History of general anesthesia
Throughout
In the late 19th century, two major advances enabled the transition to modern surgery: the development and application of
Moreover, the application of economic and business administration principles to healthcare in the late 20th and early 21st centuries led to the introduction of management practices, such as transfer pricing, to improve the efficiency of anesthetists.[1]
Etymology of anesthesia
In
In 1679, Steven Blankaart publishes Lexicon medicum graeco-latinum with the Latin term anaisthesia. In 1684, an English translation appears titled A Physical Dictionary, with anaisthesia defined as "defect of sensation, as in paralytic and blasted persons". Subsequently, the term and variant spellings like anæsthesia are used in medical literature signifying "insensibility".[2]
In 1846, in a letter, Oliver Wendell Holmes proposes the term anesthesia to be used for the state induced by an agent and anesthetic for the agent itself. Holmes motivates this with earlier uses of anesthesia in medical literature to mean "insensibility", particularly to "objects of touch".[4][5][2]
Antiquity
The first attempts at general anesthesia were probably
Opium
The Sumerians are said to have cultivated and harvested the
The ancient Egyptians had some surgical instruments,
Prior to the introduction of opium to
Classical antiquity
This section needs expansion. You can help by adding to it. (February 2015) |
In Classical antiquity, anaesthetics were described by:
- Pedanius De Materia Medica), a Greek physician living in Rome during the first century A.D., who is recorded as the first person to make explicit reference to the administration of mandrake-induced anesthesia to facilitate a surgical intervention.[25]
- Galen
- Hippocrates
- Historia Plantarum)
China and Hua Tuo's ancient chemical mixture
The exact composition of mafeisan, similar to all of Hua Tuo's clinical knowledge, was lost when he burned his manuscripts, just before his death.
The name mafeisan combines ma (麻, meaning "cannabis, hemp, numbed or tingling"), fei (沸, meaning "boiling or bubbling"), and san (散, meaning "to break up or scatter", or "medicine in powder form"). Therefore, the word mafeisan probably means something like "cannabis boil powder". Many sinologists and scholars of traditional Chinese medicine have guessed at the composition of Hua Tuo's mafeisan powder, but the exact components still remain unclear. His formula is believed to have contained some combination of:[29][32][33][34]
- bai zhi (Chinese:白芷,Angelica dahurica),
- cao wu (Chinese:草烏, Aconitum kusnezoffii, Aconitum kusnezoffii, Kusnezoff's monkshood, or wolfsbane root),
- chuān xiōng (Ligusticum wallichii, or Szechuan lovage),
- dong quai (Chinese:当归, Angelica sinensis, or "female ginseng"),
- wu tou (烏頭, Aconitum carmichaelii, rhizome of Aconitum, or "Chinese monkshood"),
- yang jin hua (洋金花, Flos Daturae metelis, or Datura stramonium, jimson weed, devil's trumpet, thorn apple, locoweed, moonflower),
- ya pu lu (押不芦, Mandragora officinarum),
- rhododendron flower, and
- jasmine root.
