Embed Size (px)
Citation preview
Why study the History of Anaesthesia?
Understanding of our past guides our future
The history of surgery is inextricably linked to the development of appropriate anaesthetic techniques and so the history of surgery follows the history of anaesthesia
We are all part of it
“Pre-history”
The Roman writer Celsius encouraged “pitilessness” as an essential characteristic of the surgeon
Authors of leading surgical texts often ignored surgical pain as a topic of discussion
In Liston's time, as in the countless ages before, pain was considered primarily a symptom of importance
Despite this sentiment, many different agents were used to achieve anesthesia. A physician from the first century
A.D., commented upon mandragora. He stated that the plant substance
could be boiled in wine and strained, and used “in the case of persons . . . about to be cut or cauterized, when they wish to produce anesthesia.”
Mandragora was still being used to anesthetize patients as late as the 17th century.
History of Anaesthesia
Pre-1846 - the foundations of anaesthesia
1846 - 1900 - establishment of anaesthesia
20th Century - consolidation and growth
21st Century - the future
Pre 1846 - The Foundations of Anaesthesia
Drug methods Alcohol
Opium (poppy)
Hyoscine (Mandrake)
Cannabis (Hemp)
Cocaine (New World)
The Foundations of Anaesthesia
Non-drug methods Cold
Concussion
Carotid compression
Nerve compression
Hypnosis
Blood letting
Henry Hill Hickman (1800-1830)
• Attended lecture “on asphyxia” by henry goldwyer - “a temporary suspension of the vital functions arising from a deficiency of atmospheric air..”.
• he studied & described reversal using artificial respiration & electrical restarting of heart
Ether
1540: synthesised and named “sweet oil of vitriol” by Valerius Cordus
renamed “ether” by Frobenius
1744: Matthew Turner published essay suggesting its inhalation in certain types of pain
late 1790’s: researched at Pneumatic Institute started & clinical use of ether was experimented
Ether Benjamin Brodie (1783-
1862)
1821: demonstrated to Royal College of Surgeons that ether inhalation could induce insensibility in a guinea pig
“….ether acted like a narcotic poison……”
Ether 1842: first use as
clinical anaesthetic in USA
16th October 1846: first public demonstration of ether anaesthesia in Boston, Mass.
Ether - the news spreads
1847: arrival of Ether Anaesthesia announced in first edition of “The Lancet” of 1847
William T. Morton Inventor and Revealer of
Inhalational Anaesthesia:
Before Whom, in All Time, Surgery was Agony;
By Whom, Pain in Surgery was Averted and Annulled; Since Whom, Science has Control of Pain.”
Before the invention of the hollow needle and an awareness of aseptic technique, the only class of potential anesthetics that could offer a prompt, profound, and temporary action were the inhaled drugs.
Morton's ether inhaler (1846)
Joseph Clover Clover was the first anaesthetist to
administer chloroform in known concentrations through the Clover bag.
After 1870, Clover favored a nitrous oxide–ether sequence. The portable anesthesia machines that he designed were in popular use for decades after his death.
He was the first Englishman to urge the now universal practice of thrusting the patient's jaw forward to overcome obstruction of the upper airway by the tongue.
Joseph Clover Joseph Clover (1825–1882) became the
leading anaesthetist of London after the death of John Snow in 1858.
• Joseph Clover anesthetizing a patient with chloroform and air passing through a flexible tube from a Clover bag.
John Snow: The First Anesthesiologist
John Snow was already a respected physician who had presented papers on physiologic subjects when the news of ether anesthesia reached England in December 1846.
He took an interest in anesthetic practice and was soon invited to work with many of the leading surgeons of the day.
• He was not only facile at providing anesthesia but was also a remarkably keen observer.
• His innovative description of the stages or degreesof ether anesthesia
• based on the patient's responsiveness was not improved upon for 70 years.
John Snow (1813-1858) Born in York in 1813
became interested in anaesthesia via work in toxicology
Researched in Newcastle, then worked in London 1836-1858 until his death
acknowledged as “first full-time” anaesthetist developing ways to improve methods of ether and chloroform administration(4000 no)
John Snow's face mask (1847). The expiratory valve can be tilted to the side to allow the patient to breathe air.
