History Of Anesthesia Research Articles

History of anaesthesia

Macintosh went to Spain at the request of the American plastic surgeon Eastman Sheehan, who had found himself unable to operate on patients with facial injuries due to the fact that the anaesthetic practitioner, a nun, insisted on keeping the mask tightly clamped to the patient’s face. Macintosh, who was forced to improvise, recalled in his diary: ‘When faced with anaesthetising for head and neck surgery in Spain, I was thankful I had seen Flagg’s demonstrations. I cannot think what I would have done without them. I settled for an empty tin of Lyle’s Golden Syrup – a strange find in the circumstances, and well it worked’.

History of anaesthesia

The direct application of volatile anaesthetic and the application of intense cold to traumatic injuries and surgical sites were important steps in 18th and 19th century anaesthesia. Local tissue temperature could be brought down by the application of ice and salt by the surgeon. Techniques used topical applications of chloroform, Dutch Oil, amyl hydrate, the vaporisation of nebulised ether, methylene and ethylene chloride applied by spray or fumigation and vaginal douche with carbonic acid gas. Mastering the projection of cold was extremely difficult. Keeping the aperture of the device used for the spraying of anaesthetic liquids clear of obstruction became a major challenge for instrument makers. To improve the precision of the jet, a different system of nozzles had to be invented. Nineteenth century medical practitioners were able to call on general anaesthesia, but some individuals and specific indications such as minor surgery called for an alternative approach. The introduction of cocaine in 1884 completely changed common practice.

Horace Wells’ “Humbug Affair” Occurred at Massachusetts General Hospital? Humbug!

ATTENTION: Any readers out there who have ever listened to historical lectures about Horace Wells’ nitrous oxide demonstration or about William Morton’s ether demonstration. Please page through this month’s issue of Anesthesiology for a fascinating article titled “Horace Wells’ Demonstration of Nitrous Oxide in Boston” by Rajesh P. Haridas, F.A.N.Z.C.A.1Many of us refer to October 16, 1846 as “Ether Day”—the day that dentist and medical student William T. G. Morton gave the first public demonstration of diethyl ether for surgical anesthesia. Some of us even recall that Morton tried to disguise his ether’s odor by adulterating it with essential oil of orange and by renaming his proprietary slurry “Letheon.” Convinced that Morton’s mixture had successfully anesthetized his patient on that fateful 16th of October, surgeon John Collins Warren announced to spectators in the surgical amphitheater that, “Gentlemen, this is no humbug.”2Most authorities assume that Dr. Warren’s choice of “humbug” was a reference to that less-than-successful attempt back in January of 1845 when dentist Horace Wells tried to demonstrate nitrous oxide anesthesia in front of some of Harvard’s medical students. Dr. Wells admitted later that he must have mistakenly “withdrawn much too soon” the bag of nitrous oxide gas from a medical student who needed anesthesia for a dental extraction. Because that patient “experienced some pain… several [spectators] expressed their opinion that it was a humbug affair….”3So how have so many historians and lecturers managed to “get it wrong”—to misinform the rest of us with the wrong location and/or the wrong date for Horace Wells’ demonstration of nitrous oxide anesthesia in Boston? Boldfaced below are examples of common mistakes made by well-intended authors of historical articles.Confirmation bias. Basic human nature encourages readers and researchers to look for facts that support their preconceived hypotheses. If Morton’s demonstration at Massachusetts General Hospital (MGH) was not a “Humbug Affair,” then why not also situate Wells’ earlier nitrous oxide event as a “Humbug Affair” … at MGH?Confusion of an event’s date with a publication date. As Dr. Haridas has suggested, after Wells’ January 20, 1845 advertisement (in the newspaper Boston Bee) was cited as a reference, some historians may have mistakenly begun accepting that date as when Horace Wells conducted his demonstration.1 Blithely assigning that same date to the “Humbug Affair,” subsequent publications were guilty of repetition of unchallenged nonprimary sources. This is the academic equivalent of social gossip.Fortunately, historical research is democratic. In other words, all of Anesthesiology’s readers can attempt to research and write about the history of anesthesia. However, not all of us can be as successful as author Rajesh Haridas. Does he work as an academic anesthesiologist in a sprawling American city? No—Dr. Haridas toils away as a private consultant anesthetist in a small town in Australia. Yet this brilliant historical researcher has garnered “winning” and “honorable mention” David M. Little Prizes in 2011 and 2012, respectively, from the Anesthesia History Association. Yes, historical research may be open to all, but few are as accomplished as Dr. Haridas. Please be sure to read his article on Horace Wells in this issue.1As for this reviewer, just one question remains. If an Australian is teaching me about America’s anesthesia history, should I now reciprocate by feverishly ferreting out historical details about the history of anesthesia “down under?”

