Page 147 - JSOM Summer 2018

nose. A jar of ether and a Bellamy dropper (Figure 4) in the
jar are required, or the provider may create one by cutting two
opposing vents in a cork and placing a rolled piece of gauze
to drop ether from the jar onto the gauze of the mask. This
is the most primitive and the least resource-intensive method
of ether administration. The method requires moistening the
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mask but not to the point of complete saturation. This method
is referenced in the first Special Forces medical handbook
printed in 1981 and is well demonstrated in a 1944 British
training video “Open Drop Ether, Part 1” and Part 2. Ether, FIGURE 5
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due to its high lipid solubility relative to the newer anesthet- Homemade
ics, has a long uptake time for induction to a stage III level ether jar.
and may take 10–15 minutes to achieve. Patient monitoring
focuses on Guedel’s physical signs to maintain the patient in
a stage III, plane III level until the procedure is complete. No
matter what method is used, the stage II level, during induc- Courtesy of Christie Morgans Photography.
tion and emergence, will be the most difficult and also the
most dangerous. Vigilance is key here. The dangers of stage II
reside in the hyperactive response of the patient, especially the
airway (e.g., laryngospasm). Of the five senses, the last to go
to sleep and first to wake up is hearing. If possible, avoiding
loud noises and stimulation of the patient during stage II can The ether jar can be as simple as a glass jar and lid, with the
reduce, but not eliminate, the danger. lower third of the jar filled with cotton balls or a sponge to act
as a wick for the ether. Two holes are cut in the top of the jar;
FIGURE 4 Ether bottle with Bellamy dropper inserted. one allows air to enter the jar, ether vapors flow out of the other
one to be inhaled. Dr Morton used a similar device with his
demonstration in the Ether Dome (Figure 6). Place tubing able
to connect to the ET tube through the lid far enough into the
jar but not long enough that it comes in contact with the liquid
ether. The tubes can be sealed to the lid with caulking or wax to
prevent gas seepage. Pour enough ether into the jar to fill the bot-
tom, but only covering half of the cotton balls or sponge. Mason
jars work well because they allow the user to see when the cotton
dries and more ether needs to be added. However, never store
ether in clear jars, as stated previously. The jar is connected to
the ET tube to keep the patient in stage III of anesthesia. If it
is suspected that the anesthesia is approaching stage IV, discon-
nect the jar for a few minutes until a lighter plane of anesthesia
is achieved and then reconnect to sustain a surgical plane. The
Flagg can is similar; it consisted of placing a rubber tube over
the opening of the ether can and then punching a few holes in
the top of the can to allow air to enter when the patient inhaled.
Courtesy of American Civil War Surgical Antiques.
FIGURE 6 Morton ether inhaler.

Ether jar
In many tropical or desert environments, the open drop mask
method may not be a viable option because ether may vaporize
right out of the dropper as it hits the mask if the ambient tem-
perature is higher than the ether boiling point. This problem
led to the ether jar method (Figure 5) and different variations
of it, similar to the original Flagg can. At its most simple, the
ether jar is a primitive drawover system. The ether jar method
helps if a patient has a breathing tube in place, such as an en-
dotracheal (ET) tube, cricothyroidotomy, or even supraglottic Universal drawover
device, or the patient can be made to directly inhale the vapor In most of the developing world, the most common anesthe-
from the tube by pinching the nose closed. sia delivery device is a drawover system. As stated, the most

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