Genuine German Induction

See if you can spot the subtle differences with the Californian induction method!

Europeans are less laid-back about hair caps - you are always made to wear one in the Anesthetic Room

On the other hand, Europeans don't think preoxygenation by mask before induction is necessary - they don't see the point in increasing the anxiety of the patient by putting a mask on their face before induction, and Propofol is injected without one. Here, the patient's eyeslashes are being flicked. If there is no blink reflex, the patient is unconscious and paralysed.

With the patient unconscious and paralyzed, now the mask is applied and oxygenation begun.

The development of modern plastics has produced several alternatives to the traditional black rubber. On this Drager anesthesia machine, the rebreathing bag is made of translucent silicone.

Intubation is the same everywhere, using a retractor to hold down the tongue and the insertion of a breathing tube with the aid of a stiff wire which is withdrawn when the tube is in place.

The eyes are usually taped shut to prevent them drying out - the paralyzed eyelids don't fully close by themselves. In some places the eyes are gelled, and in others both gelled and taped.

This Drager anesthesia machine is unusually compact, and the bellows pump UPWARDS rather than downwards. There's no evidence that how the bellows pump gas makes any difference to the patient.

Note that as well as a breathing tube, a laparoscopic tube is also inserted as a standard procedure, not just for laparoscopies. This is an extra precaution in case the trachea or oesophagus has to be examined, but it's not considered necessary in many hospitals.