Veterinary and Human Anaesthesia: An Overview of Some Parallels and Contrasts

The history of human and veterinary anaesthesia is both intertwined and parallel. Physicians and anaesthetists often first experimented on animals and developments from human anaesthesia have been incorporated into veterinary medicine. Within veterinary medicine, anaesthesia is a specialty discipline as it is in human medicine. Veterinary anaesthetists undertake additional training and rigorous examinations for a diploma or fellowship. In contrast to human anaesthesia in Australia and New Zealand, veterinary anaesthesia is often performed by non-specialists and by veterinary nurses. Veterinary anaesthesia uses many of the same drugs for premedication, induction and maintenance of anaesthesia as human anaesthesia. However, there are species specific effects of some of the drugs used that differ from the effects in humans. Furthermore, some agents, particularly alpha-2 adrenoreceptor agonists and ketamine, are used very widely in veterinary practice. Also in contrast to most human anaesthesia, in large animal and exotic animal practice the patients can present a physical danger to the anaesthetist. The most notable contrast between human and veterinary anaesthesia is in the reported perioperative complication and mortality rates, with a species dependent perianaesthetic mortality of up to 2% in dogs, cats and horses and greater than 2% in guinea pigs and birds, which is up to 100-fold higher than in human anaesthesia.

Local anaesthesia in small animals

Luis Campoy and Matt Edited by R. Read 304 pages, hardback, £79.99. Wiley-Blackwell. 2013. ISBN 978 0 8138 1994 5 ![Graphic][1] LOCAL anaesthesia is a neglected technique in small animal practice to the detriment of our patients, and this book has the potential to help practitioners use local anaesthesia in their patients more effectively. The book is logically divided into three sections: the first gives a brief history of local anaesthesia, followed by notes on patient preparation, neuroanatomy and relevant pharmacology; the second describes the equipment available for local anaesthesia, including nerve stimulators and ultrasound; and the final part gives details of the individual local … [1]: /embed/inline-graphic-1.gif

History of nerve block anesthesia

History of nerve block anesthesia

Training to be an historian of anesthesia: options at universities in the United States

Study ObjectiveTo determine whether a lack of training opportunities explains the finding that few anesthesia historians have obtained formal training in history. DesignProspective study. SettingUniversity hospital. MeasurementsA list of 128 medical schools within the United States (U.S.) was obtained from the Association of American Medical Colleges and information about graduate programs in history, history of science, and history of medicine was gathered. Editorial board members of journals affiliated with professional associations in history, history of science, and history of medicine were also queried. Main ResultsWe were unable to identify any U.S. institution that offered graduate training in history of anesthesia, while only a handful offered such training in history of medicine. As a result, individuals wishing to pursue doctoral training in history of medicine often enroll in programs devoted to history of science, but with an emphasis on medicine. The vast majority of affiliated universities offer doctoral programs in history. We identified programs that may be considered centers of excellence based on affiliations of editorial board members. ConclusionsGraduate training in history of anesthesia is currently unavailable, and specific opportunities in history of medicine are quite limited. Individuals wishing to obtain formal training in history of anesthesia need to enroll in a history of science or history of medicine program, and choose a research topic in history of anesthesia.

Preliminary evaluation of tear production in dogs hospitalized in an intensive care unit

To determine the tear production in dogs admitted to an intensive care unit (ICU). Prospective observational study from November 2010-September 2011. Private emergency and referral hospital. Thirty healthy control dogs and 30 dogs hospitalized in an ICU for treatment of systemic illness without previously diagnosed ophthalmic disorders and no recent history of anesthesia. Enrollment was based on availability of the ophthalmologist within 24 hours of admission to the ICU. Tear production was measured utilizing Schirmer tear test strips (STT) in healthy control animals as well as in hospitalized canine patients. All patients received an ophthalmic examination by a board-certified veterinary ophthalmologist within 24 hours of admission to the ICU. Lubrication with artificial tear gel every 2-4 hours as needed was implemented after STT was measured. Average tear productions in the control and canine ICU populations were 24.5 mm/min and 13.2 mm/min, respectively. This was found to be statistically significant (P < 0.001). Furthermore, there was a trend toward a decrease in tear production in patients with kidney disease and a trend toward normal tear production in patients with cardiac disease but the sample size was likely too small to enable detection of a statistically significant difference. This study demonstrates a decrease in tear production in canine ICU patients. While further study is warranted to determine how different diseases impact tear production, these finding support the implementation of frequent ocular lubrication in all ICU patients.

