The first intravenous anaesthetic: how well was it managed and its potential realized?

Abstract

Our speciality commonly traces its origin to a demonstration of the inhalation of ether by a patient undergoing surgery in Boston in 1846. Less well known is the demonstration of the i.v. injection of opium with alcohol into a dog in Oxford in 1656, leading to anaesthesia followed by full long-term recovery. After gaining i.v. access, a mixture of opium and alcohol was injected, resulting in a brief period of anaesthesia. After a period during which the dog was kept moving to assist recovery, a full recovery was made. Details from this momentous experiment allow us to compare the technique used with modern management. It is important to consider why there was a failure to translate the results into clinical practice and nearly 200 yr of potentially pain-free surgery. Possible factors include lack of equipment for i.v. access, lack of understanding of dose-response effects, and a climate of scientific discovery rather than clinical application. Given the current interest in total i.v. anaesthesia, it seems appropriate to identify its origins well before those of inhalation anaesthesia.

Total intravenous anesthesia will supercede inhalational anesthesia in pediatric anesthetic practice

“…The first intravenously administered anesthetic, followed by long‐term recovery, was performed successfully on a dog in 1656 . Unfortunately, a number of factors were responsible for the lack of translation to potential use in human clinical practice, principally the lack of a hollow bore needle for injection.…”

Lessons of the month 1: Learning from Harvey; improving blood-taking by pointing the needle in the right direction

“…For delivery of laudanum into the hind-limb vein of a dog in 1656, Boyle provided a detailed account of the surgical access achieved by Christopher Wren in Oxford using a 'slender pipe of a syringe' directed 'towards the heart'. 3,4 Conversely, for drainage of blood, if a tube occupies the whole lumen of the vein, it must clearly be pointing towards the periphery from which the blood is flowing. If it is pointing in the opposite direction, blood will need to be able to creep past the cannula before doing an about-turn to flow back out.…”

A history of injection treatments – I the syringe

“…Prominent researchers known to investigate techniques for intravenous injection were Thomas Willis, anatomist and physician, Robert Boyle, chemist and physicist ( Figure 2), and Christopher Wren, later to be the architect of London. [17][18][19][20][21] Willis may have performed the operation first and he continued the experiments subsequently particularly to study blood flow patterns in the brain. 22 In the mid-1650s, Boyle wrote a paper entitled 'An essay of turning poisons into medicines' which assessed 'some Indian Poysons' given by various routes including intravenous infusion.…”