History of Anesthesia
History of Anesthesia
Before the discovery of inhalational agents pain was considered or believed to be an inevitable outcome of surgery. At that time pitilessness was considered to be an important characteristic of the surgeon. Today, major surgery without adequate anesthesia would be unthinkable, and probably constitute grounds for malpractice litigation. Anesthesia is a recent development dating back only 160 years.
Early Analgesia: Dioscorides, a Greek physician from the first century AD, commented on the analgesia of mandragora, a drug prepared from the bark and leaves of the mandrake plant. He stated that the plant substance could be boiled in wine, strained, and used when they wish to produce anesthesia. Alcohol was another element of the pre-ether armamentarium because it was thought to induce stupor and blunt the impact of pain.
Inhaled anesthetics: Prior to the hypodermic syringe & needle (1855) and routine venous access, ingestion and inhalation were the only known routes of administering medicines to gain systemic effects.
- Ether (1540): Ether was prepared by Valerius Cordus, and called "sweet oil of vitriol". It was not used as an anesthetic until the nineteenth century when William Morton (1846), a Boston dentist, used it. Halothane (developed in 1951; released in 1956), methoxyflurane (developed in 1958; released in 1960), enflurane (developed in 1963; released in 1973), and isoflurane (developed in 1965; released in 1981).
- Nitrous oxide (1772):Joseph Priestley in England prepared nitrous oxide but it was not used as an anesthetic until about 1870. Joseph. Humphrey Davy first noted its analgesic properties in 1800. Gardner Colton and Horace Wells are credited with having first used nitrous oxide as an anesthetic in humans in 1844.
- Chloroform (1847): James Simpson, a Scottish obstetrician, used chloroform as an anesthetic agent. Chloroform gained considerable notoriety after John Snow used it during the deliveries of Queen Victoria (1853) for the birth of Prince Leopold, thus giving the drug the royal stamp of approval. For the next 50 years ether and chloroform dominated the anesthetic scene
Local/regional anesthesia: It is the art of rendering a part of the body insensible for surgical operation or manipulation. The origin of modern local anesthesia is credited to Carl Koller, an ophthalmologist, who demonstrated the use of topical cocaine for surgical anesthesia of the eye in 1884. Procaine was synthesized in 1904. Additional local anesthetics subsequently introduced clinically include dibucaine (1930), tetracaine (1932), lidocaine (1947), chloroprocaine (1955), mepivacaine (1957), prilocaine (1960), bupivacaine (1963), and etidocaine (1972).
Intravenous anesthesia: Intravenous anaesthesia followed the invention of the hypodermic syringe and needle by Alexander Wood in 1855. Early attempts at intravenous anaesthesia included the use of chloral hydrate (1872), chloroform and ether (1909), and the combination of morphine and scopolamine (1916). Barbiturates were synthesized in 1903 by Fischer and von Mering. The first barbiturate used for induction of anaesthesia was diethyl barbituric acid (barbital), but it was not until the introduction of hexobarbital in 1927 that barbiturate induction became a popular technique. Thiopental synthesized in 1932 and remains the most common induction agent for anaesthesia. Ketamine was released in 1970, the first intravenous agent associated with minimal cardiac and respiratory depression.
Muscle relaxants: The use of curare (1942) was a milestone in anesthesia. Curare greatly facilitated tracheal intubation and provided excellent abdominal relaxation for surgery. Succinylcholine was synthesized by Bovet in 1949 and released in 1951; it has become a standard agent for facilitating tracheal intubation. Until recently, Succinylcholine remained unparalleled in its rapid onset of profound muscle relaxation, but its occasional side effects continued to fuel the search for a comparable substitute. Recently introduced agents that come close to this goal include vecuronium, atracurium, pipecuronium, doxacurium, rocuronium, and cis-atracurium
Opioids: Morphine was isolated from opium in 1805. The concept of balanced anesthesia, a technique of general anesthesia based on the concept of administration drugs from several different classes used for specific purpose for creating unconsciousness, muscle relaxation, amnesia (loss of memory) and freedom from pain, was introduced in 1926 by Lundy and others and evolved to consist of thiopental for induction, nitrous oxide for amnesia, meperidine (or any opioid) for analgesia, and curare for muscle relaxation. Opioids (Morphine, fentanyl, sufentanil, and alfentanil) prevent patient awareness and suppressing autonomic responses during surgery.
Early Anesthesia Delivery Systems: The transition from ether inhalers and chloroform-soaked handkerchiefs to more sophisticated anesthesia delivery equipment, tracheal intubation set such as laryngoscope endotracheal tubes, etc and monitoring equipments are incorporated gradually, with incremental advances supplanting older methods.
The practice of anesthesia has become safer in recent years due to improvements in pharmacological agents and the introduction of sophisticated technology for safe anesthesia delivery and patient monitoring peri-operatively.