Bernard Raymond Fink (1914 – 2000) was an American anesthesiologist. Dr. Fink lectured in seven languages to 17 nations on five continents.
Clinician and innovator with scholarly intellect and research insights. More than 120 original articles that explored diffusion anoxia, medical history, pain, respiratory regulation, electromyography, anesthetic toxicity, cell metabolism, local anesthetics and nerve conduction.
- Born May 25, 1914, in London, England
- 1934 – BSc Physiology, University of London
- 1938 – BSc Physiology, University of London
- 1939-1945 Member of the South African Medical Corps
- 1952 – Completed anesthesia residency Beth Israel Hospital, New York.
- 1952 – Associated Professor of anesthesia, Columbia University.
- 1964 – Professor of anesthesia University of Washington
- 1987 – ASA Excellence in Research Award (American Society of Anesthesiologists)
- Died October 30, 2000
Fink effect (1955)
Diffusion anoxia/hypoxia or the third gas effect.
Study of eight patients undergoing gynaecologic surgery with 75% nitrous oxide – 25% oxygen mix. Fink noted that the patients’ oxygen saturations dropped 5-10% upon cessation of nitrous oxide and ventilation of room air. This lead to the conclusion that oxygen should routinely be given at the end of sedation.
The underlying mechanism of diffusion hypoxia is that given nitrous oxide is poorly soluble in blood, once the driving force of high alveolar nitrous oxide concentration is removed, its will diffuse rapidly back from the blood into the alveolar space, diffuse and possibly displace end alveolar O2.
The significance of the Fink effect has since been downplayed through other work that suggests airway obstruction, alveolar atelectasis and other respiratory irregularities play a larger role than diffuse hypoxia. However, given its sound physiologic underpinning and absence of evidence that rule out the phenomenon. It’s still prudent to place some O2 on anyone you’ve just given a nitrous sedation to.
Fink Laryngoscope Blade (1958)
Wider and with a shallower curve than the Macintosh Laryngoscope Blade, for use with difficult to intubate adults. It came in only one size, size 4
Macintosh Laryngoscope Blade widened to improve balance and reduced in height to protect the teeth. The recurved tip fits the vallecula, greatly facilitating exposure in difficult cases. The forward light gives good illumination and simplifies bulb replacement.Foregger, 1958
- Fink Non-rebreathing Valve (1954) first nonrebreathing valve that allowed the anesthesiologist to provide assisted respirations with only one hand so that the opposite hand was free to attend to other responsibilities and patient needs.
- Fink Vallecular Airway – additional rounded extension to the end of the oral airway to reach the vallecula1 and indirectly raise the epiglottis. Fink recommended his vallecular airway in patients whose airways became obstructed during anesthesia despite the use of a standard oral airway
- Fink BR. A nonrebreathing valve of new design. Anesthesiology. 1954; 15(5): 471-4.
- Fink BR. Diffusion anoxia. Anesthesiology. 1955; 16(4): 511-9. [Fink effect]
- Fink BR. Roentgenographic studies of the oropharyngeal airway. Anesthesiology. 1957; 18(5): 711-8
- Fink BR, Basek M, Epanchin V. The mechanism of opening of the human larynx. The Laryngoscope, 66: 410–425.
- Fink BR. Human Larynx – A Functional Study. New York: Raven Press, 1975
- Fink BR, Demarest RJ. Laryngeal Biomechanics. Harvard University Press, 1978
- Fink BR. Leaves and needles: the introduction of surgical local anesthesia. Anesthesiology. 1985; 63(1): 77-83.
- Bause G. Bernard Raymond Fink, M.D. ASA News. 2000; 64(12)
- Epstein RM. ASA Award: B. Raymond Fink. Anesthes. 1987; 67(4):456-458.
- Maltby R. Notable Names in Anaesthesia. The Choir Press; pp63-65. 2013
- McGoldrick K. B. In Memoriam: Raymond Fink, M.D. (1914–2000). Survey of Anesthesiology: February 2001 – Volume 45 – Issue 1 – pp 1-2
- Cheney FW. An early example of evidence-based medicine: hypoxemia due to nitrous oxide. Anesthesiology. 2007; 106(1): 186-8.
- The Fink Edition. Bull Anesth Hist. 2001 Jan;19(1):24-6.
- Fink Collection. The Wood Library-Museum.
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