As surgery on the body's most vital organs, the brain and heart, has become more daring and more effective, it has also become more complex. Each new mechanical or electronic aid to the surgeon's skills requires people to run it, and an operating room being used for open-heart surgery now looks like a mob scene from Shakespeare. The crowding and confusion not only bother the surgeon; they are also a disadvantage for the patient: every extra warm body in the operating room is a potential source of infection. Last week, at the huge Clinical Center in Bethesda, Md., the National Institutes of Health dedicated an ultramodern surgical wing designed to clear the crowds from the operating room, while giving both surgeons and patients the greatest possible benefits from advances in technology.
From the air, the $2,000,000 operating wing looks like a giant tadpole, an chored to the main building by its tail.
Earthbound doctors, noting its blue glass panels, have dubbed it "the cyanotic silo." Arranged in a basically circular pattern (see diagram), the ground floor is used for a blood bank. The second floor is for heart surgery, but the actual operating rooms occupy only two spaces shaped like generous slices of a pie. The third floor has masses of equipment for recording the research doctors' data, and glass observation domes for looking down into the heart operating rooms.
The fourth floor, for brain surgery, is much like the second, but with some added equipment that only the neurosurgeon needs, such as a stereotactic device for placing electrodes at precise points deep inside the skull.
"This wing," says the Clinical Center's Director Jack Masur, "will give our surgical investigators a new resource. It will give them information that they only guessed at before, or got only spasmodically—such things as systolic, diastolic and also venous blood pressure, blood temperature as well as body temperature, blood loss since the operation began." All the cables from the monitoring equipment that supplies such information are plugged into a junction box mounted in a pedestal at one end of the operating table.*From there, a cable in the floor carries the information to the central recording rooms that Assistant Director Robert Farrier calls "the central nervous system of the operating wing."
Mumbling Masks. In older operating rooms, Dr. Masur notes, the surgeon had to rely on an assistant, or the anesthesiologist or a nurse, to mumble bits of information to him through a muffling mask. "Now he just glances up to an illuminated display board mounted high on the wall that continually flashes the physiological data from the recording room. The data are also stored, and doctors can study them later to see what went on from beginning to end, and therefore give better care to the next patient."