A.J. Wright | University of Alabama at Birmingham (original) (raw)

Papers by A.J. Wright

Anesthesiology, 2000

To the Editor:-We read with interest the study by Gautier et al. 1 that compared bolus administra... more To the Editor:-We read with interest the study by Gautier et al. 1 that compared bolus administration of epidural bupivacaine 0.125% wt/vol and epidural ropivacaine 0.125% wt/vol in combination with 7.5 g sufentanil for labor analgesia in 90 patients. Given the relatively high concentrations used, it is not surprising that both groups experienced effective analgesia. After the third epidural injection, the ropivacaine group demonstrated significantly less motor block. Recognizing that the two initial study groups may not have received equipotent concentrations, an additional 40 patients were randomized to receive bupivacaine 0.125% wt/vol with 7.5 g sufentanil or bupivacaine 0.100% wt/vol with 7.5 g sufentanil. The authors are to be commended in attempting to adjust their methodology to consider possible potency differences. We assume the aim was to determine if ropivacaine 0.125% wt/vol appeared clinically similar to 0.100% wt/vol bupivacaine in combination with sufentanil. Bupivacaine concentrations of 0.125% wt/vol are at the top of the analgesic concentration-response curve, 2 and the addition of sufentanil results in significant reductions in bupivacaine requirements. 3 All four of the tested combinations are likely in the flat upper portion of the curve, where differences in analgesic potency are obscured. The authors concluded that patients in the 0.100% wt/vol bupivacainesufentanil group experienced inferior analgesia. This conclusion seems to be based on patient feedback elicited during the postpartum period and the greater number of epidural injections, because there was no significant difference in prospective visual analog pain scores. It should also be noted that this group was studied closer to the time of delivery, and because bupivacaine requirements increase with progression of labor, 4 this may account for the more frequent bolus doses. In addition, the authors state that "most clinical studies suggest that ropivacaine is approximately 20% less potent than bupivacaine" and reference our work. 5 In fact, our study demonstrated that ropivacaine was approximately 40% less potent than bupivacaine with a potency ratio of 0.6. Therefore, in the study by Gautier et al., the 0.125% wt/vol ropivacaine group would be approximately equipotent with a 0.075% wt/vol additional bupivacaine group. We fully agree with the authors that equipotent concentrations must be determined before making comparisons of local anesthetic side effects.

The importance of the printed word is being questioned with the advent of technological innovatio... more The importance of the printed word is being questioned with the advent of technological innovations, and in the age of electronics, reading is no longer confined to the printed page. Whether the book shall survive is being questioned as'" electronic surrogates appear and computer technology alters the publishing process. An entire product can be disseminated by electronic distribution. Theoretical and working models of the electronic book have been developed; they are represented in simple form by the hand-held electronic language dictionaries, and more sophisticated models are available. The ideal electronic book should embody the flexibility and portability of the printed book and even improve on these benefits. If the function and authority of print migrate to other media, a role may still remain for books as printed books permit greater stability and a preservation of textual authority. No matter how rosy the future of electronic information, the questions of textual authority and preservation remain. (Contains 108 references.) (SLD)

Middle East journal of anaesthesiology

Journal of Clinical Anesthesia, 1995

This paper describes how nitrous oxide inhalation survived in America through the work of Woodhou... more This paper describes how nitrous oxide inhalation survived in America through the work of Woodhouse and Wells. Traveling showmen like Samuel Colt and Gardner Quincy Colton demonstrated the gas' effects at popular lectures. Serious students found nitrous oxide included in chemistry texts and pharmacopoeias of the period. This combination of popular and serious approaches to nitrous oxide use may have made the medical community and the general public more receptive to ether inhalation for surgical anesthesia after Morton's October 1846 demonstration in Boston. Within one year of that demonstration, ether was administered in numerous countries to relieve surgical pain, a use envkioned by Davy for nitrous oxide but one he never attempted. Almost fiue decades passed after Day's original work before his vision of pain relief by gas inhalation crossed the Atlantic and surfaced in the United States.

