Elegy for Halothane
 |
Dr. Friesen |
By Robert H. Friesen, MD
Professor Emeritus
Department of Anesthesiology
Children's Hospital Colorado
University of Colorado School of Medicine
A significant historic event for the specialty of pediatric anesthesia occurred about a quarter century ago when sevoflurane was introduced to clinical practice. Due to its more favorable hemodynamic profile, sevoflurane—over a period of just a few years--replaced halothane as the preferred inhalational induction agent for infants and children. Despite its declining use, halothane was stocked in our hospital until 2006, when it was finally discontinued. At that time, I wrote this poem to celebrate this historic event.
We got the news this year
About an old friend who’s no longer here.
After forty-plus years of solid hard work
Followed by a few of semi-retirement,
Our friend has hung up his saddle,
Been put out to pasture.
“Oh, my!” said one of the gray-haired ones.
“I think I’ll miss him. You see I grew up on his watch.
Worked with him every day and learned so much.
I got to know him through and through.
We were expert partners, that I knew.”
Well, you think I’m talking about Charlie, but I’m not.
No, although he’s undoubtedly old,
He’s still kicking and producing, not quite in the retirement fold.
No, I refer to our old friend, halothane,
Forced out by a brash youngster, sevoflurane.
“But … but this cannot be;
It’s the best agent for bronchoscopy!”
Cried David, getting red in the face.
Alas, the same was said in another time and place
About ether, which fell from grace
Due to some minor issues concerning flammability.
But we survived, and bronchoscopy continued
Without the need for ether to be revived.
“But I like it!” said Rita with a look of hope,
“But only when using my precordial stethoscope.”
“Harrumph!” said the old professor.
“I’ve used halothane more than all you young whippersnappers put together,
And I don’t regret the loss of the stuff.
I’ve seen a lot and had enough
Of halothane inductions in tiny tots.
You apply the mask, and the babies squirm
And then the vital signs begin to turn …
Downward.
Heart sounds grow faint; you cannot hear!
You push the stethoscope further into your ear.
The rhythm, well it’s no longer sinus.
The problem is in the A-V node
Whose conduction by halothane is slowed.
What’s more, the sarcoplasmic reticulum
Has trouble transporting calcium.
Well, better put the tube in and turn the stuff down,
And then things will turn around.
What? Where’s the atropine? That’ll save us!
The heart gets slow, and the baby turns gray.
But, hey, don’t you ever read A & A?
Where young Friesen and boy Lichtor
Demonstrated with scientific rigor
That blood pressure falls at least by half!
And Salem and POCA and Doc Morray,
Don’t you remember what they had to say?
As vitamin H is being replaced
The incidence of cardiac arrest is going away!
Yes, I’ve seen a lot and had enough
And I don’t regret the loss of the stuff.