Others have suggested the potion may have also contained hashish,[30] bhang,[31] shang-luh,[26] or opium.[35] Victor H. Mair wrote that mafei "appears to be a transcription of some Indo-European word related to "morphine"."[36] Some authors believe that Hua Tuo may have discovered surgical analgesia by acupuncture, and that mafeisan either had nothing to do with or was simply an adjunct to his strategy for anesthesia.[37] Many physicians have attempted to re-create the same formulation based on historical records but none have achieved the same clinical efficacy as Hua Tuo's. In any event, Hua Tuo's formula did not appear to be effective for major operations.[36][38]
Other substances used from antiquity for anesthetic purposes include extracts of juniper and coca.[39][40][41]
Middle Ages and Renaissance
Circa 1020,
Throughout 1200 to 1500 AD in England, a potion called
Alchemist Ramon Llull has been credited with discovering diethyl ether in 1275.[citation needed] [46] Aureolus Theophrastus Bombastus von Hohenheim (1493–1541), better known as Paracelsus, discovered the analgesic properties of diethyl ether around 1525.[47] It was first synthesized in 1540 by Valerius Cordus, who noted some of its medicinal properties.[citation needed] He called it oleum dulce vitrioli, a name that reflects the fact that it is synthesized by distilling a mixture of ethanol and sulfuric acid (known at that time as oil of vitriol). August Sigmund Frobenius gave the name Spiritus Vini Æthereus to the substance in 1730.[48][49]
18th century
Joseph Priestley (1733–1804) was an English polymath who discovered nitrous oxide, nitric oxide, ammonia, hydrogen chloride, and (along with Carl Wilhelm Scheele and Antoine Lavoisier) oxygen. Beginning in 1775, Priestley published his research in Experiments and Observations on Different Kinds of Air, a six-volume work.[50] The recent discoveries about these and other gases stimulated a great deal of interest in the European scientific community. Thomas Beddoes (1760–1808) was an English philosopher, physician and teacher of medicine, and like his older colleague Priestley, was also a member of the Lunar Society of Birmingham. With an eye toward making further advances in this new science as well as offering treatment for diseases previously thought to be untreatable (such as asthma and tuberculosis), Beddoes founded the Pneumatic Institution for inhalation gas therapy in 1798 at Dowry Square in Clifton, Bristol.[51] Beddoes employed chemist and physicist Humphry Davy (1778–1829) as superintendent of the institute, and engineer James Watt (1736–1819) to help manufacture the gases. Other members of the Lunar Society such as Erasmus Darwin and Josiah Wedgwood were also actively involved with the institute.
During the course of his research at the Pneumatic Institution, Davy discovered the anesthetic properties of nitrous oxide.[52] Davy, who coined the term "laughing gas" for nitrous oxide, published his findings the following year in the now-classic treatise, Researches, chemical and philosophical–chiefly concerning nitrous oxide or dephlogisticated nitrous air, and its respiration. Davy was not a physician, and he never administered nitrous oxide during a surgical procedure. He was, however, the first to document the analgesic effects of nitrous oxide, as well as its potential benefits in relieving pain during surgery:[53]
As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.
19th century
Eastern hemisphere
Hanaoka Seishū (華岡 青洲, 1760–1835) of Osaka was a Japanese surgeon of the Edo period with a knowledge of Chinese herbal medicine, as well as Western surgical techniques he had learned through Rangaku (literally "Dutch learning", and by extension "Western learning"). Beginning in about 1785, Hanaoka embarked on a quest to re-create a compound that would have pharmacologic properties similar to Hua Tuo's mafeisan.[55] After years of research and experimentation, he finally developed a formula which he named tsūsensan (also known as mafutsu-san). Like that of Hua Tuo, this compound was composed of extracts of several different plants, including:[56][57][58]
- 2 parts bai zhi (Chinese:白芷,Angelica dahurica);
- 2 parts cao wu (Chinese:草烏,Aconitum sp., monkshood or wolfsbane);
- 2 parts chuān ban xia (Pinellia ternata);
- 2 parts chuān xiōng (Ligusticum wallichii, Cnidium rhizome, Cnidium officinale or Szechuan lovage);
- 2 parts dong quai (Angelica sinensis or female ginseng);
- 1 part tian nan xing (Arisaema rhizomatum or cobra lily)
- 8 parts yang jin hua (Datura stramonium, Korean morning glory, thorn apple, jimson weed, devil's trumpet, stinkweed, or locoweed).
The active ingredients in tsūsensan are
On 13 October 1804, Hanaoka performed a partial
Western hemisphere
Friedrich Sertürner (1783–1841) first isolated morphine from opium in 1804;[64] he named it morphine after Morpheus, the Greek god of dreams.[65][full citation needed][66][full citation needed]
Henry Hill Hickman (1800–1830) experimented with the use of carbon dioxide as an anesthetic in the 1820s. He would make the animal insensible, effectively via almost suffocating it with carbon dioxide, then determine the effects of the gas by amputating one of its limbs. In 1824, Hickman submitted the results of his research to the Royal Society in a short treatise titled Letter on suspended animation: with the view of ascertaining its probable utility in surgical operations on human subjects. The response was an 1826 article in The Lancet titled "Surgical Humbug" that ruthlessly criticised his work. Hickman died four years later at age 30. Though he was unappreciated at the time of his death, his work has since been positively reappraised and he is now recognised as one of the fathers of anesthesia.