Bulletin of anesthesia history, 2006

... Adolph H. Giesecke, MD Brief biographies of Doctors Robert Dodd, Robert Capps and Thomas K. B... more ... Adolph H. Giesecke, MD Brief biographies of Doctors Robert Dodd, Robert Capps and Thomas K. Burnap Rajesh P. Haridas, MD A Survery of Oropharyngeal Airways used in Anesthesiology ... C. Ronald Stephen Festive 90th Birthday Gala ...

… of anesthesia history, 2004

... Humberto Sainz Cabrera, MD Professor of Anesthesiology President of the Cuban Society of Anes... more ... Humberto Sainz Cabrera, MD Professor of Anesthesiology President of the Cuban Society of Anesthesiology and Reanimation Secretary of the Confederation ... Douglas R. Bacon, MD, MA The 1960s - The ASA Comes of Age Adolph H. Giesecke, MD Former Jenkins Professor of ...

Bulletin of anesthesia history, 2009

... Snadjr arrived at once and found Heydrich seated on the examining table, bare-chested, silent... more ... Snadjr arrived at once and found Heydrich seated on the examining table, bare-chested, silent and aloof ... At first he thought that the wound was limited to the chest wall and could be debrided ... taken to the radiology suite in a wheelchair but walked unassisted to the X-Ray machine ...

Anesthesiology, 2009

Anesthesiology spans various specialties, and innovation in the field is similarly broad. It is t... more Anesthesiology spans various specialties, and innovation in the field is similarly broad. It is therefore refreshing to find a compendium of pertinent topics under one cover in volume 24 of Recent Advances in Anesthesia and Intensive Care. As its title suggests, the series intends to offer updated reviews on a variety of topics. It reflects the expanding role of anesthesiologists in modern medicine, and it showcases their contributions to perioperative medicine, emergency care, safety, and drug and technology development. The text is a ready reference for anyone trying to understand what the specialty is about and how it might contribute to the future of medicine. As the editors point out, the topics are arranged to complement one another. They cover physiology, clinical specialty practice, comorbidities and outcomes, evolution of drugs and devices, new frontiers of care, and skills evaluation and training. The chapters, which are concise and can be read in one sitting, range from advances in vascular surgery to the new inotropic drug levosimendan, to critical care outreach (e.g., rapid or emergency response teams). For each topic, a review and synopsis of recent advances is prepared by an expert in the field. The experts are partisan, and their opinions affect the information presented, but chapters can still be balanced. As an example, chapter five nicely discusses contrasting views regarding anesthesia safety improvements in recent years. Other chapters present data with less controversy. The chapters on the evaluation of clinical performance, nontechnical skills and anesthesia, and simulators in anesthetic training are synopses of the most salient research efforts. The text should serve like-minded readers well. Although chapter topics complement one another, the chapter formats do not necessarily do the same. The focus varies from techniques in one case to prospective scoring systems in another. Tables and

ABSTRACT Between summer 1936 and spring 1939, more than 14,000 German military personnel particip... more ABSTRACT Between summer 1936 and spring 1939, more than 14,000 German military personnel participated in the Spanish Civil War, and were known as the Legion Condor. This group included thousands of Luftwaffe airmen and a medical battalion with a field hospital. Wounded were flown back to Germany aboard Ju 52 ambulance planes.The Legion's major medical contribution was the creation of a superb service of air evacuation to fly seriously injured soldiers over long distances at high altitude. This service was developed by the Luftwaffe's young and dynamic medical officers, who had a good knowledge of the U.S. literature on aviation medicine.

The German firm E. Merck released in 1928, an injectable mixture of scopolamine, oxycodone, and e... more The German firm E. Merck released in 1928, an injectable mixture of scopolamine, oxycodone, and ephedrine under the name SEE. This drug, renamed Scophedal in 1942 caused deep and prolonged analgesia, sedation, euphoria and amnesia without significant respiratory or circulatory depression. Used extensively by the German and Central European surgeons in the 1930s, Scophedal enjoyed immense popularity with the Wehrmacht's medical officers treating frontline mass casualties during World War II. The use of Scophedal declined after 1945, and its production was discontinued in 1987. Despite the clinical enthusiasm it raised, SEE was never critically investigated. This drug may deserve a rigorous re-evaluation.

