful as possible by standing outside the cage whilst all the BBC gear was dismantled and handed out to us as quietly as possible. Well don't want to go waking the patient too quickly by making too much noise eh?

Everyone safely outside and John administered the wake up and we retired right outside to wait

and wait

and wait

Just over an hour later the first signs of stirring came from the cage and the lioness with delightfully clean and repaired teeth took her first steps post anaesthetic and we retired to the bar for a well earned cup of coffee or was it something stronger, I can't quite remember.

The Lion, The Dentist and The Pulse Oximeter

“Would your device work on one of my patients?”, the gentleman sitting next to me asked.

The year 1987, the place a British Dental Association meeting somewhere in London. I had just addressed the British Dental Association advisory panel on Safety in Anaesthesia and Sedation headed by Professor Poswillo and had been extolling the virtues of a newly available piece of monitoring equipment which could, in real time non invasively, measure a patients pulse rate and oxygen saturation; The Pulse Oximeter.

Needing to know more before handing over nearly £2000 worth of monitoring equipment, I was told by the eminent and forward thinking dentist, Peter Kertesz, about a pending case involving a patient of his called Arthur.

A week later, the pulse oximeter and local rep Heather were duly dispatched. Luckily I was in the office when Heather rang me in a panic, she couldn’t get the monitor to work! Peter, I learned, was operating with a headlight on which was interfering with the monitors operation. We had originally thought we could use Arthur's tongue for the clip sensor as sadly, Arthur, being a lion, didn’t have the fingers and toes we were so used to, but the strong light stopped that. Hairy ears also precluded the successful operation of the monitor...what to do? Quickly thinking back to base principals of Pulse Oximetry...a well perfused capillary bed, with minimal pigmentation and accessible, Heather was instructed to put the “finger sensor” on Arthur's prepuce, to great effect!

Over the years, it has been my privilege to have been involved in a number of interesting cases with Peter, a particularly memorable one being, The Lioness, The Dentist and the BBC.

This is arguably the first time a pulse oximeter was used to monitor a Veterinary patient outside of the development laboratories, and I shall be eternally grateful to Peter for asking me that question. It took several more years before I was able to really introduce Veterinary Anaesthesia to the pulse oximeter and that took the help of another caring and very influential and inspirational lady: Polly put the Pulse Ox on.