Deliberate total spinal anesthesia: proponents and techniques (1901–1948)

Abstract

The first and subsequent spinal anesthesias were for operations on the lower extremity. Within 2 years, Tuffier used spinal to operate on the abdomen and kidney. Other surgeons began to explore the possibility of using deliberate total spinal anesthesia. In 1901, Morton described the use of spinal anesthesia for operations on all regions of the body. Le Filliâtre in 1901, Chaput in 1907, Jonnesco in 1908 and Koster in 1928 also used high levels of analgesia in what was called general spinal anesthesia. This was meant as distinctive from general inhalation anesthesia. It is remarkable that large series of operations on the thorax, neck and head were performed with deliberate total spinal anesthesia. After 1930, with admonition from Forgue and Basset, the use of total spinal anesthesia declined. They stated that the safety of spinal anesthesia resided in lower levels and suggested no total spinal, not even a high spinal, should be administered. The first anesthesiologists who used total spinal anesthesia for purposes of deliberate hypotension and decreased blood loss were Griffith and Gillies.