Introduction to Anesthesiology

SHERWIN F. REVIBES, M.D.

 History of Anesthesiology
• I. The Prehistory of Anesthesiology
– Celsius encouraged “pitilessness” as an essential
characteristic of a surgeon.

– Surgeons became injured to their patient’s agony.

– Prior to introduction of anesthesia with diethyl

ether, pain was an inevitable consequence of
surgery.
 History of Anesthesiology
– Agents used to achieve anesthesia:
• Mandragora, black nightshade, poppies, herbs, hypnosis,
ingestion of alcohol, ice and cold water

• Diethyl ether- therapeutic agent with only occasional use.

• Nitrous oxide- coined by Humphry Davy as the “laughing

gas”
-capable of destroying physical pain
-first prepared by Joseph Priestly in 1773 and called
dephlogisticated nitrous air (dephlogisticated- support
combustion)
 History of Anesthesiology
• Henry Hill Hickmann- 1st physician who
demonstrated in 1824 that inhalation of carbon
dioxide could produced an analgesia in animals.

• Gardner Q. Colton- dominant figure in the

eventual introduction of inhalational anesthesia
-designed an exhibit that included a
demonstration of the effects of nitrous oxide
inhalation.
 History of Anesthesiology
• II. Almost Discovery

– William E. Clarke-given the first ether anesthetic in

New York in 1842
-administered ether from a towel for dental extraction

– Crawford Williamsow Lone-administered ether for

surgical anesthesia on March 10, 1842 but remained
silent about his historic work

– Horace Wells- discovered the analgesic effect of

nitrous oxide
-attempted public demonstration at the Harvard Medical School
but judged a failure
 History of Anesthesiology
• III. William T.G. Morton and October 16, 1846

– October 16, 1846- viewed as the day “Anesthesia

was discovered”

– William Thomas Green Morton-one of the

founders of anesthesia
-use ether to produce anesthesia for excision of
neck mass
-successful public demonstration of ether anesthesia
at the amphitheater of Massachusetts General Hospital
 – Oliver Wendell Holmes- suggested the term
“Anesthesia”- state of temporary insensibility

• III. A “Blessing” to Obstetrics

• James Young Simpson- successful obstetrician of Scotland among

the first to use ether for the relief of pain in Obstetrics
-later encouraged the use of Chloroform

• IV. John Snow-first anesthesiologist and regarded as the “Father of

Anesthesiology”
-achieved fame as an Obstetric Anesthetist by relieving Queen
Victoria of her labor pains
-developed a face mask and introduced a chloroform inhaler

History of Anesthesiology
 History of Anesthesiology
• VI. 19th Century British Anesthesia After John
Snow

– Joseph Clover-became the leading anesthetist of

London after the death of John Snow
-first anesthetist to administer chloroform in known
concentrations and advocate palpating the patient’s pulse
during its administration

– Frederick Hewitt-superb and inventive clinician

-designed the first anesthetic apparatus to deliver oxygen and
N2O in variable proportions
-wrote the first true textbook of anesthesia entitled
“Anesthetics and their Administration”
 History of Anesthesiology
• VII. Discovery of Regional Anesthesia in the 19th
Century

– Cocaine-an extract of the coca leaf was the first

effective local anesthetic in 1856

– Carl Kollar-introduced cocaine as a topical anesthetic

for ophthalmic surgery in 1884

– Wiliam Halsted and Richard Hall-American surgeons

who described the use of cocaine in multiple sites and
to produce nerve blocks
 History of Anesthesiology
– Leonard Corning- a neurologist
-coined the term spinal anesthesia in 1885

– August Bier-introduced the first true spinal

anesthetic based on an understanding of
injections into the CSF in his classic experimental
studies in 1898
 History of Anesthesiology
• VIII. Spinal Anesthesia – into the 20th Century

– Heinrich Quinke-described a technique of lumbar

puncture for spinal anesthesia
-his technique was used for the first deliberate cocainization of
the spinal cord in 1899 by a surgical colleague, August Bier

– Heinrich Braun-introduced epinephrine to prolong the

action of local anesthetics with great success
-father of conduction anesthesia
-first person to use procaine
 History of Anesthesiology
• IX. Epidural Anesthesia

– Edward Tuohy- introduced Tuohy neddle to facilitate the use of

continuous spinal technique

– Caudal Anesthesia- introduced in 1901, used by Cathelin

– Lumbar and Thoracic Epidural anesthesia- described in 1921 by Fidel

Pages

– Achillo F. Dogliotti- perfected the loss of resistance method to identify

the epidural space
– Martinez Curbelo- used Tuohy’s needle and ureteral catheter to perform the
first continuous epidural anesthesia
 History of Anesthesiology
• X. The Quest for Safety in Anesthesiology

– Introduction of monitoring and advances in technology such as

machines capable of delivering calibrated amount of gas and
volatile anesthetics, CO2 absorbance, vaporizers, ventilators-
were critical to improve patient safety.

