Detailed history'

1. Chair person: Dr. Shivakumar G.
(Professor and H.O.D)
Moderator: Dr. Somsundar
(Assistant professor)
Presentor: Dr. Ankita
(1st year PG resident)

2.  Dioscorides, a Greek philosopher first used the term
“anaesthesia” in 1st century AD to describe narcotic-like
effects of plant mandragora.
 Subsequently defined in Bailey’s An Universal Etymological
English Dictionary(1721) as “a defect of sensation” and
again in the Encyclopedia Britannica (1771) as “privation of
senses”.
 The word “ANAESTHESIA” was coined by Oliver Wendell
Holmes in 1846 to denote the sleep-like state that makes
painless surgery possible.
 Originates from Greek anaisthẽsia,
an - ‘without’ + aisthẽsis -‘sensation’.

4. • Experts at controlling the airway and at emergency
resuscitation.
• Real – time cardiopulmonologists achieving hemodynamic
and respiratory stability for anesthetized patient.
• Pharmacologists and physiologists, calculating appropriate
doses and desired responses.
• Gurus of post-operative care and patient safety.
• Internists performing perianaesthetic medical evaluations.

5. • Pain experts across all medical disciples and apply
specialized techniques in pain clinics and labor wards,
manage the severely sick or injured in critical care units.
• Neurologists, selectively blocking sympathetic, sensory, or
motor functions with our regional techniques.
• Trained researchers exploring scientific mystery and clinical
phenomenon.

6.  Surgery without adequate pain control may seem cruel to
modern reader, yet this was the common practice throughout
most of history.
 Ancient civilizations had used opium poppy, coca leaves,
mandrake root, alcohol, and even phlebotomy (to the point of
unconsciousness) to allow surgeons to operate.
 The Incas local anaesthesia surgeons chewed coca
leaves and spat saliva (presumably containing cocaine) into
the operative wound.

8.  Human skull trephinations occured as early as 10,000 BC,
with archaeologic evidence of post-procedure bone infection
and healing.
 In 19th century, Fanny Burney, a well known literary artist
described a mastectomy she underwent after receiving “wine
cordial” as her sole anaesthetic.
• Burney’s description reminds us that it is difficult to
exaggerate the impact of anaesthesia on the human condition.

9.  The evolution of modern surgery was hampered not only due
to poor understanding of disease process, anatomy, and
surgical asepsis but also by the lack of reliable and safe
anaesthetic techniques.
 Techniques evolved first with inhalation anaesthesia,
followed by local and regional anaesthesia, and finally
intravenous anaesthesia.
 The development of surgical anaesthesia is considered as one
of the most important discoveries of human history.

10.  Roman writer Celsius encouraged “pitilessness” as an
essential characteristic of the surgeon, an attitude that
prevailed for centuries.

11.  The Edwin Smith Surgical Papyrus-Egyptian pictographs
from 3000-2500 BC show a surgeon compressing a nerve in
a patient’s ante-cubital fossa while operating on the patient’s
hand.
 Patient compressing his own brachial plexus while a
procedure is performed on his palm.
 In 16th century, Ambroise Parẽ, a military surgeon became
expert at nerve compression as a means of creating
anaesthesia.
 James Moore in 1874 modified the technique of Parẽ
nerve compression + opium.

12.  In 17th century, Marco Aurelio Severino, an Italian surgeon
and anatomist - “refrigeration anaesthesia”.
• By placing a snow in parallel lines across the incisional
plane, he was able to make surgical site insensate within
minutes.
• Saved lives during an epidemic of diphtheria by performing
tracheostomies and inserting trochars to maintain patency of
airways.
Marco Aurelio Severino

13.  In late 1820s formal manipulation of psyche to relieve
surgical pain was undertaken by French physicians Charles
Dupotet and Jules Cloquet with hypnosis called
“mesmerism”.
• Faded in 1846 when renowned surgeon Robert Liston
performed the first operation under ether anaesthesia in
England and remarked, “This Yankee dodge beats
mesmerism all hollow”.
Jules Cloquet

14.  Dioscorides, a Greek physician from 1st century AD
commented upon mandragora, drug prepared from bark and
leaves of the mandrake plant.
• He stated that the plant substance could be boiled in wine ,
strained, and used “in case of persons... about to be cut or
cauterized, when they wish to produce anaesthesia”.
• Mandragora was still being used to anaesthetize patients as
late as the 17th century.

