Medical History for Anesthesiologists: Continuation of a Primer (original) (raw)
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Four Forgotten Giantsof Anesthesia History
The anesthesiology profession may one day serve as a cautionary tale of how power, politics and privilege can perturb science and progress. Previous anesthesia practitioners possessed a superior understanding of physiology and pharmacology, but overenthusiastic CO2 supplementation with inadequate monitors and machines caused asphyxiation disasters that were improperly attributed to CO2 toxicity. Dr. Ralph Waters founded the anesthesiology profession on the basis of a practical new anesthetic tech- nique that introduced elective intubation and hyperventilation to eliminate CO2 toxicity, but mechanical hyperventilation dangerously depletes CO2 tissue reserves and exag- gerates morbidity and mortality. The bene ts of CO2 supplementation were forgotten, and consequent CO2 confusion has derailed research, discouraged opioid treatment, damaged patient safety, and disrupted professional progress. Anesthesiologists can no longer claim to provide superior service, and hospital administrators are replacing them with nurses. Professional membership is in decline, and professional survival is in ques- tion. Modern machines have eliminated asphyxiation, and modern monitoring enables safe and bene cial hypercarbia that complements opioid treatment and minimizes sur- gical morbidity and mortality. CO2 reform promises revolutionary advance but faces formidable opposition.
Indian Journal of Clinical Anaesthesia (IJCA) publishes definitive, peer-reviewed articles devoted to the clinical practice of anaesthesia. IJCA publishes a wide range of articles in the discipline of anaesthesiology including basic science, translational medicine, education, and clinical research to create a platform for the authors to make their contribution towards the field without restrictions/barriers of subscription and language. IJCA addresses all aspects of anaesthesia practice, including anaesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anaesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. This Journal is an Open Access journal and aims to publish research articles, reviews, case studies, commentaries, short communications, and letters to the editor on various aspects of anaesthesiology and perioperative medicine and making them freely available worldwide.
A brief history of anaesthesia
2020
According to the definition of the International Association for the Study of Pain (IASP), pain is defined as: "Unpleasant subjective feeling and emotional experience associated with current or potential tissue damage of a particular localisation", which, as such, poses a challenge for epidemiological research to determine its frequency and prevalence. We have all heard the motto that surgery has experienced its unprecedented development on the wings of anaesthesia. This is most certainly the case, since it is precisely the pain that prevents any invasive procedure on the human body, hence the very elimination of pain has opened up the way for the application and development of surgery. For this reason, the skill and now the science of anaesthesia are epochal civilizational achievements, which is why it is worth remembering the attempts and successes of its application. The very beginning of mankind cannot be imagined without the humans facing some sort of pain. As long ag...
History of anesthesia for ambulatory surgery
Current Opinion in Anaesthesiology, 2012
Purpose of review Anesthesia for ambulatory surgery has come a long way since 1842 when James Venable underwent surgery for removal of a neck mass with Crawford W. Long administering ether and also being the surgeon. We examine major advances over the past century and a half. Recent findings The development of anesthesia as a medical specialty is perhaps the single most important improvement that has enabled advances in the surgical specialties. Moreover, improved equipment, monitoring, training, evaluation of patients, discovery of better anesthetic agents, pain control, and the evolution of perioperative care are the main reasons why ambulatory anesthesia remains so safe in modern times. The development of less invasive surgical techniques, economic factors, and patient preferences provided addition impetus to the popularity of ambulatory surgery. Summary Beyond the discovery in the mid-19th century that ether and nitrous oxide could be used to render patients unconscious during surgical procedures, subsequent developments in our specialty have added modestly, in a stepwise manner, to reduce mortality and morbidity associated with its use. These improvements have allowed us to safely meet the steadily increasing demand for ambulatory surgery.