John Snow's ether inhaler (1847). The ether chamber (B) contained a spiral coil so that the air entering through the brass tube (D) was saturated by ether before ascending the flexible tube (F) to the face mask (G). The ether chamber rested in a bath of warm water (A).
John Snow: The First Anesthesiologist
Nitrous oxide
Nitrous oxide was first prepared in 1773 by Joseph Priestley, an English clergyman and scientist, who ranks among the great pioneers of chemistry.
Like ether, nitrous oxide was known for its ability to induce lightheadedness and was often inhaled by those seeking a thrill.
It was not used as frequently as was ether because it was more complex to prepare and awkward to store.
Nitrous oxide Humphry Davy (1778–1829)
was a young man of ability and drive.
He performed a brilliant series of investigations of several gases but focused much of his attention on nitrous oxide, which he and his associates inhaled through face masks designed for the Institute by James Watt, the distinguished inventor of the steam engine
1834: Colton “anaesthetised” 6 Red Indians by mistake
1846-1900 General Anaesthesia
Ether○ spread to Europe
Nitrous oxide
Chloroform○ James Young
Simpson○ John Snow
Local Anaesthesia anaesthesia without
sleep
New techniques early landmarks
James Young Simpson (1811-1870)
Professor of Midwifery in Edinburgh from 1840
Tried chloroform on himself and friends at suggestion of David Waldie, a chemist
Secured and popularised chloroform as clinical anaesthetic, esp. in Obstetrics
Chloroform 1831: Chloroform synthesised
1833: Cynthia Guthrie accidentally anaesthetised herself!
1847: Anaesthetic properties recognised
1847: First clinical use, St Barts, London
1847: James Young Simpson used chloroform for obstetric anaesthesia
Chloroform 1847: John Snow’s
regulating inhaler
1847/48: Chloroform eclipses ether
1848: Hannah Greener - first anaesthetic death
1858: John Snow “On Chloroform and other
anaesthetics”
The Discovery of Regional Anesthesia in the 19 Century
Cocaine, an extract of the coca leaf, was the first effective local anesthetic.
In 1884, Koller's friend, Sigmund Freud, became interested in the cerebral-stimulating effects of cocaine and gave him a small sample in an envelope, which he placed in his pocket.
When the envelope leaked, a few grains of cocaine stuck to Koller's finger, which he casually licked with his tongue.
It became numb.
At that moment, Koller realized that he had found the object of his search. He dashed to the laboratory and made a suspension of cocaine crystals
He and Gustav Gartner, a laboratory associate, observed its anesthetic effect on the eyes of a frog, a rabbit, and a dog before they dropped the solution onto their own corneas.
To their amazement, their eyes were insensitive to the touch of a pin.
The Discovery of Regional Anesthesia in the 19 Century
Spinal anesthesia
The term spinal anesthesia was coined in 1885 by Leonard Corning, a neurologist who had observed Hall and Halsted.
Corning wanted to assess the action of cocaine as a specific therapy for neurologic problems..”
An intravenous regional technique with procaine was reported in 1908 by August Bier, the surgeon who had pioneered spinal anesthesia.
Bier injected procaine into a vein of the upper limb between two tourniquets.
Even though the technique is termed the Bier block, it was not used for many decades until it was reintroduced 55 years later by Mackinnon Holmes.
Holmes used lidocaine, the very successful amide local anesthetic synthesized in 1943 by Lofgren and Lundquist of Sweden.
Regional Anesthesia
Other 19th century Landmarks
1865: Lister introduced “Carbolic spray” - antisepsis
1878: first oral ETT - flexible brass, 0.95cm diam
1891: first partial pneumonectomy; no ETT
1894: first anaesthetic charts
Anaesthetic Equipment 1908: Rotameters
1917: Boyles machine (Plenum flow)
1914-18: “Flagg can”
Anaesthetic Equipment 1926: McKesson demand machine (intermittent flow)
1938: Artificial respiration via ventilator
1940: Oxford vaporiser
Anaesthetic Equipment 1954: classification of breathing circuits
1961: Manley ventilator
1972: Bain circuit
1976: Lack circuit
Anaesthesia in the 21st Century
The future of Anaesthesia is bright - but we may see our roles and how
we practice might change
