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HISTORY OF ANESTHESIA.pptx
- 1. HISTORY OF ANAESTHESIA Presenter: Om Prakash Tandon
- 2. Objectives • To know about means of anesthesia before 1846 • To know about notable historical inhalational, intravenous, local and regional anesthetic agents and equipments • To know about notable personalities in the history of anesthesia • To know about history of anesthesia in Nepal
- 6. Anesthesia Practice …. Before 1846 • Compression of nerve. For eg: compression on antecubital fossa for operation on hand • Application of cold with snow, ice • “Mesmerism” – hypnosis • Bloodletting – (which probably worked by reducing consciousness)
- 7. Before 1846 Dioscorides first use the term “anesthesia ‘’ to denote “defect of sensation “ or “ privation of senses” Mandragora - prepared for leaves and bark of mandrake plant
- 8. Sporofic sponge Mandrake leaves + black nightshade+ poppies + other herbs ) Alcohol • Laudanum = alcohol based solution of opium • Abused or misused
- 9. Anesthesia • Oliver Wendell Holmes – first propose to use the term “anesthesia “ to denote state of analgesia , amnesia and narcosis. Amnesia Narcosis Analgesia
- 10. Inhalation Anesthesia Nitrous Oxide • Discovered by Joseph Priestly • Humpry Davy – first noted it’s analgesic property
- 11. The tragedy !!! • Colton and Horace Wells are credited for the first use of nitrous oxide for dental extraction. • Demonstrated it’s use at Boston – failed ……. • later committed suicide
- 12. Inhalational Anesthesia Contd.. Ether • Was known as sulfuric ether • Used for frivolous purpose “Ether frolics” • Crawford W. Long and William E. Clark independently used it on patients for surgery and dental extraction, respectively however didn’t publish.
- 13. 1846 (16th October ) • Anesthetist William T.G Morton • Agent Ether • Patient Gilbert Abort • Procedure Excision of tumor under jaw • Surgeon John Collin Warren • Place Massachusetts General Hospital(Boston, USA) The Ether Dome
- 15. Inhalational Anesthesia Contd.. Chloroform • introduced into clinical practice by the Scot Sir James Simpson • administered to relieve labor pain
- 16. • Jon Snow Used chloroform to deliver the two children of Queen Victoria
- 17. Others inhalational agents • Nitrous oxide revived : Edmund Andrews administered it with 20% oxygen • Cyclopropane – rivaled ether safety and popularity • Introduction of fluorinated hydrocarbons – halothane , methoxyflurane, enflurane, isoflurane , sevoflurane , desflurane
- 18. Local and Regional anesthesia • Cocaine – isolated from coca leaves • Carl Koller demonstrated topical anesthesia in eye • William Halsted used cocaine for intradermal infiltration and nerve blocks (facial, brachial plexus, posterior tibial )
- 19. Local and regional anesthesia • First spinal anesthestic was administered by – August Bier • also described Total Intravenous Regional Anesthesia – Bier’s block in 1908 • Added epinephrine to local anesthetics -Heinrich Braun
- 20. Local and regional anesthesia • In 1944, Nils Löfgren and Bengt Lundquist developed Lidocaine • Need of longer acting local anesthestics grew • Bupivacaine introduced in 1965 • immediate popularity because of its potency, rapid onset, decreased incidence of allergic reactions, and effectiveness for all types of regional anesthetic blocks
- 21. Intravenous Anesthesia • Development of hypodermic needle- Dr Alexander wood • First intravenous anesthetic agent – choral hydrate • Morphine + scopolamine , chloroform + ether were also tried • No improvement over inhaled anesthetics
- 22. Intravenous Anesthesia contd. • Barbituates phenobarbiturates and derivatives – protacted action Hexobarbital • Short acting , Short induction time • Widely used for minor procedures
- 23. Intravenous Anesthesia contd • Thiopentone replaced oxybarbiturates • Ketamine synthesized – Dr Calvin Stevans in 1962 • “dissociative anesthesia” neologism created by Guenter Corrsen and Edward Domino
- 24. Intravenous Anesthesia contd • Propofol - synthesized by Imperial Chemical Industries and tested clinically in 1977 - induction and antiemetic action made it popular - severe anaphylactic reaction- Cremephor El the solvent in which it was created - reintroduced with formulations of egg lecithin, glycerol , soyabean oil
- 25. Neuromuscular blocking agents • Curare- the first known neuromuscular blocking agent • Earliest clinical use – to treat muscle spasm of tetanus • Dr Harold Griffith and Enid Johnson – first administer curare in surgery • Succinylcholine was prepared – Novel Laureate Daniel Bovet in 1949
- 26. Airway Management and Equipments • Airway control Dr Joseph Clover • Jaw thrust -to overcome obstruction of the upper airway by the tongue -First to use cricothyroid canula Fig. RCoA crest
- 27. • Oral intubation First undertaken by Scottish surgeon Willaim Macewan • In 1895 by Alfred Kirstein in Berlin, who devised the first direct vision laryngoscope. • To increase visualization of vocal cords Miller’s blade Macintosh blade Fig. Macintosh laryngoscope Fig. Miller’s laryngoscope
- 28. • In 1926, Arthur Guedel - introduction of the cuffed tube. • Fashioned cuffs from the rubber of dental dams, condoms, and surgical gloves that were glued onto the outer wall of tubes.