Introduction Hidden behind Jacob Bigelow's imposing mausoleum at Mt. Auburn cemetery stands a sma... more Introduction Hidden behind Jacob Bigelow's imposing mausoleum at Mt. Auburn cemetery stands a small tablet engraved "William SB (1850-1926)." The humble marker covers the ashes of William Sturgis Bigelow, the only child of Henry J. Bigelow, and the last of the line (figure 1). William Bigelow gave up medicine after two years of surgery and only made minor contributions to anesthesia: his biography of his father pointed out the latter's decisive role in the adoption of ether in surgery, and as Harvard trustee he saw to it that ether anesthesia was used in all surgical operations and animal experiments. But his colorful life and his contributions to the arts deserve to be remembered. Early Years (1850-1871) William S. Bigelow, the only son of Henry J. and Susan Bigelow, was born on April 4, 1850, at 5 Chauncey Place, in the heart of old Boston. His mother was the eldest daughter of William Sturgis, a Salem captain who had amassed an enormous fortune in whaling and in the China trade. Susan Bigelow committed suicide when William was three, and doting aunts and grandmothers, all Mayflower descendants, raised him in the best upper class, or "Boston Brahmin" traditions. Like his father, William attended the Dixwell's Latin School. Two of his schoolmates were Henry Cabot Lodge, the future senator, and Frederick Cheever Shattuck, later Harvard physician and medical librarian. Both became lifelong friends. Bigelow ranked in the middle of his class 2 2 2 2 BULLETIN OF ANESTHESIA HISTORY BULLETIN OF ANESTHESIA HISTORY BULLETIN OF ANESTHESIA HISTORY BULLETIN OF ANESTHESIA HISTORY

Anesthesiology, 2000

To the Editor:-We read with interest the study by Gautier et al. 1 that compared bolus administra... more To the Editor:-We read with interest the study by Gautier et al. 1 that compared bolus administration of epidural bupivacaine 0.125% wt/vol and epidural ropivacaine 0.125% wt/vol in combination with 7.5 g sufentanil for labor analgesia in 90 patients. Given the relatively high concentrations used, it is not surprising that both groups experienced effective analgesia. After the third epidural injection, the ropivacaine group demonstrated significantly less motor block. Recognizing that the two initial study groups may not have received equipotent concentrations, an additional 40 patients were randomized to receive bupivacaine 0.125% wt/vol with 7.5 g sufentanil or bupivacaine 0.100% wt/vol with 7.5 g sufentanil. The authors are to be commended in attempting to adjust their methodology to consider possible potency differences. We assume the aim was to determine if ropivacaine 0.125% wt/vol appeared clinically similar to 0.100% wt/vol bupivacaine in combination with sufentanil. Bupivacaine concentrations of 0.125% wt/vol are at the top of the analgesic concentration-response curve, 2 and the addition of sufentanil results in significant reductions in bupivacaine requirements. 3 All four of the tested combinations are likely in the flat upper portion of the curve, where differences in analgesic potency are obscured. The authors concluded that patients in the 0.100% wt/vol bupivacainesufentanil group experienced inferior analgesia. This conclusion seems to be based on patient feedback elicited during the postpartum period and the greater number of epidural injections, because there was no significant difference in prospective visual analog pain scores. It should also be noted that this group was studied closer to the time of delivery, and because bupivacaine requirements increase with progression of labor, 4 this may account for the more frequent bolus doses. In addition, the authors state that "most clinical studies suggest that ropivacaine is approximately 20% less potent than bupivacaine" and reference our work. 5 In fact, our study demonstrated that ropivacaine was approximately 40% less potent than bupivacaine with a potency ratio of 0.6. Therefore, in the study by Gautier et al., the 0.125% wt/vol ropivacaine group would be approximately equipotent with a 0.075% wt/vol additional bupivacaine group. We fully agree with the authors that equipotent concentrations must be determined before making comparisons of local anesthetic side effects.