15.  The soporific sponge was the dominant mode of providing
pain relief during surgery.
 Mandrake leaves, along with black nightshade, poppies, and
other herbs, were boiled and cooked onto a sponge.
• Reconstituted in hot water, and placed under the patient’s
nose prior to surgery.
• Generally contained morphine and scopolamine in varying
amounts- drugs used in modern anaesthesia.

16.  In addition to using the “soporific sponge”, europeans
attempted to relieve pain by ingestion of
• Alcohol.
• Laudanum, alcohol-based solution of opium.
 Laudanum was first compounded by Paracelsus in 16th
century, and prescribed for wide variety of ailments from the
common cold to tuberculosis.
• Used as an analgesic in some instances, it was frequently
misused and abused.

17.  Prior to the hypodermic syringe and routine venous access,
ingestion and inhalation were the only known routes of
administering medicines to gain systemic effects.

18.  Ether (diethyl ether) certainly known in the 16th century,
both to Valerius Cordus and Paracelsus, who prepared it by
distilling sulphuric acid (oil of vitriol) with fortified wine to
produce an oleum vitrioli dulce (sweet oil of vitriol).
• Caused chickens to fall asleep and awaken unharmed.
• Recommended for use in painful illnesses.
 For three centuries thereafter, remained a therapeutic agent
with only occasional use.

19.  Only routine application came as an inexpensive recreational
drug among the poor of Britain and Ireland, who sometimes
drank an ounce or two of ether when taxes made gin
prohibitively expensive.
 Used by the medical community for frivolous purposes
(“ether frolics”).
 Not used as an anaesthetic agent in humans until 1842, when
Crawford W. Long and William E. Clark used it
independently on patients.

20.  William E. Clark, a medical student from Rochester, New
York, gave the 1st ether anaesthetic in January 1842.
• He administered ether, from a towel, to a young woman
named Hobbie.
• One of her teeth was then extracted without pain by a dentist
named Elijah Pope.
William E. Clark

21.  On March 30, 1842, Crawford Williamson Long
administered ether with a towel for surgical anaesthesia in
Jefferson, Georgia.
• His patient, James M. Venable had two small tumors on his
neck but refused to have them excised because of the pain
that accompanied surgery.
• Dr. Long proposed that ether might alleviate pain and gained
his patient’s consent to proceed.
• Venable reported that he was unaware of the removal of the
tumors.
• In determining the first fee for anaesthesia and surgery, Long
settled on a charge of $2.00.

22. Four years later in Boston, on October 16, 1846, William T. G.
Morton conducted the 1st publicized demonstration of general
anaesthesia using ether.

23. The Ether Dome is a surgical operating amphitheater in the
Bulfinch Building at Massachussets General Hospital in Boston.
Site of 1st public demonstration of the use of inhaled ether as a
surgical anaesthetic on 16 October, 1846.

26.  Known to induce lightheadedness and often inhaled by those
seeking thrill.
 Not frequently used complex to prepare and awkward to
store.
 First prepared in 1773 by Joseph Pristley,an English
clergyman and scientist.
 At the end of 18th century in England, there was great
interest in the potential use of gases as remedies for scurvy,
tuberculosis, and other diseases.

27.  Thomas Beddoes opened his Pneumatic Institute in Bristol,
to study the effect of inhaled gases.
• Hired Humphry Davy in 1798 to conduct research projects
for the institute.
• Measured the rate of uptake of nitrous oxide, its effect on
respiration, and other CNS actions.
• Davy commented that nitrous oxide transiently relieved a
severe headache, obliterated a minor headache, and briefly
quenched an aggravating toothache.
• Davy’s lasting nitrous oxide legacy was coining the phrase
“laughing gas” to describe its unique property.