Thoughts on the Bulletin

In this issue of the Bulletin, Mulita and colleagues1 present a 10-year analysis of publication trends for articles about anesthesia history. They conclude that the publication of history articles is “low” at 1.25% of all articles. Even this frequency is inflated. Subtracting the “Cover Notes” of Anaesthesia and Intensive Care and the “Reflections” in Anesthesiology leaves a more indicative estimate of about 0.7%. To be sure, there are legitimate concerns about this article: the absence of factoring in the number of submissions; the lack of comparison to other specialties; and the role of authors’ perceptions of the ability to get published. But these concerns do not outweigh the need to discuss the conclusions. How legitimate is the value judgment that mainstream journals publish too few history articles? That depends on the mission. While missions of journals vary, the British Medical Journal provides a good summary: “Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. We aim to help doctors to make better decisions.”2 All the while, among other matters, editors must keep an eye on the influential impact factor, which reflects the number of citations of the journal’s articles. The American football coach Bill Parcells quipped, “You are what your record says you are,” in response to teams claiming that they were better than their won-lost records indicated. According to Parcells, the number of history articles published is the correct number of articles for those journals. I agree. The characteristics of published history articles reflect in large part the cachectic academic discipline of anesthesia history in the United States. Reversing this state requires a robust academic home. Without a home, young academics struggle to develop careers, senior academics do not receive proper credit within the anesthesiology community, and the anesthesia history community withers. Successful academic homes have meaningful journals. A respected Bulletin of Anesthesia History will provide a home for aspiring authors to hone their skills and gain academic credibility. It will spur interest in history, which will increase publications in mainstream journals. The right Bulletin will undergird a credible, self-sustaining academic discipline. The progenitor of the Bulletin, the Anesthesia History Association Newsletter, was started in 1982 by the first editor, Selma H. Calmes, MD. Dr. Calmes was followed by C. Ron Stephen, MD, and who later passed the pen to my immediate predecessor, Doris K. Cope, MD. These editors (with unflagging support from many others, including Roderick K. Calverley, MD, and A. J. Wright, MLS) brought the Bulletin from a “cut-and-paste” kitchen-table newsletter to being recognized within the history community as the United States journal for anesthesia history. The next step is to move that recognition into the mainstream academic community. To do so requires investments that are neither simple nor risk-free. So I am asking readers to weigh in. What should the Bulletin be? Whom should it serve? Most importantly, do we want to take that next step? I invite your thoughts.

An Interview with A.H. “Buddy” Giesecke Jr, MD

A. H. “Buddy” Giesecke Jr, MD, is an important figure in the history of the Department of Anesthesiology and Pain Management at the University Southwestern Medical Center and at Parkland Memorial Hospital in Dallas (Figure 1). He studied anesthesiology and later practiced there, where he worked closely with other renowned anesthesiologists, including M.T. “Pepper” Jenkins. Dr. Giesecke’s articles on endotracheal intubation in obstetrics and the interaction between succinylcholine and magnesium produced change in the practice of anesthesia. In his later years, he became interested in the history of anesthesia and was very active in the Anesthesia History Association. His passion for the specialty was evident in the way he spoke about anesthesia. Hear his words, and perhaps even his voice, in the interview below. school, I did my internship at William Beaumont Army Hospital in El Paso. I went into the army because the pay was better, and we were extremely poor. I went through medical school on $200 a month.

The Anesthesiology, Surgery and Cognition Professional Interest Area of the Alzheimer’s Association International Society to Advance Alzheimer’s Research and Treatment—Inaugural Satellite Symposium and Featured Research Session Report

The Anesthesiology, Surgery and Cognition Professional Interest Area of the Alzheimer’s Association International Society to Advance Alzheimer’s Research and Treatment—Inaugural Satellite Symposium and Featured Research Session Report

Medical History for Anesthesiologists: Continuation of a Primer

Editor’s note: The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai to provide a primer on the history of medicine and anesthesia history. The goals of this primer are to educate and to help individuals target future study. Below is the second article in a continuing series.

