In 1844, Horace Wells, an American dentist
demonstrated the use of laughing gas for tooth extraction on a patient. During
the demonstration, as it had turned out the patient was experiencing pain and
cried out. On further investigation it was observed that inadequate delivery of
gas had been the cause of pain.
‘On 16th October, the successful and historical ether anesthesia administration by Dr. William T. G. Morgan made it possible to perform surgeries that could sometimes be even lifesaving without experiencing pain.’
After
two years on 16
th October 1846 William T. G. Morgan demonstrated the
use of anesthesia for jaw
tumor removal surgery. Following this discovery doctors started using ether for
general surgeries all over the world.
Dr. Morgan had single handily proved
ether's effectiveness as an anesthetic gas as well the importance of delivery
of proper dose for safe practice.
This discovery in subsequent
years saw the advent of chloroform and its combinational use with ether
worldwide.
And to mark the
advent of fully functional anesthesia, in 1853 John Snow, a leading London
anesthetist administered chloroform to Queen Victoria for the birth of Prince
Leopold. She received it again for painless labor when Princess Beatrice was
born. Beatrice was also known as
'chloroform a la Reine.
Towards Safer Anesthesia Chloroform's dangerous tendency to cause
death from overdose and its severe post-operative symptoms were realized over
time and an incessant pursuit was undertaken to look for safer agents and less
harmful agents for anesthesia.
Development of
Anesthetic Apparatus
Further studies on animals, lead to the
discovery of tubes that could be placed into the windpipe (leading to the lung)
through which oxygen could be inhaled and other anesthetic inhalation agents
could be administered at safe levels and keep the animal alive.
This proved to
be path-breaking, since anesthetic gases like nitrous oxide, vapors from
ether for anesthesia, oxygen for resuscitation and ventilation of a
patient could now be given via the tube directly into the lungs in a more
controlled manner.
Late in the 18
th
century, a pediatrician named Joseph O'Dwyer had performed an endotracheal intubation blindly
in a diphtheria patient.
In 1932, a cuff was added to
the endotracheal tube by Arthur Guedel and Ralph M. Waters, this in turn helped
the anesthetists to give positive pressure ventilation for surgeries.
Further
advancement of the anesthetic apparatus and the material of the tubes have
continued and marked sophistication has made the whole process very safe. The
continuous monitoring of oxygen saturation of the body and blood pressure is
now a routine in any operation room of a hospital.
An Arrow Poison called Curare used as a
Muscle Relaxant for Anesthesia
The next major
breakthrough came in 1942 with the discovery that curare, an arrow poison that
could be used as a muscle relaxant. This made it possible for surgeons to
access organs and structures within the depths of the body.
The
anesthetist could now keep the patient asleep with the anesthetic gases, the muscles
of the body sufficiently relaxed or immobile for the surgeon to work
unhindered, while the patient was in deep sleep experiencing no pain.
This helped
the evolution of the modern concept of 'balanced anesthesia' which is followed
currently even today.
Evolution
of Local & Spinal Anesthesia
Administrating
anesthesia to a section of the body for pain, came with the advent of local and
spinal anesthesia. In Peru the leaves of the coca
plant were traditionally used as a stimulant and cocaine was isolated from its
leaves in 1859-1860.
Cocaine was
found to have some local topical anesthetic effect. The discovery of lignocaine
in the year 1884 launched this form of anesthesia.
Injecting this agent into the spinal canal in
the lower lumbar section of the spinal cord region resulted in this section
getting paralyzed and pain free.
This lead to
the
discovery in 1898 of spinal anesthesia. But it was not
introduced into clinical practice until 1899, when August Bier decided to
inject the drug himself and observe its anesthetic effect.
Epidural anesthesia
- Is a variant of
spinal anesthesia where the local anesthetic is instilled in the epidural
space of the spinal cord. Though first discovered in 1901, the epidural
anesthesia first success came from Spain in 1921.
- It became popular for painless childbirth
and liberated women from labor pains. However, 80 years later this routine practice is now
being questioned and not considered safe either for the baby or the
mother.
Progress with Modern Anesthesia
The later part of the 19th
century also saw the development of anesthetic agents with less side-effects that
could be administered through the veins as an injection and machines that would
continuously monitor the patients' vital parameters. The anesthetist could
therefore, now, pick up changes in the patient's vital parameters and quickly
take remedial measures,
if required.
The present day anesthetists use different drugs for specific effects. This
helps them avoid using large doses - (causing dangerous side effects at times) of a single drug
that was often required in the past to produce sleep, lack of pain sensation
& muscle relaxation simultaneously.
Advances in
technology helped develop machines that could monitor not just the level of
oxygen or carbon dioxide in the patient's blood but even the anesthetic gases
used, so that the anesthetist can fine tune the amount of anesthetic needed.
Almost every organ in the body can be monitored during the course of an
operation involving that particular organ.
Thus, today, one could have anesthesia for the most
complicated surgeries that could stretch for hours or could have an anesthetic
in the morning for a short surgery and walk home by evening to have dinner in
the comfort of the home. From premature babies to the frail elderly individual,
anesthesia can be administered to almost everyone. Anesthesia today is safe,
versatile and indispensable to the patient undergoing surgery.
The foundation of modern
anesthesia and surgery was laid by brave doctors who experimented with the
various agents on themselves rather than on their patients.
Modern
anesthesia owes a lot to doctors like Horace Wells, William T.G Morgan, who had
the conviction about their discovery and dedication to the profession and
wanted to make their patients experience surgery without pain.
References :- World anaesthesia day - (https://en.wikipedia.org/wiki/World_Anaesthesia_Day)
- Historical Development of Modern Anaesthesia - (http://www.tandfonline.com/doi/abs/10.3109/08941939.2012.690328?journalCode=iivs20)
Source: Medindia