By the late 1830s, Humphry Davy's experiments had become widely publicized within academic circles in the northeastern United States. Wandering lecturers would hold public gatherings, referred to as "ether frolics", where members of the audience were encouraged to inhale diethyl ether or nitrous oxide to demonstrate the mind-altering properties of these agents while providing much entertainment to onlookers.[67] Four notable men participated in these events and witnessed the use of ether in this manner. They were William Edward Clarke (1819–1898), Crawford W. Long (1815–1878), Horace Wells (1815–1848), and William T. G. Morton (1819–1868).
While attending undergraduate school in Rochester, New York, in 1839, classmates Clarke and Morton apparently participated in ether frolics with some regularity.
Crawford W. Long was a physician and pharmacist practicing in
With the beginnings of modern medicine the stage was set for physicians and surgeons to build a paradigm in which anesthesia became useful.[74]
On 10 December 1844, Gardner Quincy Colton held a public demonstration of nitrous oxide in Hartford, Connecticut. One of the participants, Samuel A. Cooley, sustained a significant injury to his leg while under the influence of nitrous oxide without noticing the injury. Horace Wells, a Connecticut dentist present in the audience that day, immediately seized upon the significance of this apparent analgesic effect of nitrous oxide. The following day, Wells underwent a painless dental extraction while under the influence of nitrous oxide administered by Colton. Wells then began to administer nitrous oxide to his patients, successfully performing several dental extractions over the next couple of weeks.
William T. G. Morton, another New England dentist, was a former student and then-current business partner of Wells. He was also a former acquaintance and classmate of William Edward Clarke (the two had attended undergraduate school together in Rochester, New York). Morton arranged for Wells to demonstrate his technique for dental extraction under nitrous oxide general anesthesia at Massachusetts General Hospital, in conjunction with the prominent surgeon John Collins Warren. This demonstration, which took place on 20 January 1845, ended in failure when the patient cried out in pain in the middle of the operation.[75]
On 30 September 1846, Morton administered diethyl ether to Eben Frost, a music teacher from
In 1847, Scottish
After Austrian diplomat Karl von Scherzer brought back sufficient quantities of coca leaves from Peru, in 1860 Albert Niemann isolated cocaine, which thus became the first local anesthetic.[82][83]
In 1871, the German surgeon Friedrich Trendelenburg (1844–1924) published a paper describing the first successful elective human tracheotomy to be performed for the purpose of administration of general anesthesia.[84][85][86][87]
In 1880, the Scottish surgeon
20th century
The 20th century saw the transformation of the practices of tracheotomy,
In 1902,
Until 1913,
Also in 1913,
In 1928 Arthur Ernest Guedel introduced the cuffed endotracheal tube, which allowed deep enough anesthesia that completely suppressed spontaneously respirations while the gas and oxygen were delivered via positive pressure ventilation controlled by the anesthesiologist.[102] Also important for the development of modern anesthesia are anesthesia machines. Only three years later Joseph W. Gale developed the technology where the anesthesiologist was able to ventilate only one lung at a time.[103] This allowed the development of thoracic surgery, which had previously been vexed by the pendelluft [104] problem in which the bad lung being operated on inflated with patient exhalation due to the loss of vacuum with the thorax being open to the atmosphere. Eventually by early 1980s double lumen endotracheal tubes made out of clear plastic enabled anesthesiologists to selectively ventilate one lung while using flexible fiberoptic bronchoscopy to block off the diseased lung and prevent cross contamination.[81] One early device, the copper kettle, was developed by Dr. Lucien E. Morris at the University of Wisconsin.[105][106]
Sodium thiopental, the first intravenous anesthetic, was synthesized in 1934 by Ernest H. Volwiler (1893–1992) and Donalee L. Tabern (1900–1974), working for Abbott Laboratories.[107] It was first used in humans on 8 March 1934 by Ralph M. Waters in an investigation of its properties, which were short-term anesthesia and surprisingly little analgesia. Three months later, John Silas Lundy started a clinical trial of thiopental at the Mayo Clinic at the request of Abbott Laboratories. Volwiler and Tabern were awarded U.S. Patent No. 2,153,729 in 1939 for the discovery of thiopental, and they were inducted into the National Inventors Hall of Fame in 1986.