– George W. Crile and Harvey Cushing-advocated systemic blood

pressure monitoring during anesthesia

– Severinghaus-stated that pulse oximetry is arguably the most

important technological advance made in monitoring the well
being and safety of patients during anesthesia, recovery, and
critical care
 History of Anesthesiology
• XI. Tracheal Intubation in Anesthesia

– The development of techniques and instruments for

intubation ranks among the major advances in the
history of anesthesiology

– Joseph Clover- first Englishman who introduced the

practice of thrusting the patient’s jaw forward to
overcome obstruction of the upper airway by tongue

– William Macewan- undertaken the first use of

elective oral intubation for anesthesia
 History of Anesthesiology
– Joseph O’ Dwyer-remembered for his extraordinary
dedication to the advancement of tracheal intubation

– Albert Kirstein- devised the first direct vision

laryngoscope (1895)

– Robert Miller-introduced a slender, straight

laryngoscope blade (1941)

– Robert Macintosh- introduced a curved laryngoscope

blade (1943)
 History of Anesthesiology
– Ivan Magill- developed a wide bore tube that would
resist kinking but conformable to the contours of the
upper airway (Magill Tubes)

– Arthur Guedel- introduced cuffed tubes

– Emery Rovenstine- introduced double cuffed, single

lumen tube

– Frank Robertshaw- designed the currently most popular

double lumen tube in both right and left sided version.

– Archie Brain- 1st recognized the principle of Laryngeal

Mask Airway
 History of Anesthesiology
• XII. Fluorinated Anesthetics
– Fluorine-lightest and most reactive halogen, forms exceptionally
stable bonds

– Charles Suckling- chemist, synthesized Halothane which became

available in 1956

– Methoxyflurane-popular only in 1970 due to dose related

nephrotoxicity

– Enflurane-has convulsant properties

– Isoflurane- nearly abandoned

– Sevoflurane

– Desflurane-newest
 History of Anesthesiology
• XIII. Intravenous Anesthetics
– Intravenous chloroform and ether

– Intravenous Morphine and Scopolamine

– Barbital-first barbiturate

– Thiopental-synthesized in 1932
-its successful introduction into clinical practice was due
to John S. Lundy in 1934.
 History of Anesthesiology
• XIV. Muscle Relaxants
– Curare-the 1st known neuromuscular blocking
agent
-earliest clinical used in humans was to ameliorate the
tortuous muscle spasms of infectious tetanus
-first applied by Harold Griffith in anesthesia
– Succinylcholine-introduced as a depolarizing
muscle relaxant in 1949 by Hunt and Traveaux
– 1994- Rocuronium was introduced
 History of Anesthesiology
– Balanced anesthesia-introduced by John S. Lundy in
1926
-this emphasized the use of multiple drugs to produce
unconsciousness and anti nociception , provide
skeletal muscle relaxation, and obliterate reflex
responses
• XV. Evolution of Professional Anesthesiology
– Long Island Society of Anesthetists- America’s first
specialty anesthesia

– Francis Hoffer McMehan- editor of the first journal

devoted to anesthesia, current researches in
anesthesia and analgesia
 History of Anesthesiology
– Ralph M. Waters- first chair of an academic
anesthesia department at the University of
Wisconsin in 1927

– American Society of Anesthesiologists- reflected

physician training in contrast to non physician
technicians
Scope of Anesthesiology

SHERWIN F. REVIBES, M.D.

 Scope of Anesthesiology
• I. Introduction
– Beginning in 1842, anesthesiology has evolved
into a recognized medical specialty- affirmed by
the American Medical Association and the
American Board of Medical Specialties
-provides continuous improvement in patient care based
on the introduction of new drugs and techniques made
possible in large part by research in the basic and
clinical sciences
 Scope of Anesthesiology
• II. Scope
-extends beyond the operating room to include
preoperative evaluation clinics, respiratory therapy,
treatment of acute postoperative pain, management of
chronic pain problems, care of critically ill patients in
intensive care units, and administrative responsibilities
in daily management of the operating rooms.

-Anesthesiologists function as perioperative physicians

with patient care responsibilities during the
preoperative, intraoperative, and postoperative
periods.
 Scope of Anesthesiology
• III. Definition of Anesthesiology as a Field of Medicine
by ASA

– 1. field of medicine that specializes in the medical

management of patients who are rendered unconscious
and/or insensible to pain and emotional stress during
surgical, obstetric, and certain other medical procedures;
– 2. protection of life functions and vital organs (brain,
heart, lungs, kidneys, liver) under the stress of anesthetic,
surgical, and other medical procedures;
– 3. management of problems in pain relief;
– 4. management of cardiopulmonary resuscitation;
– 5. management of problems in pulmonary care; and
– 6. management of critically ill patients in special care units
 Scope of Anesthesiology
• IV. Anesthesiologist’s Responsibilities to
Patients
– 1. preanesthetic evaluation and treatment,
– 2. medical management of patients and their
anesthetic procedures,
– 3. postanesthetic evaluation and treatment, and
– 4. onsite medical direction of any nonphysician
who participates in the delivery of anesthesia care
to the patient.