28.  In the mid -19th century, a few dentists searched for new
ways to relieve pain.
• One of the first to “discover” a solution was Horace Wells of
Hartford, Connecticut on December 10, 1844.
• Lecture-exhibition on Nitrous oxide by an scientist, Gardner
Quincy Colton.
Horace Wells

29.  In January 1845, Wells attempted a public demonstration in
Boston at the Harvard Medical School.
• Began the dental extraction without an adequate level of
anaesthesia, and the trial was judged a failure.
• Committed suicide in 1848.

30.  James Young Simpson, an Obstetrician of Edinburgh,
Scotland – 1st to use ether for the relief of labor pain.
• Dissatisfied with ether and sought a more pleasant, rapid-
acting anaesthetic.
 David Waldie suggested chloroform, 1st prepared in 1831.
 Simpson and his friends inhaled at an dinner party on
November 4, 1847.
 Submitted his 1st account of its use to The Lancet.

31.  Introduced chloroform with boldness, and enthusiasm, and
defended its use for women in labor.
• Argued against the prevailing view, which held that relieving
labor pain was contrary to God’s will.
• Addressed these concerns in a pamphlet.
• Additionally, he told that labor pain was a result of scientific
and anatomic causes, and not the result of religious
condemnation.
• Simpson’s pamphlet probably did not have much impact.

32.  Chloroform gained considerable notoriety after John Snow
used it during the deliveries of Queen Victoria.
• In 1848, John Snow introduced a chloroform inhaler.

33. • Realized that successful anaesthetics must not only abolish
pain but also prevent movement.
• His studies led him to recognize the relationship between
solubility, vapor pressure, and anaesthetic potency, which
was not fully appreciated until after World War II.
• Also invented an experimental closed-circuit device.
• Published two remarkable books, On the Inhalation of the
Vapour of Ether(1847) and On Chloroform and Other
Anaesthetics(1858).
• Died of a stroke at the age of 45.

34.  Ether remained the standard general anaesthetic until the
early 1960s even after the introduction of other inhalation
anaesthetics (ethyl chloride, ethylene, divinyl ether,
cyclopropane, tricholoroethylene).
 Only agent that rivaled Ether’s safety and popularity was
Cyclopropane(discovered in 1929).
 Brown and Henderson Propylene nausea and cardiac
irregularities in human.

35.  George Lucas, a chemist, identified cyclopropane.
• Prepared a sample in low concentration with oxygen
and administered to two kittens.
• Henderson and Lucas arranged a public
demonstration – Frederick Banting, was
anaesthetized before a group of physicians.
• Henderson encouraged Ralph Waters, to use
cyclopropane at the University of Wisconsin.
• Reported clinical success in 1934.
 Ether and Cyclopropane, both being highly
combustible and have been replaced by the
nonflammable potent “fluorinated hydrocarbons”.

36.  Fluorine, the lightest and most reactive halogen,
forms exceptionally stable bonds.
 Fluorine substitution for other halogens lowers the
boiling point, increases stability, and decreases
toxicity.
 In 1951, Charles Suckling, a British chemist created
Halothane.
• Offered to Michael Johnstone, an anaesthetist of
Manchester of England, recognised its advantages
over other anaesthetics available in 1956.

37.  Methoxyflurane(released in 1960) : Dose-related
nephrotoxicity.
 Two fluorinated liquid anaesthetics – Enflurane and its
isomer isoflurane were synthesized by Ross Terrell in 1963
and 1965, respectively.
• Enflurane – cardiovascular depressant and convulsant
properties.
 Desflurane (released in 1992) and Sevoflurane (released in
1994).
 Xenon – extreme costs associated with its removal from air.

38.  Cocaine, an extract of coca leaf, was the 1st effective local
anaesthetic.
 In 1884- Carl Koller, demonstrated the use of topical cocaine
for surgical anaesthesia of the eye.