- 29. Early Anesthesia Delivery System • Morton’s Ether Inhaler – the first anesthetic machine • Clover ‘s bag Morton’s Ether Inhaler Clover bag
- 30. • Complex inhalers Nitrous oxide /ether apparatus Consists of : ether vaporizer, a steel cyclinder containing liquid nitrous oxide , an india rubber bag, facepiece Clover’s nitrous oxide/ether apparatus
- 31. Hewitt apparatus • Among the first devices to combine nitrous oxide with oxygen • Consists of 2 Nitrous oxide cylinders, oxygen cylinder, structure to support and combine the cylinders, a double India- rubbertube (internal and external), a double india-rubber bag, a stopcock and a face mask. • Stopcock: regulate the administration of the two gases.
- 32. Gwathmey Anesthesia machine • Incoporated waterflow meter • Allowed oxygen, nitrous oxide or ether to be administered either alone or in combination • Fitted with lamps – heat the gases
- 33. Boyles Anesthesia Machine • Developed from Gwathmey’s basic model • Addition of : manometers - measure pressure in cyclinder alcohol lamp - to prevent nitrous oxide from freezing and thus obstructing the cyclinder sensitive pressure reducing valves
- 35. Anaesthesia In Nepal • Very little evidence about anesthesia practice before 1933 • Doctors, Paramedic staff who could put drop after drop of ether or chloroform were considered anesthesist Fig. Schimmelbusch mask
- 36. Anesthesia In Nepal Contd. • Dr Bhawani Bhakta Singh Pradhan- first post graduate diploma holder anesthesist in 1955 • Practiced open drop ether in Schimmelbusch mask and spinal anesthesia • Introduced endotracheal intubation Fig. Open drop ether techinque
- 37. • Improvised a Horlick’s bottle with inlet orifice, outlet orifice with rubber tubing , oxford inflating bellow corrugated tubing. • Anesthetized a patient with this circuit and endotracheal intubation of intracranial surgery Fig. The Horlicks bottle vaporizer
- 38. Anaesthesia In Nepal Contd. • In 1963 , Sir Robert Macintosh visited Nepal – encouraged the use of (Epstein Macintosh Oxford Vaporizer) EMO- a calibrated ether vaporizer • In 1965, Dr G P Rajlawat- used indian Boyle Machine with Ether bottle Vaporizer for Closed Mitral Valvotomy – “beginning of Cardiac anesthesia”
- 39. • In 1966, Dr Narendra Bahadur Rana – first use gallamine or curare in combination with draw over technique using ether to provide balanced anesthesia
- 40. Anaesthesia In Nepal Contd. • Available agents and Equipments Inhalational agents – ether, chloroform, trichloroethylene Intravenous agents – thipentone sodium, curare, suxamethonium, gallamine Local anesthesia – procaine First oxygen plant was established in 1972
- 41. Anaesthesia In Nepal Contd. • Till late 1980’s, Ether and EMO system usually supplemented with halothane from an Oxford Miniature vaporizer “OMV” the standard equipment to provide anesthesia
- 42. Anaesthesia In Nepal Contd. 1970 • First clinical trial • using ketamine and diazepam 1984 • Training in anesthesia began 1996 • Beginning of MD program 1987 • Society of Anesthesiologist (SAN) formed • Chairman : Dr Puspa Das Shrestha
- 43. References • Barash PG. Clinical anesthesia, 8E. Philadelphia: Wolters Kluwer; 2017. • Butterworth JF. Morgan and Mikhail’s clinical anesthesiology, 7th edition. McGraw-Hill Education; 2022. • Romero-ávila P, Márquez-espinós C, Cabrera JR. Historical development of the anesthetic machine : from Morton to the integration of the mechanical ventilator. Brazilian J Anesthesiol (English Ed [Internet]. Sociedade Brasileira de Anestesiologia; 2021;71(2):148–61. Available from: https://doi.org/10.1016/j.bjane.2021.02.017 • Home. Wood Library-Museum of Anesthesiology. (2023, January 27). https://www.woodlibrarymuseum.org/ • The history of Anaesthesia. The Royal College of Anaesthetists. (n.d.). https://www.rcoa.ac.uk/about-college/heritage/history- anaesthesia • Amatya R. Special Article Evolution of Anesthesia in Nepal: A historical perspective. 2014;3–6.
- 44. Thank You