The importance of the printed word is being questioned with the advent of technological innovatio... more The importance of the printed word is being questioned with the advent of technological innovations, and in the age of electronics, reading is no longer confined to the printed page. Whether the book shall survive is being questioned as'" electronic surrogates appear and computer technology alters the publishing process. An entire product can be disseminated by electronic distribution. Theoretical and working models of the electronic book have been developed; they are represented in simple form by the hand-held electronic language dictionaries, and more sophisticated models are available. The ideal electronic book should embody the flexibility and portability of the printed book and even improve on these benefits. If the function and authority of print migrate to other media, a role may still remain for books as printed books permit greater stability and a preservation of textual authority. No matter how rosy the future of electronic information, the questions of textual authority and preservation remain. (Contains 108 references.) (SLD)

Middle East journal of anaesthesiology

Journal of Clinical Anesthesia, 1995

This paper describes how nitrous oxide inhalation survived in America through the work of Woodhou... more This paper describes how nitrous oxide inhalation survived in America through the work of Woodhouse and Wells. Traveling showmen like Samuel Colt and Gardner Quincy Colton demonstrated the gas' effects at popular lectures. Serious students found nitrous oxide included in chemistry texts and pharmacopoeias of the period. This combination of popular and serious approaches to nitrous oxide use may have made the medical community and the general public more receptive to ether inhalation for surgical anesthesia after Morton's October 1846 demonstration in Boston. Within one year of that demonstration, ether was administered in numerous countries to relieve surgical pain, a use envkioned by Davy for nitrous oxide but one he never attempted. Almost fiue decades passed after Day's original work before his vision of pain relief by gas inhalation crossed the Atlantic and surfaced in the United States.

Bulletin of anesthesia history, 2006

... Adolph H. Giesecke, MD Brief biographies of Doctors Robert Dodd, Robert Capps and Thomas K. B... more ... Adolph H. Giesecke, MD Brief biographies of Doctors Robert Dodd, Robert Capps and Thomas K. Burnap Rajesh P. Haridas, MD A Survery of Oropharyngeal Airways used in Anesthesiology ... C. Ronald Stephen Festive 90th Birthday Gala ...

… of anesthesia history, 2004

... Humberto Sainz Cabrera, MD Professor of Anesthesiology President of the Cuban Society of Anes... more ... Humberto Sainz Cabrera, MD Professor of Anesthesiology President of the Cuban Society of Anesthesiology and Reanimation Secretary of the Confederation ... Douglas R. Bacon, MD, MA The 1960s - The ASA Comes of Age Adolph H. Giesecke, MD Former Jenkins Professor of ...

Bulletin of anesthesia history, 2009

... Snadjr arrived at once and found Heydrich seated on the examining table, bare-chested, silent... more ... Snadjr arrived at once and found Heydrich seated on the examining table, bare-chested, silent and aloof ... At first he thought that the wound was limited to the chest wall and could be debrided ... taken to the radiology suite in a wheelchair but walked unassisted to the X-Ray machine ...

