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Anesthetics through history lymphocyte | Description &
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Alan William Cuthbert | See All Contributors Human sensory reception
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Alternative Title: anaesthetic

Anesthetic, also spelled anaesthetic, any agent that produces a

local or general loss of sensation, including pain. Anesthetics
achieve this effect by acting on the brain or peripheral nervous
system to suppress responses to sensory stimulation. The
unresponsive state thus induced is known as anesthesia. General
anesthesia involves loss of consciousness, usually for the purpose of
relieving the pain of surgery. Local anesthesia involves loss of
sensation in one area of the body by the blockage of conduction in
nerves.

Anesthetic
QUICK FACTS

 KEY PEOPLE
Gardner Quincy Colton
William Thomas Green Morton
Horace Wells
Crawford Williamson Long
Walter Channing
Hua Tuo
Charles Thomas Jackson
Some anesthetics are administered via intravenous drip. Sir James Young Simpson, 1st
Baronet
Image: © Lim Yong Hian/Shutterstock.com
Carl Koller

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RELATED TOPICS
Drug
Ketamine
Anesthesiology
Cocaine
Anesthesia
Propofol
Chloroform
Cyclopropane
Procaine hydrochloride
Lidocaine

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General Anesthetics

General anesthetics induce anesthesia throughout the body and can

be administered either by inhalation or by direct injection into the
bloodstream. The relationship between the amount of general
anesthetic administered and the depression of the brain’s sensory
responsiveness is arbitrarily, but usefully, divided into four stages.
Stage I is the loss of consciousness, with modest muscular
relaxation, and is suitable for short, minor procedures. Additional
anesthetic induces stage II, in which increased excitability and
involuntary activity make surgery impossible; rapid passage
through stage II is generally sought by physicians. Full surgical
anesthesia is achieved in stage III, which is further subdivided on
the basis of the depth and rhythm of spontaneous respiration, pupil
reflexes, and spontaneous eye movements. Stage IV anesthesia is
indicated by the loss of spontaneous respiration and the imminent
collapse of cardiovascular control.

Not infrequently, general anesthetics are combined with drugs that

block neuromuscular impulse transmission. These additional drugs
are given to relax muscles in order to make surgical manipulations
easier. Under these conditions, artificial respiration may be
required to maintain proper levels of oxygen and carbon dioxide in
the blood. The ideal anesthetic agent allows rapid and pleasant
induction (the process that brings about anesthesia), close control
of the level of anesthesia and rapid reversibility, good muscle
relaxation, and few toxic or adverse effects. Some anesthetics have
been rejected for therapeutic use because they form explosive
mixtures with air, because of their excessive irritant action on the
cells that line the major bronchioles of the lung, or because of their
adverse effects on the liver or other organ systems.

Inhalational anesthetics are administered in combination with

oxygen, and most are excreted by the lungs with little or no
metabolism by the body. Except for the naturally occurring gas
nitrous oxide (laughing gas), all the major inhalational anesthetics
are hydrocarbons, compounds formed of carbon and hydrogen
atoms. Each carbon has the potential to bind four hydrogen atoms.
The potency of a given series of hydrocarbons depends on the
nature of the bonds between the carbons and the degree to which
the hydrogen atoms have been replaced with halogens. In the
ethers, the carbon atoms are connected through a single oxygen, as
in diethyl ether, and halogen substitution increases potency, as is
seen in enflurane and methoxyflurane. A peculiar, unpredictable,
and serious adverse property of halogen anesthetics and muscle
relaxants is their ability to trigger a hypermetabolic reaction in the
skeletal muscles of certain susceptible individuals. This potentially
fatal response, called malignant hyperthermia, produces a very
rapid rise in body temperature, oxygen utilization, and carbon
dioxide production.

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Rapid, safe, and well-controlled anesthesia can be obtained by the

intravenous administration of depressants of the central nervous
system, such as the barbiturates (e.g., thiopental), the
benzodiazepines (e.g., midazolam), or other drugs such as propofol,
ketamine, and etomidate. These systemic anesthetics result in a
rapid onset of anesthesia after a single dose, because of their high
solubility in lipids and their relatively high perfusion rate in the
brain. The intravenous anesthetics are frequently used for induction
of anesthesia and are followed by an inhalational agent for
maintenance of the anesthetic state. Unconsciousness occurs
smoothly within 10 or 15 seconds of starting the injection.
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Certain drugs that are used to induce general anesthesia can also be
used to produce a state known as conscious sedation (also called
procedural sedation). This semiconscious or drowsy state can be
induced when the drugs are administered in relatively small doses.
Conscious sedation typically is used for outpatient diagnostic or
minor surgical procedures, such as dental procedures, laceration
repair, or endoscopy. Examples of drugs used for procedural
sedation include fast, short-acting agents, such as ketamine,
propofol, and midazolam. These agents may be combined with an
opioid analgesic (pain reliever), such as fentanyl.