The Evolution of the Anesthesiologist: Novel Perioperative Roles and Beyond
Anesthesiology Clinics, 2009
Delivery of the spectrum of anesthesia from sedation to general anesthesia for patients undergoing procedures outside of the operating room (OR) poses several problems not encountered in the OR. These include limited time to assess the patient and often no time to obtain consultations for medical conditions that may be outside of the usual purview of an anesthesiologist, such as initial management of infections, diabetic ketoacidosis or hyperosmotic hyperglycemic state, inadequately managed cardiovascular disease, and toxic ingestions. Anesthesiologists trained in critical care usually have more experience with the initial assessment and management of patients with such conditions. Some of these conditions, however, also draw on training in internal medicine that is usually not provided in the continuum of anesthesiology residencies or anesthesiology critical care fellowships. Consequently, it can be argued that because procedures performed outside of the OR are becoming more common, the curriculum for anesthesia residencies should be modified to provide more training in conditions typically assessed and managed by internists or medical subspecialists. Many anesthesiologists have written about expanding anesthesia into the perioperative arena, usually referring not only to increasing the role of anesthesiologists in the already established programs in pain management and critical care but also expanding into the relatively less formalized roles in the preoperative and postoperative assessment and in-hospital management of surgical patients. 1-9 One arena that has received relatively little attention is the increasing number and complexity of patients undergoing procedures outside of the OR who often have multiple medical problems,
A Clinician's Rationale for the Study of History of Medicine
Journal of Education in Perioperative Medicine, 2014
History of medicine does not receive the coverage it deserves in medical school curricula, or during graduate medical training, in part, because of its lack of impact on direct clinical care. This is particularly disturbing for the specialty of anesthesiology not only due to its colorful history, but also because ours is the only major medical discipline to have developed entirely in the United States. We examine four commonly cited reasons for the study of history in general, and comment on whether these lessons are applicable to medicine and anesthesiology. We provide compelling reasons why studying history is important to clinicians. Background: Humans are the only species to be aware of their past. Our future is largely unknown, and the present is fleeting. Thus, almost everything that is known with certainty falls within the realm of history. Thus one would expect society at large, and physicians and anesthesiologists in particular, to be history enthusiasts. As the facts suggest otherwise, one wonders whether history is regarded much like art, music, and fine cuisine-more adornment than an essential and integral part of education in any discipline, especially medicine.
The Anesthesia Records of Harvey Cushing and Ernest Codman
Anesthesia & Analgesia, 2018
I n America, the task of giving the patient a "whiff" of ether or chloroform during surgical procedures was often left to junior house officers, nurses, medical students, orderlies, or individuals with no medical training. Harvard medical students Harvey Cushing (1869-1939) and Ernest Amory Codman (1869-1940) were required to do their share of "anesthesia duty" in the mid-1890s. Death under anesthesia was not uncommon, and in some instances, the surgical procedure would be continued despite the patient's death to maximize the learning opportunity. 1 During one fateful operation, Cushing's patient died during anesthesia, an event that greatly affected him and even led him to question his career choice. 2,3 However, instead of succumbing to despair, he and fellow medical student Codman began keeping accurate records during anesthesia. Their motivation for this action is not known, although Cushing writes that he was instructed to do so by the chief of surgery. In the process, these 2 medical students made a lasting contribution to a medical specialty that had not yet been born. They kept anesthesia records for more than 100 surgical procedures, which are now the property of Massachusetts General Hospital (MGH) and are preserved at the Francis A. Countway Library. 4 Every anesthesia record in this collection was examined for this study, and never before have they been subjected to the detailed analysis we offer: their notes, comments, drugs administered, and vital signs recorded. There is no indication that other students or house officers continued to maintain anesthesia records after Cushing and Codman. Later in their distinguished careers, these physicians continued to make major contributions to the safety and improved outcomes of surgical procedures.
When East Meets West: History of Obstetric Anesthesia
2021
The practice of obstetric anesthesia in both the eastern and western parts of the world has evolved through time. The development of obstetric anesthesia in western medicine has been credited to Sir James Simpson in 1847 with the use of ether in childbirth. Ancient and traditional practice and the influence of the west contributed to the modern-day labor analgesia in the east. Methods of labor analgesia have changed to enhance the labor experience of parturients from a wide array of herbs and opiates to dural puncture neuraxial technique. This manuscript aims to put in perspective the history of obstetric anesthesia in both the western and eastern medicine, and how each has contributed to the other.