Anesthesiology, 2009

Anesthesiology spans various specialties, and innovation in the field is similarly broad. It is t... more Anesthesiology spans various specialties, and innovation in the field is similarly broad. It is therefore refreshing to find a compendium of pertinent topics under one cover in volume 24 of Recent Advances in Anesthesia and Intensive Care. As its title suggests, the series intends to offer updated reviews on a variety of topics. It reflects the expanding role of anesthesiologists in modern medicine, and it showcases their contributions to perioperative medicine, emergency care, safety, and drug and technology development. The text is a ready reference for anyone trying to understand what the specialty is about and how it might contribute to the future of medicine. As the editors point out, the topics are arranged to complement one another. They cover physiology, clinical specialty practice, comorbidities and outcomes, evolution of drugs and devices, new frontiers of care, and skills evaluation and training. The chapters, which are concise and can be read in one sitting, range from advances in vascular surgery to the new inotropic drug levosimendan, to critical care outreach (e.g., rapid or emergency response teams). For each topic, a review and synopsis of recent advances is prepared by an expert in the field. The experts are partisan, and their opinions affect the information presented, but chapters can still be balanced. As an example, chapter five nicely discusses contrasting views regarding anesthesia safety improvements in recent years. Other chapters present data with less controversy. The chapters on the evaluation of clinical performance, nontechnical skills and anesthesia, and simulators in anesthetic training are synopses of the most salient research efforts. The text should serve like-minded readers well. Although chapter topics complement one another, the chapter formats do not necessarily do the same. The focus varies from techniques in one case to prospective scoring systems in another. Tables and

ABSTRACT Between summer 1936 and spring 1939, more than 14,000 German military personnel particip... more ABSTRACT Between summer 1936 and spring 1939, more than 14,000 German military personnel participated in the Spanish Civil War, and were known as the Legion Condor. This group included thousands of Luftwaffe airmen and a medical battalion with a field hospital. Wounded were flown back to Germany aboard Ju 52 ambulance planes.The Legion's major medical contribution was the creation of a superb service of air evacuation to fly seriously injured soldiers over long distances at high altitude. This service was developed by the Luftwaffe's young and dynamic medical officers, who had a good knowledge of the U.S. literature on aviation medicine.

The German firm E. Merck released in 1928, an injectable mixture of scopolamine, oxycodone, and e... more The German firm E. Merck released in 1928, an injectable mixture of scopolamine, oxycodone, and ephedrine under the name SEE. This drug, renamed Scophedal in 1942 caused deep and prolonged analgesia, sedation, euphoria and amnesia without significant respiratory or circulatory depression. Used extensively by the German and Central European surgeons in the 1930s, Scophedal enjoyed immense popularity with the Wehrmacht's medical officers treating frontline mass casualties during World War II. The use of Scophedal declined after 1945, and its production was discontinued in 1987. Despite the clinical enthusiasm it raised, SEE was never critically investigated. This drug may deserve a rigorous re-evaluation.

Introduction Hidden behind Jacob Bigelow's imposing mausoleum at Mt. Auburn cemetery stands a sma... more Introduction Hidden behind Jacob Bigelow's imposing mausoleum at Mt. Auburn cemetery stands a small tablet engraved "William SB (1850-1926)." The humble marker covers the ashes of William Sturgis Bigelow, the only child of Henry J. Bigelow, and the last of the line (figure 1). William Bigelow gave up medicine after two years of surgery and only made minor contributions to anesthesia: his biography of his father pointed out the latter's decisive role in the adoption of ether in surgery, and as Harvard trustee he saw to it that ether anesthesia was used in all surgical operations and animal experiments. But his colorful life and his contributions to the arts deserve to be remembered. Early Years (1850-1871) William S. Bigelow, the only son of Henry J. and Susan Bigelow, was born on April 4, 1850, at 5 Chauncey Place, in the heart of old Boston. His mother was the eldest daughter of William Sturgis, a Salem captain who had amassed an enormous fortune in whaling and in the China trade. Susan Bigelow committed suicide when William was three, and doting aunts and grandmothers, all Mayflower descendants, raised him in the best upper class, or "Boston Brahmin" traditions. Like his father, William attended the Dixwell's Latin School. Two of his schoolmates were Henry Cabot Lodge, the future senator, and Frederick Cheever Shattuck, later Harvard physician and medical librarian. Both became lifelong friends. Bigelow ranked in the middle of his class 2 2 2 2 BULLETIN OF ANESTHESIA HISTORY BULLETIN OF ANESTHESIA HISTORY BULLETIN OF ANESTHESIA HISTORY BULLETIN OF ANESTHESIA HISTORY