In 1939, the search for a synthetic substitute for atropine culminated serendipitously in the discovery of meperidine, the first opiate with a structure altogether different from that of morphine.[108] This was followed in 1947 by the widespread introduction of methadone, another structurally unrelated compound with pharmacological properties similar to those of morphine.[109]
After World War I, further advances were made in the field of intratracheal anesthesia. Among these were those made by Sir Ivan Whiteside Magill (1888–1986). Working at the Queen's Hospital for Facial and Jaw Injuries in Sidcup with plastic surgeon Sir Harold Gillies (1882–1960) and anesthetist E. Stanley Rowbotham (1890–1979), Magill developed the technique of awake blind nasotracheal intubation.[110][111][112][113][114][115] Magill devised a new type of angulated forceps (the Magill forceps) that are still used today to facilitate nasotracheal intubation in a manner that is little changed from Magill's original technique.[116] Other devices invented by Magill include the Magill laryngoscope blade,[117] as well as several apparatuses for the administration of volatile anesthetic agents.[118][119][120] The Magill curve of an endotracheal tube is also named for Magill.
The first hospital anesthesia department was established at the Massachusetts General Hospital in 1936, under the leadership of Henry K. Beecher (1904–1976). Beecher, who received his training in surgery, had no previous experience in anesthesia.[121]
Although initially used to reduce the sequelae of spasticity associated with
Sir Robert Macintosh (1897–1989) achieved significant advances in techniques for tracheal intubation when he introduced his new curved laryngoscope blade in 1943.[123] The Macintosh blade remains to this day the most widely used laryngoscope blade for orotracheal intubation.[124] In 1949, Macintosh published a case report describing the novel use of a gum elastic urinary catheter as an endotracheal tube introducer to facilitate difficult tracheal intubation.[125] Inspired by Macintosh's report, P. Hex Venn (who was at that time the anesthetic advisor to the British firm Eschmann Bros. & Walsh, Ltd.) set about developing an endotracheal tube introducer based on this concept. Venn's design was accepted in March 1973, and what became known as the Eschmann endotracheal tube introducer went into production later that year.[126] The material of Venn's design was different from that of a gum elastic bougie in that it had two layers: a core of tube woven from polyester threads and an outer resin layer. This provided more stiffness but maintained the flexibility and the slippery surface. Other differences were the length (the new introducer was 60 cm (24 in), which is much longer than the gum elastic bougie) and the presence of a 35° curved tip, permitting it to be steered around obstacles.[127][128]
For over a hundred years the mainstay of inhalational anesthetics remained ether with cyclopropane, which had been introduced in the 1930s. In 1956 halothane[129] was introduced which had the significant advantage of not being flammable. This reduced the risk of operating room fires. In the sixties the halogenated ethers superseded Halothane due to the rare, but significant side effects of cardiac arrhythmias and liver toxicity. The first two halogenated ethers were methoxyflurane and enflurane. These in turn were replaced by the current standards of isoflurane, sevoflurane, and desflurane in the eighties and nineties although methoxyflurane remains in use for prehospital anesthesia in Australia as Penthrox. Halothane remains in common place throughout much of the developing world.
Many new intravenous and inhalational anesthetics were developed and brought into clinical use during the second half of the 20th century.