Local Anesthetics

Local anesthetics provide restricted anesthesia because they are

administered to the peripheral sensory nerves innervating a region,
usually by injection. Thus, local anesthetics are useful in minor
surgical procedures, such as the extraction of teeth. The first known
and generally used local anesthetic was cocaine, an alkaloid (a
naturally occurring organic nitrogen-containing compound)
extracted from coca leaves obtained from various species of
Erythroxylum.

The feeling of pain depends upon the transmission of information

from a traumatized region to higher centres in the brain. The
information is passed along fine nerve (sensory) fibres from the
peripheral areas of the body to the spinal cord and then to the
brain. Local anesthetics cause a temporary blocking of conduction
along these nerve fibres, producing a temporary loss of pain
sensation.

Local anesthetics can block conduction of nerve impulses along all

types of nerve fibres, including motor nerve fibres that carry
impulses from the brain to the periphery. It is a common experience
with normal dosages of an anesthetic, however, that, while pain
sensation may be lost, motor function is not impaired. For example,
use of a local anesthetic in a dental procedure does not prevent
movement of the jaw. The selective ability of local anesthetics to
block conduction depends on the diameter of the nerve fibres and
the length of the fibre that must be affected to block conduction. In
general, thinner fibres are blocked first, and conduction can be
blocked when only a short length of fibre is inactivated.
Fortunately, the fibres conveying the sensation of dull aching pain
are among the thinnest and the most susceptible to local
anesthetics. If large amounts of local anesthetic are used, pain is the
first sensation to disappear, followed by sensations of cold, warmth,
touch, and deep pressure.

Many synthetic local anesthetics are available, such as procaine

(trade name Novocain), lidocaine, and tetracaine. It is the
convention to end the names of local anesthetics with -caine, after
cocaine. In general, they are secondary or tertiary amines linked to
aromatic groups by an ester or amide linkage. The hydrophobic
nature of the molecules makes it possible for them to penetrate the
fatty membrane of the nerve fibres and exert their effects from the
inside. When an impulse passes along a nerve, there are transient
changes in the properties of the membrane that allow small
electrical currents to flow. These currents are carried by sodium
ions. The influx of these sodium ions through small channels (ion
channels) that open briefly in the surface of the nerve membrane
during excitation transports the impulse. Local anesthetics block
these channels from the inside, preventing the movement of the
sodium ions and small electrical currents. The action of a local
anesthetic is terminated as the agent is dispersed, metabolized, and
excreted by the body. Its dispersal from the injection site depends,
in part, on the blood flow through the region. In some cases
epinephrine is added to the local anesthetic solution to cause local
vasoconstriction (narrowing of blood vessels) and to prolong the
action of the local anesthetic.

procaine; Novocain
The chemical structure of procaine (Novocain), a local anesthetic.

Local anesthetics are used to induce limited areas of anesthesia.

The limited area is achieved largely by the site and method of
administration and partly by the physiochemical properties of the
drug molecules. The drug may be injected subcutaneously around
sensory nerve endings, enabling minor procedures such as repair of
skin laceration. This is called infiltration anesthesia. Some local
anesthetics are applied directly to mucous membranes, such as
those of the nose, throat, larynx, and urethra or those of the
conjunctiva of the eye. This is called surface or topical anesthesia. A
familiar example of topical anesthesia is the use of certain local
anesthetics in throat lozenges to relieve the pain of a sore throat.
Local anesthetics may be injected near a main nerve trunk in a limb
to produce what is called regional nerve block anesthesia. In this
situation, conduction in both motor and sensory fibres is blocked,
enabling procedures to be carried out on a limb while the patient
remains conscious. A special form of regional nerve block may be
achieved by injecting a local anesthetic into the spinal canal, either
into the space between the two membranes (the durae) that
surround the cord (epidural anesthesia) or into the cerebrospinal
fluid (spinal or intrathecal anesthesia). In spinal anesthesia, the
specific gravity of the local anesthetic solution is appropriately
adjusted, and the patient is positioned in such a way that the
anesthesia is confined to a particular region of the spinal cord. In
both epidural and spinal anesthesias, the anesthetic blocks
conduction in nerves entering and leaving the cord at the desired
level.

Anesthetics Through History

Drugs of various kinds have been used for many centuries to reduce
the distress of surgical operations. Homer wrote of nepenthe, which
was probably cannabis or opium. Arabian physicians used opium
and henbane. Centuries later, powerful rum was administered
freely to British sailors before emergency amputations were carried
out on board ship in the aftermath of battle.

