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Changing Perspectives: Capnography


On November 27th 1972, the Dutch medical society was shocked by the oration speech by dr. Bob Smalhout, an anaesthesiologist, entitled “De dood op tafel” (English “death on the table”). In this public lecture, he opened up about perioperative complications and deaths due to anaesthesia related errors. He made a plea to make anaesthesia related healthcare safer: he suggested necessitating adequate airway monitoring of patients during an operation.

Until then, there was no standard practice in the monitoring of endotracheal intubation. To distinguish between the proper endotracheal versus unwanted oesophageal intubation, detection of exhaled carbon dioxide was made possible via capnography. John Scott Haldane was the first to design a capnogram apparatus in the early 20th century (which was later improved by Luft in 1943), but it was largely due to prof. Smalhouts efforts that capnography was introduced in
the anaesthesia practice in the Netherlands. He continued to contribute to capnography knowledge by publishing the vademecum called “An atlas of capnography” (1975). He was a true pioneer in the use of capnography as the standard of aesthetic care, as the technique was not introduced in the United States until 1978. July 2nd 2015 Bob Smalhout passed away. However, by introducing capnography as standard perioperative care, his contributions to patient safety will live on.

S.M. Bossers & D.N.H. van Vemde

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