Moving Boldly Forward: A History of Neuroanesthesia

Abstract

Today thousands of patients will undergo neurosurgery. The surgery often requires invasive and elaborate monitoring, complex anesthetic delivery devices, challenging airway manipulation, and detailed knowledge of neuroanatomy and physiology. Success in the operating room should inspire anesthesiologists to be appreciative that they have the tools, knowledge, and skills to routinely deliver safe care for the most challenging operations. We are indebted to the pioneers of neuroanesthesia. The oldest form of neurosurgery is trephining. Multiple holes, four or five centimeters in diameter, were cut or drilled into skull. Examples have been discovered all over Europe and parts of Africa and Asia, as well as North and South America. The holes were made by cutting, scraping, or boring with a sharp stone. The cavities were created to allow devils, spirits, or supernatural elements to escape, thereby facilitating the cure for convulsions, developmental delay, insanity, or infection. Hippocrates trephined to treat blindness and headaches. Researchers are unclear how or if anesthesia was employed. In Peru, coca leaves may have been chewed and spit into the wound to be used as a local anesthetic. Possibly pressure on the carotid artery was used to produce a state of unconsciousness. The Greek word for carotid artery means the “artery of sleep.” Significant advances in neurosurgery required safe and adequate anesthesia. Despite the use of narcotics, nitrous oxide, cannabis, alcohol, and herbs no reliable and potent anesthetic available was until 1842 when ether was first-employed by Dr. Crawford Long. Neurosurgery became recognized as a specialty towards the end of the nineteenth century. In 1884 Sir Rickman Godlee was the first surgeon to successfully remove a brain tumor. In 1886 Arthur Barker drained a brain abscess. By the turn of the century progress in neurosurgery was hastened by the discovery of antisepsis, functional anatomy of the central nervous system, and advanced diagnostic techniques. Shortly after the advent of aggressive brain surgery, it became apparent that in no other branch of surgery could inattentive anesthesia hinder the surgeon or jeopardize the patient more easily. The inherent challenges of anesthesia Continued on Page 16 “Ernst von Bergmann Performs a Brain Operation” painted by Franz Skarbina. Reproduced with kind permission of Bildarchiv Preussischur Kulturbesitz, Berlin, Germany.