About the Author

While an author is yet living, we estimate his powers by his worst performance; and when he is dead by his best.

Samuel Johnson 1765

Alan Grogono

Alan W. Grogono, MB, BS, MD (Lond), FRCA

Professor Emeritus, Department of Anesthesiology
Tulane University School of Medicine
1430 Tulane Avenue, New Orleans, LA 70112

Alan Walter Grogono (“Grog”) was the Chair of the Department of Anesthesiology at Tulane University in New Orleans from 1981 to 1998. He was an active member of the Council of the Association of Anesthesiology Program Directors and served as the Association’s President from 1995-1997.

His early medical education was in London, England. From the London Hospital Medical College as a student, to King’s College Hospital as a registrar, he was appointed to the Royal Free Hospital as a consultant anaesthetist. His journeys to and fro across the Atlantic made many friends in Syracuse, New York – so much so that it was an easy decision to relocate there in 1974.

He has had a lifelong interest in equipment and efficiency, holds a number of patents, and was responsible for many of the design features of the man/machine interface for the PhysioflexR closed circuit anesthesia machine which was marketed by Dräger in Europe. From 1990 to 1997, Grog was chairman of the Education Planning Committee of the Society for Technology in Anesthesia and organized the Society’s meetings at the Annual Meeting of the American Society of Anesthesiologists.

He is known for his interest in teaching Acid Base Balance, his annual reports in the ASA Newsletter about the trends in recruitment into anesthesiology, and for creating one of the earliest techniques for measuring health. His interests outside medicine include the creation of artistic mobiles – several of which have been displayed in the Art Show at the Annual Meeting of the ASA, and high speed sailing: during the years 1977 through 1982 he actively participated in establishing the “B Class” world sailing speed record in “Icarus”– the hydrofoil-born Tornado designed by his surgeon-brother, James Grogono.

In recent year he has increased his interest in creating websites. In addition to this website he has websites devoted to Animated Knots, Night Navigation Lights, An Extensive Unicode Table, Magic Squares, and Stereo Art. In 2006, Animated Knots by Grog was launched as a highly successful App for the iPhone followed by Apps for Android phones, iPads, Macs, and Windows Computers.

His wife, Anthea, was an Associate Professor of Dentistry at the Louisiana State University School of Dentistry. They now live in Hilton Head Island, SC. They have four (absolutely wonderful) children and ten (also wonderful) grandchildren. That last sentence is written to discover whether these (absolutely wonderful) descendants ever actually read any of this.

Career, Acid-Base & Ventilators

Grogono with Anesthetic Molecules Mobile

Grogono with Anesthetic Molecules Mobile

Medical School: Grog entered The London Hospital Medical College in 1953 – one year after the Copenhagen poliomyelitis epidemic. Fear of polio was understandable: children were at risk, results were crippling, and critical care and formal recovery rooms did not exist. He enjoyed medical school but was not a particularly good student – focusing principally on writing, and participating in, the annual Christmas Review. Several in his group managed to fail a pharmacology course several times and created a “failed pharmacology course tie” which they wore to the professor’s remedial lectures. This failure makes an interesting contrast with anesthesiology as his career choice and his creation, years later, of a mobile (shown here) consisting of a history lesson of anesthetic molecules. Long after he graduated, a chance meeting with the professor occurred when he and his wife were house-hunting. As the door opened he detected long dormant pain on the professor’s expression. He made no reference to the past and they didn’t buy the house.

Ether: Grog started his first training job in anesthesiology at the The London Hospital in 1960. There were only one or two ventilators in the entire suite of operating rooms and fear of the use of curare was common: “For patients that worry you – trust ether!” At the time, anesthesia gases were casually and freely released into the room. When he administered ether, particularly when dripping it onto a gauze mask over a child’s face, he inhaled it and it was absorbed into his fat. His friends could smell it on his breath for many hours. After 13 weeks he abandoned anesthesiology in favor of obstetrics – because the obstetric job was associated with directing the Christmas Review. He made this switch even though he had already designed a new ventilator.

