Genuine Californian Induction

In Western medicine, the standard induction method is Propofol injected thru a cannula. This causes rapid unconsciousness in around 5 seconds. The patient is already anesthetized by the time the last drop is injected.

A side effect however is paralysis - the patient will stop breathing. Therefore an anesthesia mask is immediately pressed on the face, and pure oxygen is forced into the lungs by squeezing and releasing the rebreathing bag. A nurse will now inject a muscle-relaxant into the cannula. This causes a more powerful paralysis that shuts down all reflexes except for heartbeat, making intubation and surgery easier. The pure oxygen being squeezed into the lungs builds a reserve of oxygen in the lungs and blood to keep the patient alive, as there will be no breathing during intubation.

A throat retractor holds the tongue down out of the way, giving clear access to the windpipe (trachea). The breathing tube is then inserted with the help of a stiff wire inside it, so it can be gently forced right through the voice box and into the trachea proper. The wire is then pulled out. A small rubber cuff at the end of the tube is then inflated with air by a syringe to make a gas-tight seal, so no gas can leak out through the mouth.

The tube is then connected to the anesthesia machine by a double-hose. One hose carries gas to the patient, another carries the patient's breath back to the machine, where it passes through a soda-lime absorber which scrubs out the carbon dioxide. It's then mixed with fresh gas and pumped back into the patient's lungs by a ventilator.

Tape is then use to keep the breathing tube in place.

The Propofol syringe is inserted into the cannula

The Propofol is injected

The patient is told to take some deep breaths to start building a reserve of oxygen. By the time half the Propofol is injected, the patient is already unconscious.

With all the Propofol injected, the patient is paralyzed. The mask is held tightly to make a good seal and the head tilted back to stop the paralyzed airway closing itself.

Muscle Relaxant is now injected. You can feel when it's working because there's less resistance to the oxygen being squeezed into the lungs.

The oxygenation goes on for a minute or two more to make sure there's plenty in the system before intubation.

With the patient fully oxygenated, the throat retractor holds down the tongue out of the way so the breathing tube can be inserted down the throat.

Once fully inserted, the cuff inside the trachea is inflated to make a gas-tight seal.

The tube is connected to the anesthesia machine by a double-hose.

The patient is now fully connected to the anesthesia machine. The machine pumps a mixture of gases into the patients lungs. This is usually around 20% oxygen, 78% nitrous oxide and 2% sevoflurane vapor. The outbreath passes thru a soda-lime absorber, scrubbed of carbon dioxide a recirculated with fresh gas mixture.