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Anesthesia 1

This document provides a historical overview of anesthesia as a specialty from ancient times to present day. [1] Initial attempts at surgical anesthesia used plants like the mandrake in ancient times. [2] Important developments included the first documented use of ether as an anesthetic in 1842 and the discovery of chloroform's anesthetic properties in 1847. [3] The history of anesthetic agents includes ether, chloroform, and nitrous oxide, and the role of the anesthesiologist has evolved from inducing unconsciousness to maintaining physiological stability throughout surgery.

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95 views

Anesthesia 1

This document provides a historical overview of anesthesia as a specialty from ancient times to present day. [1] Initial attempts at surgical anesthesia used plants like the mandrake in ancient times. [2] Important developments included the first documented use of ether as an anesthetic in 1842 and the discovery of chloroform's anesthetic properties in 1847. [3] The history of anesthetic agents includes ether, chloroform, and nitrous oxide, and the role of the anesthesiologist has evolved from inducing unconsciousness to maintaining physiological stability throughout surgery.

Uploaded by

Mah Shawd
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Anesthesia as a specialty:

past, present and future

Teimouraz Vassilidze MD, PhD, DSc

Professor of Cardiovascular Surgery and Anesthesiology


Initial attempts at surgical anesthesia began many centuries ago, with the
plants of antiquity. The mandragora, or mandrake, was used as a sedative
and to induce pain relief for surgical procedures. It has been depicted in
tablets. The Romans used the mandrake for surgery. The Arabs translated
the scientific work of the ancients and expanded on their knowledge.
They developed the Spongia Somnifera, which contained the juice of the
mandrake plant. After the fall of the Islamic cities of Europe to the
Christians, scientific work was translated into Latin and the Spongia
Somnifera was used in Europe until the discovery of the use of ether for
surgical anesthesia.
• Blow to the Head-Dominique Lorey, Napoleonic Sx 1807

• Carotid-neck obstruction

• Physical Pressure-tourniquet to constrict nerves, blood


flow, before amputation
History of inhalational anesthetics

• Ether (diethyl ether)

-Originally prepared by Valerius Cordus in 1540

-Used as an anesthetic agent in humans in 1842, but was not

publicized until 1846

• Chloroform

-First used in 1847 in clinical practice by a Scottish obstetrician

• Nitrous oxide

-First produced in 1772

-Used as an anesthetic in humans in 1844

-Still commonly used in practice today


Before its development as a surgical anesthetic, ether was used

throughout the history of medicine, including as a treatment for

ailments such as scurvy or pulmonary inflammation. A pleasant-

smelling, colorless and highly flammable liquid, ether can be

vaporized into a gas that numbs pain but leaves patients


conscious.

In 1842, Georgia physician Crawford Williamson Long became


the first doctor to use ether as a general anesthetic during
surgery, when he used it to remove a tumor from the neck of his
patient James M. Venable
In 1847 , the same year he was appointed physician to Queen Victoria while she
was visiting in Scotland, Simpson discovered the anesthetic properties of
chloroform. Together with two of his friends, Drs Keith and Duncan, Simpson used
to sit every evening in his dining room to try new chemicals to see if they had any
anesthetic effect. On 4 November 1847 they decided to try a ponderous material
named chloroform that they had previously ignored. On inhaling the chemical they
found that a general mood of cheer and humor had set in. But suddenly all of them
collapsed only to regain consciousness the next morning. Simpson knew, as soon
as he woke up, that he had found something that could be used as an anesthetic. It
was very much by chance that Simpson survived the chloroform dosage he
administered to himself. If he had inhaled too much and died, chloroform would
have been seen as a dangerous substance , which in fact it is.
Sleep allows us to reconstitute, to form memories, to help
consolidate memories that we formed during the day and it
helps us to learn. It is very important for reconstituting our
immune system so we can ght off infections. So that's a
physiologic condition.
Anesthesia is different and is a coma.It is a drug-induced
reversible coma that has four components:
unconsciousness , analgesia, akinesia and amnesia.
Anesthesiologist keeps patient physiologically stable.
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Pre-operative assessment of the patient Immediately before
surgery or days to weeks before surgery

• this can be immediately before surgery if patient is healthy and


surgical procedure is low risk
• surgery will be canceled at this point if the anesthesiologist is
dissatis ed that the patient is safely prepared for surgery
• in many hospitals, patients are seen days to weeks before
surgery so that the anesthesiologist can assure that the patient
is fully prepared for surgery

• history of previous anesthetics


• family history of anesthetic problems: malignant hyperthermia?
pseudocholinesterase de ciency?
• examination of airway, lungs and heart
• general history and physical for other potential medical
conditions (diabetes, heart disease, asthma, rheumatoid
arthritis, etc.)
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• INDUCTION DRUGS

• PROPOFOL
• KETAMINE
• ETOMIDATE
• THIOPENTAL
• BENZODIAZEPINE
• OPIOIDS
Recovers
Reverse muscle relaxation and reduce vapors

• Remember to give narcotic analgesics during surgery so that


patient is comfortable on awakening
• Monitor muscle relaxation through surgery and reverse
• Reduce or turn-off vapor - continue to ventilate until patient
begins to make ventilatory efforts - let patient take control of
ventilation and continue to recover
• Extubate when patient is awake and responding to your
voice - do not extubate too soon or patient may become
apneic and require manual ventilation; laryngospasm may
occur making ventilation dif cult.
• Place oxygen mask on patient, move to stretcher and
transport to post-anesthesia care unit (PACU) - maintain
verbal contact with patient during transfer
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