Historical Development of Modern Anesthesia

Abstract

Of all milestones and achievements in medicine, conquering pain must be one of the very few that has potentially affected every human being in the world. It was in 1846 that one of mankind's greatest fears, the pain of surgery, was eliminated. This historical review article describes how the various elements of anesthesiology (gasses, laryngoscopes, endotracheal tubes, intravenous medications, masks, and delivery systems) were discovered and how some brilliant entrepreneurs and physicians of the past two centuries have delivered them to humanity. One name stands out amongst all others when the founder of modern anesthesia is discussed, William T.G. Morton (1819-1868). A young Boston Dentist, Dr. Morton had been in the search for a better agent than what had been used by many dentists: nitrous oxide. With Dr. Morton's tenacity driven by enthusiasm and discovery, he and renowned surgeon at Massachusetts General Hospital, John Collins Warren (1778-1856) made history on October 16, 1846 with the first successful surgical procedure performed with anesthesia. Dr. Morton had single-handedly proven to the world that ether is a gas that when inhaled in the proper dose, provided safe and effective anesthesia. One of the first accounts of an endotracheal tube being used for an airway comes from the pediatrician Joseph O'Dwyer (1841-1898). He used the metal "O'dwyer" tubes in diphtheria cases and passed them into the trachea blindly. Adding a cuff to the tube is credited to Arthur Guedel (1883-1956) and Ralph M. Waters (1883-1979) in 1932. This addition suddenly gave the practitioner the ability to provide positive pressure ventilation. The anesthesiologist Chevalier Jackson (1865-1958) promoted his handheld laryngoscope for the insertion of endotracheal tubes and its popularity quickly caught hold. Sir Robert Reynolds Macintosh's (1897-1989) breakthrough technique of direct laryngoscopy came after being appointed Nuffield professor of anesthetics at the University of Oxford in 1937. He was the first to describe the routinely placing of the tip of his newly re-designed laryngoscope in the epiglottic vallecula which is attached to the base of the tongue, thus when lifted exposed the entire larynx. Macintosh was genuinely astonished at what a great view he could achieve with his new blade and technique. The use of barbiturates as an intravenous anesthetic began in 1932. Sodium thiopental gained popularity after its use was described in detail by a Dr. John Lundy (1894-1973) of the Mayo Clinic. Other I.V. medications were tried over the past seventy years, but the newest induction drug which provided for a substantially shorter recovery period and seemed to actually suppress laryngeal reflexes has brought with it many benefits. Propofol, introduced clinically in 1977, demonstrated many positive effects even as an anti-emetic compound. Before October of 1846, surgery and pain were synonymous but not thereafter. As we entered the information age where the infrastructure of evidence based medicine and newer fields of genetics, tra...

Endotracheal Tubes: Old and NewDiscussion

“…These tubes were sealed using pharyngeal sponges with hand-sewn gauze pull strings to help with removal. 1,2,9 Although the detachable inflatable cuff had been introduced by Trendelenburg, it had fallen out of favor due to technical issues, and clinicians preferred to use pharyngeal packing with sponges to seal the upper airway. Guedel (1928) and Waters (1931) reintroduced the inflatable cuff to Magill's rubber tube and are credited with starting a period of ETT design.…”

Rethinking Innovation: Characterizing Dimensions of Impact

“…The paper then dimensionalizes innovation impact by introducing the terms reach, significance, and paradigm change that can be used to identify enabling and progressive innovations. The identified dimensions of reach, impact, and paradigm change stem from the integration of literature that focuses on describing societal impact across fields such as government, business, science, technology, and engineering [9][10][11][12][13][14][15][16][17][18] and in-depth reviews of historical innovations [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] to establish new links between impact and innovation. Emphasis is placed on reviewing cases that do not have a commercial orientation to underscore the importance of becoming effective at describing innovation regardless of the nature of the innovative activity (e.g., research, development, commercialization).…”

“…A broad array of cases present the pattern described in Figures 4 and 5, and Table 2 presents example cases of breakthroughs, enabling innovations, and progressive innovations, which were assembled by reviewing literature on the history of discovery, invention, and innovation [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] . This table shows that in enabling innovations, the cumulative impact of exploiting a novel paradigm is greater than the focused (yet still positive) impact of progressive innovations.…”

Comparison of Lignocaine, Diltiazem and Combination for Controlling the Cardiovascular Responses to Tracheal Intubation-A Cohort Study

“…Endotracheal intubation has turned out to be a routine procedure in the modern day anesthesia care by the middle of the last century 1 .The most popular general anaesthetic technique of the present day is endotracheal intubation following direct laryngoscopy after intravenous induction and muscle relaxation 2,3 . This procedure of endotracheal intubation produces reflex cardiovascular responses in the form of tachycardia and hypertension, which has been recognised since 1951 4,5 .…”