39.  In December 1884,two young surgeons, William Halsted and
Richard Hall, described blocks of the sensory nerves of the
face and arm.
• Halsted demonstrated the use of cocaine for intradermal
infiltration and nerve blocks (including facial nerve, the
brachial plexus, the pudendal nerve, and the posterior tibial
nerve).
William Halsted

40.  In 1885- Leonard Corning, a neurologist coined the term
“Spinal Anaesthesia”.
• Performed a neuraxial block using cocaine on a man
“addicted to masturbation”.
• Suggested that cocainization might in time be “a substitute
for etherization in genito-urinary or other branches of
surgery”.

41.  In 1898- August Bier is credited with administering the 1st
spinal anaesthesia ; he used 3mL of 0.5% cocaine
intrathecally.
• Also the 1st to describe IVRA (Bier block) in 1908.

42.  Heinrich Quincke of Kiel, Germany described the technique
of lumbar puncture.
• His technique was used by August Bier for the 1st deliberate
cocainization of the spinal cord in 1899.
 Professor Bier permitted his assistant, Dr.Hildebrandt, to
perform a lumbar puncture.
 During 1899, Dudley Tait and Guidlo Caglieri- use of fine
needles to lessen escape of CSF and urged that the skin and
deeper tissues be infiltrated behorehand with local
anaesthesia.
 Theodor Tuffier- solution should not be injected before CSF
was seen.

43.  In 1900- Heinrich Braun was the 1st to add epinephrine to
prolong the action of LA.
• Developed several new nerve blocks, coined the term
“conduction anaesthesia”.
• Remembered by European writers as the “father of
conduction anaesthesia”.
• 1st to use Procaine, which, along with Stovaine, was one of
the 1st synthetic LA produced to reduce the toxicity of
cocaine.
Heinrich Braun

44.  Arthur Barker, a surgeon – property of baricity.
 In 1946, John Adriani advanced the concept further when he
used hyperbaric solution to produce “saddle block”, or
perineal anaesthesia.
 William Lemmon, a surgeon(1940), devised an apparatus for
continuous spinal anaesthesia to overcome the problem of
inadequate duration of single injection spinal anaesthesia.
 In 1944, Edward Tuohy of the Mayo clinic- introduced
Tuohy needle as a means of improving the ease of passage of
lacquered silk ureteral catheters through which he injected
incremental doses of LA.

45.  In 1901- Jean Sicard and Ferdinand Cathelin – caudal
anaesthesia alternative to spinal anaesthesia for hernia
repairs.
 Lumbar epidural anaesthesia was described first in 1921 by
Fidel Pagẽs and again in 1931 by Achille Dogliotti.
• Pagẽs used a tactile approach to identify the epidural space
and Dogliotti identified it by the loss-of-resistance technique.
 In 1902, Harvey Cushing coined the phrase “regional
anaesthesia”.

46.  August Bier in 1908 introduced intravenous regional
technique with procaine- “Bier block”.
• Mackinnon Holmes – modified technique by exanguination
before applying a single proximal cuff.
• Holmes used lidocaine, the very successful amide LA
synthesized in 1943 by Lofgren and Lundquist of Sweden.

47.  Intravenous anaesthesia followed the invention of the
hypodermic syringe and needle.
 In 1845, Francis Rynd from Dublin created hollow needle for
injection of morphine into nerves to treat “neuralgias”.
 In 1853- Charles Gabriel Parvaz designed the 1st functional
syringe for perineural injections.
 Alexander Wood, however, is credited with perfecting the
hypodermic glass syringe in 1855.

48.  Early attempts at intravenous anaesthesia included the use
of :
1. Chloral hydrate by Pierre Orẽ of Lyons in 1872.
2. Chloroform and ether by Ludwig Burkhardt of Germany in
1909.
3. Combination of morphine and scopolamine by Elisabeth
Bredenfeld of Switzerland in 1916.

