Ozinsky’s role in heart op

THE historic event of the world’s first human heart transplant, performed 50 years ago this month, has rightly been accorded prominent space in your newspaper with appropriate accolades to the team leader Professor Christiaan Barnard.

However, almost no mention has been made of one of the most central figures in this extraordinary event – the anaesthetist, Dr Joseph Ozinsky.

Ozinsky played a crucial role in the pre-operative preparation of Louis Washkansky, the management of the anaesthetic and the post-operative care.

His achievements have been largely overlooked as a consequence of his reticence.

However, it must be recorded that the anaesthetic management of the heart transplant required extraordinary skill, courage and knowledge of physiology and pharmacology. While the surgical technique could be perfected in the animal laboratory, there was no precedent for the anaesthetic management of the patient with what Ozinsky described accurately as “a dying heart”.

Ozinsky used his exceptional experience in and knowledge of anaesthesia for cardiovascular procedures to achieve the nearimpossible feat of keeping this dying patient alive to enable the transplant to be completed successfully.

Modern anaesthetic practice is characterised by the availability of a variety of highly accurate scientific instruments that allow the anaesthetist to make intelligent and rational decisions based on the physiological information that can be obtained for every patient.

The range of pharmacological agents available to today’s anaesthetist is remarkable with powerful, precise medications available to manage most crises that may arise during an operation.

Ozinsky had only primitive monitoring devices and an extraordinarily limited choice of anaesthetic agents.

Despite these limitations, the anaesthetic management of the first human heart transplant operation was extraordinarily successful.

In his typically laconic report of the anaesthetic in the South African Medical Journal, Ozinsky describes how Washkansky was weaned from his breathing machine within 24 hours of leaving the operating theatre, something that still cannot be achieved in all patients undergoing such procedures.

Ozinsky was integrally involved in the post-operative care of Washkansky to the extent of taking over his breathing support during his terminal pneumonia when the rather primitive mechanical breathing devices available proved inadequate for the task.

It is of interest that rugby legend, Dr Cecil Moss, also played a crucial role in these events as he was intimately involved in the resuscitation of Denise Darvall.

Moss was the anaesthetist involved in her care to ensure her heart was maintained in the best possible condition prior to the performance of the transplantation.

Sadly, both of these giants of anaesthesia died within months of each other this year, but both have provided inspiration to generations of anaesthesiologists in this country and throughout the world.

The signal events of the world’s firsthuman heart transplant are rightly commemorated and it is fitting that the pivotal role played by Ozinsky is recognised.

Joseph Ozinsky