The concept of using a fiberoptic endoscope for tracheal intubation was introduced by Peter Murphy, an English anesthetist, in 1967.[146] By the mid-1980s, the flexible fiberoptic bronchoscope had become an indispensable instrument within the pulmonology and anesthesia communities.[147]
21st century
The
Xenon, which does not act as a greenhouse gas, has recently been approved in some jurisdictions as an anaesthetic agent.[150]
See also
- ACE mixture
- American Association of Nurse Anesthesiology
- American Society of Anesthesiologists
- Anaesthetic machine
- ASA physical status classification system
- Blood transfusion
- Henry Edmund Gaskin Boyle
- Walter Channing (physician)
- Joseph Thomas Clover
- Curare
- James Esdaile
- General anaesthesia
- Arthur Ernest Guedel
- History of anatomy
- History of medicine
- History of neuraxial anesthesia
- History of neuroscience
- History of surgery
- History of tracheal intubation
- Local anesthesia
- Fidel Pagés
- Royal College of Anaesthetists
- John Snow
- Takamine Tokumei
- The Zoist: A Journal of Cerebral Physiology & Mesmerism, and Their Applications to Human Welfare
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In a letter to dentist William T. G. Morton
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Further reading
- Goldsmith, WM (1945). "Trepanation and the 'CatlinMark'". American Antiquity. 10 (4): 348–52. S2CID 163518652.
- Guerra Doce, E (2006). "Evidencias del consumo de drogas en Europa durante la Prehistoria". Trastornos Adictivos (in Spanish). 8 (1): 53–61. doi:10.1016/S1575-0973(06)75106-6. Archived from the originalon 15 May 2008. Retrieved 14 November 2010.
- Gurlt, EJ (1898). "VI: Volkschirurgie in Japan in alter und neuerer". Geschichte der Chirurgie und ihrer Ausübung (in German). Vol. 1. Berlin: Verlag von August Hirschwald. p. 83. Retrieved 14 November 2010.
- Hrdlicka, A (1939). "Trepanation among prehistoric people, especially in America". Ciba Foundation Symposium. 1 (6): 170–7.
- Matsuki, A (2005). "A brief history of the biographical study of Seishu Hanaoka". Nihon Ishigaku Zasshi (in Japanese). 51 (3): 355–84. PMID 16450478. Retrieved 14 November 2010.
- Matsuki, A (2006). "Why did Hanaoka's Method of Anesthesia Decay Rapidly at the End of the Edo Period?". Nihon Ishigaku Zasshi (in Japanese). 52 (1): 40–1. ISSN 0549-3323.
- Ruffer, MA (1918). "Studies in paleopathology. Some recent researches on prehistoric trephining". Journal of Pathology and Bacteriology. 22: 90–104. .
- Stewart, TD (1958). "Stone Age skull surgery. A general review with emphasis on the New World". Smithsonian Annual Report of the Board of Regents, 1957. pp. 469–91.
- Arashiro Toshiaki, Ryukyu-Okinawa Rekishi Jinbutsuden, Okinawajijishuppan, 2006 p66 ISBN 978-4-903042-04-6
- "Reevaluation of surgical achievements by Tokumei Takamine". Matsuki A. Masui. November 2000; 49(11):1285-9. Japanese.[full citation needed]
- "The secret anesthetic used in the repair of a hare-lip performed by Tokumei Takamine in Ryukyu". Matsuki A. Nippon Ishigaku Zasshi. October 1985 31(4):463-89. Japanese.
External links
- Wood Library-Museum of Anesthesiology The most comprehensive educational, scientific and archival resources in anesthesiology.
- "Chloroform: The molecular lifesaver" An article at University of Bristol providing interesting facts about chloroform.
- Australian & New Zealand College of Anaesthetists Monitoring Standard
- Royal College of Anaesthetists Patient Information page
- Turning the Pages: a virtual reconstruction of Hanaoka's Surgical Casebook, c. 1825. From the U.S. National Library of Medicine
- (in German) Die Geschichte der Anästhesie.
- "Anesthesia as a specialty: Past, present and future" Presentation by Prof. Janusz Andres.