49.  The 1st barbiturate used for induction of anaesthesia was
Barbital(diethylbarbituric acid).
 Phenobarbital and all other successors of barbital –very
protracted action.
 Oral pentobarbital- used as a sedative- long periods of
unconsciousness.
 The 1st short-acting oxybarbiturate was
Hexobarbital(Evipal), available clinically in 1932.
• A London anaesthetist, Ronald Jarman, found that it had
dramatic advantage over inhalation inductions for minor
procedures.

50.  Replaced by thiobarbiturates- Thiopental(Pentothal) and
Thiamylal(Surital) synthesized by Donalee Tabern and
Ernest H. Volwiler of the Abbott company in 1932.
• Thiopental was 1st used clinically by John Lundy and his
colleagues at the Mayo clinic in June 1934.
• Sulfated barbiturates proved to be more satisfactory, potent,
and rapid acting than their oxybarbiturate analogs.
• Vasodilatory effects were widely appreciated only when
thiopental caused cardiovascular collapse in hypovolemic
burned civilian and military patients in World War II used
with greater caution.

51.  In 1962, Ketamine was synthesized by Dr. Calvin Stevens at
the Parke Davis laboratories in Ann Arbor, Michigan.
• It is a cyclohexylamine compound that includes
phencyclidine.
• Others: postanaesthetic delirium and psychomimetic
reactions.
• In 1966, the neologism “dissociative anaesthesia” was
created by Guenter Corrsen and Edward Domino to describe
trance-like state of profound analgesia produced by
ketamine.
• Released for use in 1970.

52.  Etomidate(Hypnomidate) was 1st synthesized by Paul
Janssen and his colleagues in 1964.
• Adv.: minimal hemodynamic depression and lack of
histamine release.
• Drawback: pain on injection, myoclonus, PONV, and
inhibition of adrenal steroidogenesis.
• DOC for anaesthetizing hemodynamically unstable patients.

53.  Propofol (2,-6 di-isopropyl phenol), was 1st synthesized by
Imperial chemical industries and tested clinically in 1977.
• Produced hypnosis quickly with minimal excitation and that
patients awoke promptly once the drug was discontinued.
• In addition has anti-emetic action – agent of choice in
patients prone to nausea and emesis.
• Cremophor EL, the solvent – anaphylactic reactions.
• Reformulated with egg lecithin, glycerol, and soybean oil.
• Suppressed pharyngeal reflexes – permitted the insertion of
LMA without a need for either muscle relaxants/inhaled
anaesthetics.

54.  Opium is derived from the seeds of the poppy (Papaver
somniferum).
 Morphine, the 1st alkaloid isolated was extracted by Prussian
chemist Freidrich A. W. Sertṻrner in 1803.
• Named after the Greek god of dreams, Morpheus.
• Used as supplement to inhaled anaesthesia and post-
operative pain control.
 Codeine, another alkaloid of opium, was isolated in 1832 by
Robiquet – relatively weaker analgesic potency and nausea at
higher doses.

55.  Meperidine, was 1st synthetic opioid developed by German
researchers at IG Farben, Otto Eisleb and O. Schaumann in
1939.
 Paul Janssen, the founder of Jansenn pharmaceuticals is
credited with the development of over 70 pharmaceutical
compounds.
• In 1960,Janssen’s team synthesized Chemical R4263
( Fentanyl),the 1st of phenylpeperidine derivatives.
• Fentanyl was followed by sufentanil(1974) and
alfentanil(1976).

56.  Remifentanil, an ultra short-acting opioid introduced by
Glaxo-Wellcome in 1996- rapid onset and equally rapid
offset due metabolism by nonspecific tissue esterases.
 Ketorolac, a NSAID approved for use in 1990, was the 1st
parenteral NSAID indicated for postoperative pain.
• Used as a sole i.v. Agent in minor procedures, or for pain
attenuation when an opioid -sparing approach is essential.
• Inappropriate in patients with underlying renal dysfunction,
bleeding problems, or compromised bone healing.