First Ventilator: Experience with the new balanced anesthetic approach using a blend of curare, nitrous oxide and morphine very rapidly convinced trainees then that this mantra about ether was outdated. The need for more ventilators was dire – arriving late in the operating room eliminated the chance of grabbing a ventilator and manual ventilation was tedious. This manual ventilation stimulated creativity. The oxygen and nitrous oxide exiting the flow meters could surely be stored under pressure until there was enough for the next breath. Grog’s first ventilator used wood and a rubber bellows and he suggested trying it on a patient. Sadly, as he then thought, wiser heads prevented a trial. He likened the mechanism to the tank above a men’s urinal. It filled until a trigger caused a flush or, in this case, a breath.

Competition: At the time he was oblivious of almost identical and independent creativity by Howells and Manley, two other anesthesiology trainees in London. They both produced excellent minute-volume divider anesthesia ventilators that were widely adopted. Howells later became a colleague and a friend when he became a consultant at the Royal Free Hospital.

Critical Care: While completing his training at King’s College Hospital, Grog became acutely aware of the need for Critical Care. The battle to find space, staff, personnel, and other essential resources was overwhelming. It also taught him another valuable lesson: it requires dedicated medical staff as well. Completing his training and devoting “spare” time to Critical Care was impossible – he and his wife were raising four children and rebuilding an old Victorian house with their bare hands.

Second Ventilator: Grog’s fascination with anesthesia ventilators eventually resulted in a New Ventilator/Humidifier. Now the anesthesia gas accumulated in a metal container – a pressure cooker. Rising pressure tripped a mechanism that released the gas to the patient. The prototype was used for years in the animal laboratory in the Upstate Medical Center, Syracuse NY. However, it was never a commercial success due to difficulty achieving the required reliability and growing concern about releasing high flows of anesthetic gases into the operating rooms.

First Acid-Base Diagram: In 1974, Hawke, Byles and he experimented with various diagrams to represent acid-base base balance. The magnificent but intimidating Siggaard-Andersen Alignment Nomogram provided them with data which allowed every possible combination to be plotted: PCO2 against pH, pH against Bicarbonate, Standard Base Excess against pH, Hydrogen ion concentration against Standard Base Excess, etc. All of these attempts produced awkward curves or misshapen clinical zones. Imagine their excitement when  PCO2 plotted against Standard Base Excess produced straight pH lines with clinical zones like straight spokes of a wheel.

Meeting John Severinghaus: In 1984 Jack Aron made a generous endowment to honor his friends and Grog became the Merryl and Sam Israel Chair of the department of Anesthesiology at Tulane University School of Medicine. He was asked to invite a speaker and, to his delight, John Severinghaus accepted the invitation that formed the basis for an enduring friendship. Towards the end of his life Jack Aron developed Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease). He asked Grog for his advice, which was disturbing but flattering. Grog would like to think he helped Jack make a final critical decision.

More on Ventilators: Around 1988 Prof. Wilhelm Erdmann of the Erasmus University in Rotterdam visited unexpectedly. He stimulated Grog’s interest in The Physioflex© – a new electronic anesthesia machine, and extended an invitation to join the design team. This was exciting because among its many other innovations, it minimized waste gas liberation and allowed Oxygen Consumption to be measured. It was never sold in the US and was acquired by Dräger who eventually allowed it to vanish. Grog concluded that he obviously brought bad luck to ventilators!

Another Acid Base Diagram: In the late 1990s John Severinghaus introduced Grog to Robert Schlichtig who had compiled an extraordinary set of acid-base values from 21 published reports of patients with purely acute or chronic metabolic or respiratory acid-base problems. From this Schlichtig calculated regression equations which allowed the original Grogono diagram to be updated to accurately locate the Clinical Zones.

This Website: Grog originally created this tutorial in 1998 while Chairman of the Anesthesiology Department at Tulane University School of Medicine in New Orleans. Now in retirement as Professor Emeritus he has time to modify the website. With the help of graphic-designer son Martin, this site is now responsive and more suitable for use with phones, tablets, as well as computers. Feedback and suggestions will be welcomed. Originally hosted on the Tulane Medical Center website, it remained there until 2005 when hurricane Katrina inactivated the Tulane servers for some weeks. The website has attracted several hundred links and many kind testimonials.