Publication Trends for Articles Related to the History of Anesthesia: A 10-year Analysis from Six Journals

Anesthesia historians believe they have difficulty in getting their work published in peer reviewed journals devoted to anesthesiology. To test the hypothesis of whether such publication bias exists, we conducted a review of all articles published in six journals. We examined all articles published between January 2001 and December 2010. In order to enable comparison among journals, articles were categorized as major or minor. We also examined whether there were trends in publication over this period. During this 10-year period, 30,600 articles were published in these journals (range, 2573 to 8563 articles). Of all articles published, only 382 (1.25%, range, 0.41% to 2.87%) were related to the history of anesthesia. The proportion of all articles related to history showed a significant difference with time (P<.001), primarily from differences in minor articles (P<.001). Analysis of the number of history-related articles published shows no obvious difference over the 10-year period (P=.25), but a significant difference among journals (P=.005). For major articles, there was a significant effect with time (P=.046) and journal (P<.001). Minor articles revealed no significant effect with time (P=.15), but significant differences among journals (P=.02). Our analysis of 30,600 articles published in six mainstream journals devoted to anesthesiology found that considerable differences exist in the proportion and number of articles that were related to history of anesthesia.

History of Anaesthesia VII

History of Anaesthesia VII

A reply

Sneyd misunderstands the intention of our opening paragraph 1, which simply sets the historical context. It is only in recent times that there has been a focus on disentangling amnesia from intra-operative unconsciousness in anaesthesia research, and even now the two often remain interchangeable as endpoints in anaesthesia practice. We are not convinced that all anaesthetists fully understand the significance of intra-operative response to command with post-operative amnesia. The isolated forearm technique (IFT) is not simply a footnote in the history of anaesthesia as Sneyd suggests, it remains the only reliable and direct means of determining and interrogating intra-operative mental state in the presence of neuromuscular blockade and this is accepted by the awareness research community as demonstrated by the regular invited keynote lectures on the IFT at international symposia on memory and awareness in anaesthesia from 1989 to the present. There have been 21 published articles on the topic in the last 12 years. The myths surrounding IFT have been addressed elsewhere 2 and the reader is directed to this detailed description. The fact that it is ‘not commercially available’ is one of its advantages; it does not require expensive equipment, it is perfectly practical and we have rarely encountered a clinical situation when it could not be applied in the presence of neuromuscular blockade. Neither is there any risk of forearm ischaemia: there have been no reported cases of injury to the forearm as a result of the IFT and limb tourniquets are used in some surgical techniques for as much as two hours without complications. In our classification we have been careful to employ ‘response to command’ (not IFT response) as an intra-operative criterion: whatever the controversies of the IFT, it is incontrovertible that in the absence of neuromuscular blockade, a motor response to command indicates consciousness. At no point do we suggest the IFT is the only means of meaningful depth of anaesthesia monitoring, as Sneyd suggests. However we would reiterate that it is the only direct means of assessing intra-operative cognitive state in the presence of neuromuscular blocking agents. Sneyd states that we don't know whether cognitive function without recall is harmful to patients or whether it is a ‘bad thing’ (for example resulting in impaired outcome or psychological damage). On the contrary, there is significant evidence of psychopathology following intra-operative consciousness with (explicit) amnesia in some patients 3, let alone the ethical issues, to which we refer in our editorial. Professor Sneyd's statement that “virtually all cases of awareness with recall can be abolished by application of 0.7 MAC of an inhalational anaesthetic agent” highlights the conflation of amnesia with intra-operative unconsciousness in everyday clinical anaesthesia – which nicely illustrates our point about the continuing influence of the binary approach in our opening paragraph. Our classification does not rely only on immediate and late postoperative state as Professor Sneyd suggests; there is clearly a column headed ‘intra-operative state’, which includes observations of clinical signs, movement and response to command. Phenomena at all three time points are used to classify intra-operative cognitive states and their outcome. Of course, it is true that there may be more than one postoperative outcome for the same intra-operative state due to individual factors, just as not everyone witnessing the same traumatic incident will go on to develop post-traumatic stress disorder. This does not undermine the validity of the classification. Dr Slater seems to have misunderstood our use of the term ‘hypnosis’ which was intended to refer to the goal of an intra-operative state of unconsciousness or oblivion, rather than the conscious psychological phenomenon to which he refers.