57.  Entered anaesthesia practice nearly a century after
inhalational anaesthetics.
 Curare, an alkaloid, the 1st NMB agent , originally used in
hunting and tribal warfare by native peoples of South
America.
 In 1564, Sir Walter Raleigh – described effects of curare
upon their targets, as well as the use of an antidote.
 In 1811, Benjamin C. Brodie- large animals treated with
curare could be kept alive if ventilated for hours through
bellows sewn directly to the trachea.
 Earliest clinical use of curare- ameliorate the tortuous muscle
spasms of infectious tetanus.

58.  In 1900, Jacob Pal, a Viennese physician, recognised that
curare could be antagonized by Physostigmine.
• Isolated from Calabar bean by Scottish pharmacologist Sir T.
R. Fraser.
• In 1931, Neostigmine methysulphate synthesized – more
potent.
 On January 23, 1942, Harold Griffith, the chief anaesthetist
of Montreal Homeopathic Hospital and his resident, Enid
Johnson- anaesthetized and intubated the trachea of a young
before injecting curare early in the course of his
appendicectomy.
• Satisfactory abdominal muscle relaxation was obtained.
• Milestone in anaesthetic care.

59.  Other NMB agents- Gallamine, decamethonium, metocurine,
alcuronium and pancurium – introduced clinically-
associated with significant side effects.
 Recently introduced- Vecuronium, atracurium,
pipecuronium, doxacurium, rocuronium, and cis-atracurium.
 Succinylcholine (Sch)- Nobel laureate Daniel Bovet-
synthesized in 1949 and released in 1951.
 Mivacurium , a newer short acting nondepolarizing NMBA-
slower onset, longer duration of action, minimal side effects.
 Rocuronium, an intermediate acting- rapid onset.
 Rapacuronium, most recently released NMBA – rapid onset,
short acting with an improved safety profile.
• Manufacturer voluntarily withdrew it from the market due
to several reports of bronchospasm.

61.  1958- monitor intraop. NMB with nerve stimulators.
 T.H. Christie and H. Churchill-Davidson , working at St.
Thomas’ Hospital in London- monitoring peripheral NMB
during anaesthesia.
 In 1970, H. H. Ali and colleagues- “Train of Four”
• Four supramaximal impulses delivered at 2Hz(0.5s apart).
• Method of quantifying the degree of residual neuromuscular
blockade.

63.  One of the earliest anaesthesia apparatus designs was that of
John Snow, who had realized the inadequacy of ether
inhalers through which patients rebreathed via a mouthpiece.
• Created the 1st of his series of ingenious ether inhalers.
• Apparatus featured unidirectional valves within a malleable,
well-fitting mask of his own design, which closely resembles
the form of a modern face mask.

64. John Snow’s face mask (1847)
(The expiratory valve can be tilted to the side to
allow the patient to breathe air.)
John Snow’s ether inhaler
(1847)
The ether chamber (B) contained a spiral
coil so that the air entering through the
brass tube (D) was saturated by ether
before ascending the flexible tube (F) to
the face mask (G) .The ether chamber
rested in a bath of warm water (A).

65.  Joseph Clover, another British physician, was the 1st
anaesthetist to administer chloroform in known
concentrations through “Clover bag”.
• He was the 1st Englishman to urge the now universal practice
of thrusting the patient’s jaw forward to overcome
obstruction of the upper airway by the tongue.
Joseph Clover anaesthetizing a patient
with with chloroform and air passing
through a flexible tube from a Clover
bag.

66.  In the late 19th century, freestanding anaesthesia machines
were manufactured in the United States and Europe.
 Three American dentist-entrepreneurs, Samuel S. White,
Charles Teter, and Jay Heidbrink, developed the original
series of U.S. instruments to use compressed cylinders of
nitrous oxide and oxygen.
 Heidbrink added reducing valves in 1912.
 Frederick Cotton and Walter Boothby introduced water-
bubble flow meters – allowed the proportion of gases and
their flow rate to be approximated.
• The Cotton and Boothby apparatus was transformed into a
portable machine by James Tayloe Gwathmey of New York.

