Celebrating Painless Surgery on World Anesthesia Day

Highlights :

• On 16^th October, The world Anesthesia day annually immortalizes the first successful ether anesthesia administration performed by William T.G. Morgan in 1846
• This day is globally celebrated as to signify as an important event in the history of medicine
• This discovery has led surgeons of yesteryears to various advancements in the field of medicine and surgery

On October 16, 1846 at Massachusetts General Hospital by William. T. G. Morgan for the first time successfully used ether for general anesthesia. The day is celebrated as World Anesthesia Day.

This day is globally celebrated as an important event in the history of medicine, as it had contributed immensely to all surgical advancement both historical and modern.

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.

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:

1. World anaesthesia day - (https://en.wikipedia.org/wiki/World_Anaesthesia_Day)
2. Historical Development of Modern Anaesthesia - (http://www.tandfonline.com/doi/abs/10.3109/08941939.2012.690328?journalCode=iivs20)

Source: Medindia