SIMILAR TOPICS
 · Analgesic
· Antihistamine
· Anticancer drug
· Narcotic
· Sedative-hypnotic drug
· Tranquilizer
· Immunosuppressant
Sir Humphry Davy
Sir Humphry Davy, detail of an oil painting after Sir Thomas Lawrence; in the National · Stimulant
Portrait Gallery, London.
· Generic drug
Image: Courtesy of the National Portrait Gallery, London
· Decongestant

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In 1799 Sir Humphry Davy, British chemist and inventor, tried

inhaling nitrous oxide and discovered its anesthetic properties, but
the implications of his findings for surgery were ignored. By the
early 1840s parties had become fashionable in Britain and the
United States at which nitrous oxide, contained in bladders, was
passed around and inhaled for its soporific effect. It was soon found
that ether, which could be carried much more conveniently in small
bottles, was equally potent. In the United States several young
dentists and doctors experimented independently with the use of
nitrous oxide or ether to dull the pain of tooth extractions and other
minor operations. In 1845 American dentist Horace Wells
attempted to publicly demonstrate the use of nitrous oxide
anesthesia for dental extractions. Unfortunately, the demonstration
was deemed unsuccessful, as the patient cried out during the
procedure.

Horace Wells
Horace Wells, detail of an engraving.
Image: Boyer/H. Roger-Viollet

Historians argue about who should be credited with the first use of
true surgical anesthesia, but it fell to William Morton, an American
dentist, to convince the medical world that general anesthesia was a
practical proposition. He administered ether to a patient having a
neck tumour removed at the Massachusetts General Hospital in
Boston in October 1846. American surgeon Crawford Long had
used ether in his practice since 1842 but did not make his findings
public until 1849.

William Thomas Green Morton administering ether anesthesia

William Thomas Green Morton administering ether anesthesia during the first successful
public demonstration of its use during surgery, undated engraving.
Image: Science History Images/Alamy

A few weeks after Morton’s demonstration, ether was used during a

leg amputation performed by Robert Liston at University College
Hospital in London. In Britain, official royal sanction was given to
anesthetics by Queen Victoria, who accepted chloroform from her
physician, John Snow, when giving birth to her eighth child, Prince
Leopold, in 1853.

Early anesthetics had unpleasant side effects (often causing

vomiting on recovery) and were somewhat hazardous, since the
dose needed to produce unconsciousness and full muscle relaxation
(so that the surgeon could work unimpeded) was not far short of
that which would paralyze the breathing centre of the brain. In
addition, the early anesthetics were administered by simple devices
consisting of glass or metal containers for sponges soaked in ether
or chloroform (which was introduced as an anesthetic in 1847) and
allowed no control of dosage.
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Modern inhalation anesthetics such as trichloroethylene and

halothane have a much wider safety margin and are administered,
mixed with oxygen and nitrous oxide, from an anesthetic machine.
The anesthetist can control the flow and composition of the gas
mixture precisely and, using a tube placed down the trachea
(windpipe) after the patient is unconscious, can, if necessary,
maintain respiration by mechanical means. Delivering the gas
mixture to the lungs through a close-fitting endotracheal tube also
prevents accidental inhalation of mucus, saliva, and vomit. With
respiration artificially maintained, it is possible to paralyze the
muscles with drugs like curare, a neuromuscular blocking agent, so
that procedures requiring full muscle relaxation, such as chest and
abdominal surgery, can be carried out under light anesthesia.

The local anesthetic cocaine was used for anesthetizing the cornea
during eye operations in 1884 by Viennese surgeon Carl Koller,
acting on the suggestion of Austrian psychoanalyst Sigmund Freud.
A solution of the drug was applied directly to the part to be
operated on. Soon it was being injected under the skin to facilitate
small local operations, and it was later successfully used for larger
procedures, such as dental procedures, by injecting it into the
trunks of nerves supplying a part. Synthetic cocaine substitutes
were later widely used.

Uncover the science of traditional Chinese medicine and the use of

acupuncture instead of anesthetic during surgery
Discussion of traditional Chinese medicine, with a focus on the use of acupuncture as an
anesthetic during surgery.
Image: Contunico © ZDF Enterprises GmbH, Mainz

See all videos for this article

In the 20th and 21st centuries, the claimed anesthetic effects of

acupuncture, a technique used in traditional Chinese medicine,
gained interest among practitioners of Western (conventional)
medicine. As applied in Western medicine, apparently painless
major operations are carried out after the insertion of acupuncture
needles into specified points on the skin. Often an electric current is
passed through the needle used. The results of some research into
the efficacy of acupuncture have suggested that the stimulation of
the peripheral nerves by the needles triggers the release of
endorphins, a group of neurochemicals that have painkilling effects.

Floyd E. Bloom

Alan William Cuthbert

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