Thiopentone anaesthesia at Pearl Harbor

Abstract

A wartime embargo on casualty figures and an imprecise contemporary editorial contributed to the persisting belief that a grossly excessive mortality rate from barbiturate anaesthesia for surgery of the injured occurred after the Japanese attack on the American bases in Hawaii in December 1941. From accounts by surgical staff and official hospital records which have become available through US Freedom of Information legislation, it is clear that the rumoured death rate from this cause has been greatly exaggerated.

Total Intravenous Anaesthesia for War Surgery

“…It would certainly be wrong to assume that "…anyone who could depress the plunger of a syringe in response to movement in a patient could give an anaesthetic" [2]. There is great potential for harm with poorly administered TIVA, and advances in military pre-hospital care have meant that increasingly sick patients are now surviving to reach Role 2/3 facilities.…”

“…Despite being associated with an increased mortality rate in casualties of the attack at Pearl Harbour [1] (a proposition that has since been challenged [2]), British military anaesthetists successfully employed continuous thiopentone anaesthesia during World War II [3]. The use of ketamine during the Falklands conflict informed the development of TIVA regimes [4] and in the first Gulf War, further examples of TIVA were described [5,6].…”

An analytical study of standard propofol- sufentanil target controlled infusion protocols for total intravenous anaesthesia requirements in an Indian population using bispectral index monitoring

“…16 Both suboptimal and supraoptimal doses of anaesthetic agents, as happened in famous Pearl Harbour surgical cases, is detrimental and needs to be avoided. 17,18 At the same time it is very difficult to ascertain the correct dosage of these anaesthetic agents. Many human factors affect the concentration achieved by these agents at the effect site that is the brain.…”

Anesthesiology: From Patient Safety to Population Outcomes

“…The first intravenous anesthetic, thiopental, was associated with problems when it was first made available in a 5% concentration. 5 The first major study 6 of anesthetic mortality noted that anesthesia was associated with a mortality of 1 in 1,560 individuals and was estimated to cause more deaths than polio during the height of the epidemic. Ironically, 50 yr later, in an Institute of Medicine report, 7 anesthesiology was highlighted as a leader in patient safety and recognized for notably reducing errors by using a "combination of technological advances and standardized equipment."…”