History of anaesthesia

History of anaesthesia

Spinal anesthesia for emergency cesarean section in a preeclampsia patient diagnosed with type 1 neurofibromatosis

Spinal anesthesia for emergency cesarean section in a preeclampsia patient diagnosed with type 1 neurofibromatosis

A philatelic history of anesthesiology

Thematic or topical philately deals with stamp collection based on a particular topic or theme. This article deals with a thematic depiction of the history of anesthesia from ancient to modern times using stamps, postal stationery and cancellations.

Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

Can Propofol Mimic Alcohol-related Pain in Patients with Hodgkin Lymphoma?

Alcohol-related pain was first reported in 1950 in association with Hodgkin lymphoma (HL).1Initially considered a highly predictive and specific symptom of HL, over the years however, it has also been seen in osseous diseases, pancreatitis, and malignancies of the thymus and pancreas.2We present the case of a patient who experienced a painful episode mimicking alcohol-related pain, in association with the anesthetic agent propofol.A 34-yr-old woman was scheduled for a diagnostic biopsy of an enlarged lymph node, possible right video-assisted thoracoscopic surgery, and biopsy of a mediastinal mass under general anesthesia. She had earlier presented with a 4-month history of episodic right shoulder discomfort with acute worsening after alcohol ingestion. A week before seeking medical help, she noticed a “lump” in her right shoulder, which on examination was provisionally diagnosed as an enlarged supraclavicular lymph node. Computed tomography scan of the chest revealed an anterior mediastinal mass. Of note, she had no history of anesthesia. On the day of surgery, general anesthesia was induced with the patient lying comfortably in a supine position on the operating table. Immediately after intravenous injection of the induction dose of propofol (150 mg), the patient complained of severe upper back pain on the right side (site of underlying disease) and became agitated and restless. Local extravasation of the induction agents was excluded by visual examination of the intravenous site. Because there was no significant change in vital signs and the patient remained hemodynamically stable, succinylcholine (100 mg) was administered intravenously and the airway was secured uneventfully. The procedure and remainder of the patient’s hospital course were uneventful. The histopathology report confirmed the diagnosis of HL (nodular sclerosis type). The peculiar set of circumstances, i.e ., severe pain in the upper back during intravenous administration of propofol, prompted us to review the literature regarding this particular symptom. Association of pain with alcohol ingestion is well known and has been reported in the past, particularly in the oncology literature.3–5Alcohol-related pain has been classically associated with HL. The reported incidence of this disorder is approximately 3%.6Women and those with nodular sclerosis subtype of HL are especially prone; the alcohol content of a liqueur-filled chocolate or even a sip of beer has been reported to trigger the pain.3,5,7The onset of pain is immediate; the patient descriptions of pain vary from “aching” to “stabbing,” and the intensity ranges from mild to unbearable, forcing some patients to give up alcohol entirely.5The exact mechanism is unknown, but it is hypothesized that a localized alcohol associated allergic response induces vasodilatation and swelling in the diseased tissue, activating nociceptive signals.5,8This may help explain the high correlation observed between the site of the pain and underlying disease.3Although it is difficult to establish an exact cause-and-effect relationship in our case, several features about our patient’s episode led us to speculate that her symptom was propofol associated. First, the patient’s pain was precipitated immediately after intravenous injection of propofol and in the absence of any other inciting factors, so this witnessed temporal relationship between the onset of pain and propofol infusion, and its location in the vicinity of her underlying disease lends credence to our assumption. The previous descriptions of alcohol-related syndrome have also been based on circumstantial evidence and establishment of a temporal association between alcohol consumption and pain.3–5Second, the vasodilatory effect of propofol could possibly have stimulated nociceptors by a similar mechanism. Finally, the patient’s sex, diagnosis of nodular sclerosis type of HL, and history of alcohol-related pain in the shoulder suggest that she may be susceptible to painful episodes of such nature.Despite the circumstances surrounding the patient’s episode and her suggestive history, in the absence of supportive literature, the reason for the cross-reactivity between alcohol and propofol (as manifested by a common symptom) is unknown. It would also be unfair to suggest that all patients with HL who experience alcohol-related pain will experience propofol-associated pain also. That said, it would be beneficial for anesthetists to be cognizant of this association.*Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. oshakil@bidmc.harvard.edu