67.  Henry E. G. Boyle, a London anaesthetist incorporated
Gwathmey’s concepts in the 1st of the series of “Boyle”
machines.
• Marketed by Coxeter and British Oxygen corporation.
 Heinrich Draeger and his son, Bernhaard, adapted
compressed gas technology- originally developed for mine
rescue equipment, to manufacture ether and chloroform-
oxygen machines.

68.  Alfred Coleman(1828-1902) devised a system of absorbing
carbon dioxide by passing the expired gases over slaked
quick lime.
• Recovered gases were then used for subsequent anaesthetics.

69.  Franz Kuhn(1866-1929), a German surgeon described soda
lime absorption of exhaled carbon dioxide in 1905, but the
report did not attract attention.
 In 1915, Dennis Jackson, a pharmacologist used solutions of
sodium and calcium hydroxide to absorb carbon dioxide.
 In 1923,Ralph Waters(1884-1979) introduced a simpler
device using soda lime granules.
• Positioned a soda lime canister between a face mask and an
adjacent breathing bag to which was attached the fresh gas
flow.

70. • Drawback: Awkward positioning of the canister close to the
patient’s face.
 Brian C. Sword overcame this limitation in 1930 with a
freestanding machine with unidirectional valves to create a
circle system and an in-line carbon dioxide absorber.

71.  In 1937, Phillip Ayre introduced valveless T-piece to reduce
the effort of breathing in neurosurgical patients.
• Popular for cleft palate repairs, as the surgeon had free
access to the mouth.
• A significant alteration was Gordon Jackson Rees’ circuit-
permitted improved control of ventilation by substituting a
breathing bag on the out-flow limb.

72.  In 1910, M. Neu – 1st to apply rotameters in anaesthesia for
administration of nitrous oxide and oxygen.
• Machine was not a commercial success due to great cost of
nitrous oxide in Germany.
• 1st employed in Britain in 1937 by Richard Salt; but as World
War II approached, the English were denied to access these
flowmeters.

73.  The Copper Kettle was the 1st temperature- compensated,
accurate vaporizer developed by Lucien Morris at the
University of Wisconsin in response to Ralph Waters’ plan to
test chloroform by giving it in controlled concentrations.

74.  The 1st tracheal tubes were developed for the resuscitation of
drowning victims, but were not used in anaesthesia until
1878.
 The 1st use of elective oral intubation for an anaesthetic was
undertaken by Scottish surgeon William Macewan.
• Practiced passing flexible metal tubes through the larynx of
cadaver before attempting the maneuver on an awake patient
with an oral tumor at the Glasgow Royal Infirmary, on July
5, 1878.

75.  In 1885,an American surgeon named Joseph O’Dwyer
designed a series of metal laryngeal tubes, which he inserted
blindly between vocal cords of children suffering a
diphtheritic crisis.
• 3 years later, designed a second rigid tube with a conical tip
that occluded the larynx.
 After O’Dwyer’s death, the outstanding pioneer of tracheal
intubation was Franz Kuhn, a surgeon of Kassel, Germany.
• Described techniques of oral and nasal intubation that he
performed with flexible metal tubes composed of coiled
tubing.
• Kuhn even monitored the patient’s breath sounds
continuously through a monaural earpiece connected to an
extension of the tracheal tube by a narrow tube.

76.  Early practitioners of intubation of the trachea were
frustrated by laryngoscopes that were cumbersome, ill
designed for the prevention of dental injury, and offered only
a very limited view of larynx.
 Before the introduction of muscle relaxants, tracheal
intubation was challenging. This challenge was made easier
with the advent of laryngoscope blades specifically designed
to increase visualization of vocal cords.

77.  Robert Miller of San Antonio, Texas, and Robert Macintosh
of Oxford University created their respectively named blades
within an interval of
2 years.
 In 1941, Miller- slender, straight blade with a slight curve
near the tip to ease the passage of the tube through the
larynx.

78.  After a patient experienced an accidental endobronchial
intubation, Ralph Waters reasoned that a very long cuffed
tube could be used to ventilate the dependent lung while the
upper lung was being resected.
 On learning of his friend’s success with intentional one-lung
anaesthesia, Arthur Guedel proposed an important
modification for chest surgery, the double-cuffed single-
lumen tube, introduced by Emery Rovenstine.
• Tubes were easily positioned(advantage) over bronchial
blockers that had to be inserted by a skilled bronchoscopist.

79.  Following World War II, these tubes were replaced by
double-lumen endobronchial tubes, currently most popular
and was designed by Frank Robertshaw of Manchester,
England.
• Robertshaw tubes were 1st manufactured from mineralized
red rubber but currently made of extruded plastic, a
technique refined by David Sheridan.
• Sheridan- 1st person to embed “cm” markings along the side
of tracheal tubes.

80.  Conventional laryngoscopes proved inadequate for patients
with “difficult airway”.
 In 1964, Shigeto Ikeda – 1st flexible fiberoptic bronchoscope.
 Roger Bullard frustrated by failed attempts to visualise the
larynx of the patient with Pierre-Robin syndrome- developed
“Bullard laryngoscope”-simultaneously examine the larynx
and intubate the vocal cords.
 Similarly, in 1994, Tzu Lang Wu- “Wu scope”- to combine
and facilitate visualization and intubation of the trachea in
patients with difficult airways.

81.  Patients requiring continuous oxygen administration during
fiberoptic bronchoscopy - “Patil face mask” -, features a
separate orifice through which the scope is advanced –
created by “Vijay Patil”.
 In 1981, Dr. A. I. J. Archie Brain- principle of the laryngeal
mask airway (LMA).
• Refined their shapes by conducting postmortem studies of
hypopharynx to determine the form of cuff that would be
functional.

82.  Pre-ether era: Begins from Sushruta when in 500 B.C.
operations were performed using opium, wine, indian hemp
& by tying up.
• In 527 A.D. Raja bhoj undergone cranial operation using
Sammohini for induction & Sanjivani for recovery.

83.  Next Hundread years:
 1st administration of Ether anaesthesia in India was on
22nd March 1847, in medical college hospital , Calcutta,
under supervision of Dr. O’saughnessy, the surgeon.
 1st chloroform anaesthesia was administered on 12th Jan
1848
• David Valdie, chemist, who introduced chloroform to
clinical anaesthesia came to Calcutta, started a business
& lived here till death.

84.  HYDERABAD COMMISION:
• Chloroform anaesthesia caused 334 deaths & only 48 deaths
were reported due to ether.
• Controversy arose between two medical school namely
Edinbergh (simpson) claiming deaths due to respiratory
failure & London school claiming deaths due to cardiac
failure.
• Glassgow committee in 1880 stated-chloroform is more
dangerous to heart & in comparison more dangerous than
Ether.
• Edward Laurie refuted the statement and formed 1st
Hyderabad Commision in 1889.

85. • Experiments were carried out & concluded that chloroform
is perfectly safe & no danger of accidental death.
• Not accepted in England & 2nd Hyderabad commision was
formed. Experiments were carried out on animals & humans.
Finally, concluded that Edinbergh school was right.

86.  1st female anaesthetist of India & perhaps the world was
“Roopabai Fedunji” .
 Upto 1928 only chloroform was used.
 1st case of delayed chloroform poisoning in world was in
1869.
 1st Boyle machine introduced in India was in 1935 at
Calcutta.Total price was about 645 Rs.
 Thiopentope introduced in 1940’s by Dr. M.M. Desai &
Dr. B.N. Sircar.
 D-tubocuranine introduced in 1949.
 1st ICCU was set up in KEM hospital, Mumbai in 1962.
 Indian society of anaesthesia formed in 1947.

87. 1. Miller’s Anaesthesia, Ronald D. Miller, 6th edition.
2. Clinical Anaesthesia, Paul G. Barash, 5th edition.
3. Clinical Anaesthesiology, G. Edward Morgan, Jr., 4th edition.