168th World anaesthesia day

1. Prepared By: Dr. Tanjim Reza
DA Student, CMCH
ORGANISED BY
Bangladesh Society of anaesthesiologist
Chittagong branch

2.  It is a pharmacologically induced and reversible state of
amnesia, analgesia, loss of responsiveness, loss of skeletal
muscle reflexes or decreased stress response, or all
simultaneously.
 An alternative definition is a ‘’reversible lack of
awareness’’ including a total lack of awareness of a part of
the body such as spinal anesthetic.
 The word Anaesthesia was coined by Oliver Wendell
Holmes Sr. in 1846

3. Triad of Anaesthesia
• Relive from painful surgery
• Need of unconsciousness
• Need of muscle relaxation

4.  An understanding of our past, guiding our future
 The history of surgery follows the history of
Anaesthesia
 We are all part of it

5.  Pre- 1846 – The foundation of Anaesthesia
 1848-1900 – Establishment of Anaesthesia
 20th century – Consolidation and growth
 21st century – The future

6. Drug Methods –
• Alcohol
• Opium
• Hyoscine
• Cannabis
• Cocaine

7. Non Drug Methods:
 Cold
 Concussion
 Carotid compression
 Nerve compression
 Hypnosis
 Mesmeric Magnetism
 Blood letting

8. Status of surgery:
• Barber shop surgery
Types of Surgery:
• Amputation and dental extractions
• No antisepsis
• Appalling Mortality
Indications:-
• Unbearable pain
• Crippling deformity
• Imminent death

9.  1665 _ 1st IV injection opiate through a quill
 Late 1700 –
- Lots of new gases identified
- Treatment of existing diseases rather than novel use

10.  Joseph Priestly – Produced N2O in 1772
 Humphrey Davy – 1st Noted N2O’s analgesic properties
in 1800

11. Contd.
1834 – Colton Anesthetized 6 Indians by mistake
1844 – Horace Wells had his tooth pulled under N2O
1845 –Wells failed to demonstrate N2O at MGH

12. 1540 – Synthesized and named sweet oil of vitriol by
Valerius Cordus
* Forbenius renamed it to Ether
* 1744 – Methew Turner Published essay suggesting its
inhalation in certain types of pain
• Michael faraday Described narcotic effect of Ether
• 1842 First used as a clinical anesthetic in USA
• Clarke and Long used Ether for operations

14. Ether Dome

15. • On 16th October 1846 first public demonstration of
Ether Anaesthesia took place in Boston
• William T G Morton
- Inventor and revealer of inhalation Anaesthesia:
- Before whom, in all time, surgery was agony by whom
pain in surgery was averted and annulled; since whom
science has control of pain.

16.  Anesthetist: William Thomas
Green Morton
 Agent: Diethyl Ether
 Patient: Gilbert Abbott
 Operation: Excision of tumor
under jaw
 Surgeon: John Collins Warren
 Comment: Gentleman this is
no humbug

17. AnaesthesiaMemorial Boston
Monument in Charlton Massachusetts

18. Henry Hill
Hickman:
- 1821 semi asphyxiation due to air
starvation or by breathing CO2 gas
* After unconsciousness was induced
operated on them –
# Amputation
# Removal of ears
# Skin Incisions and observed
response to surgery
# Evidence of Pain
# Amount of bleeding to recovery

19.  1831 – Chloroform was synthesized
 1847 – James Young Simpson used chloroform for
obstetric Anaesthesia
 1847 – John Snows Regulating inhaler
 1848 – Honnoh Greeners – First Anesthetic death

20. Dr. John Snow used Chloroform as anesthetic in 1853
Queen Victoria used it when she gave birth to her son Leopold, since it became
mainstream

21. - Intubation and Airway advances
- Anesthetic equipment
- Monitoring
- Drug Advance
- Local Anaesthesia
- Anaesthesia and intensive Care
- Pain Management
- Organization of Specialty

22.  1919 – Endotracheal
intubation
 1928 – Blind Nasal
Intubation
 1950 – PVC tube
introduced
 1980 – LMA introduced

23.  1908 – Rota Meter
 1917 – Boyles Machine
 1919 – Endotracheal Intubation
 1938 – Artificial Respiration
 1940 – Oxford vaporizer

24.  Blood pressure recorded at MGH
 1946 –O2 analyzer
 1949 –Nerve stimulator
 1956-Blood gas monitoring
 1960-ECG and Capnograph, CVP ,arterial monitoring.

25.  1911-balanced anaesthesia
 1942-Curare
 1951-Suxamethonium
 1956-Halothane
 1964-introduction of entonox
 1980-Opioids-fentanyl/
PROPOFOL,vecuron
ium/atracurium
 1990-
sevoflurane,desflurane,Rocur
onium

26.  In the 1940s scientists discovered the active ingredient in
South american Amazon Indian arrow poison;It’s Curare.
 The only problem with using this stuff is that person was so
relaxed that be can’t breathe or swallow –but he was fully
awake .This opened the “age of Anaesthesia.”

27.  1860-Cocaine isolated
 1884-Koller ;Topical Anaesthesia
 1885-spinal analgesia by corning
 1898-August bier –Spinal
Anaesthesia
 1901-Epidural Anaesthesia
 1908-IVRA –Bier’s block
 1921-Lumber epidural analgesia –
pages
 1943-Lignocaine
 1963-Bupuvacaine August Bier

28.  1967-PCA
 1990-Acute pain team, Multimodal analgesia, Epidural
analgesia

29.  1932-Assosiation of anesthetist GB & I
 1935-Diploma in Anaesthesia
 1948-Faculty of anesthetist of RCS
 1953-FRCA

30.  New and better drugs
 New equipments
 Increased demand for anaesthetic services
 Questioning roles inside theatre
 Stuffing and workload issues

31.  In 2000 BC , Sushratha used to perform plastic surgery
of cut nose with use of opium,Indian hemp and wine
to keep the patient sedated.
 In the Buddhist Era ,in BC 247 ,laparotomy was
described using alcohol to obtund pain.
 In 1843 Esdale reported surgical operation under
mesmeric anaesthesia in Hoogly Hospital In West
Bengal.
 Ether anaesthesia was used in India only six months its
official demonostration on october 16,1846 in
MGH,USA.

32.  For operative procedures,Local anaesthesia and
regional blocks were in use and practiced by the
Surgeons themselves at DMC.
 General anaesthesia was used under supervision of the
surgeons and used to be administered by the house
surgeons of the respective departments.

33.  Dr.Beni Madhab Basak a house surgeon was mostly
responsible to administer general anaesthesia till
December ,1948.
 Dr.S.M Mukhlesur Rahman ,MB was the first
physiacian appointed as an Anaesthetist,DMCH.
 Upto sixties most of the hospital have no recognized
anaesthetist to deliver anaesthesia and sometimes it
was given by nondoctors under the supervision of
surgeon.

34.  The first post-graduate anaesthetist is Dr.k.A.S.M.A
Quader ,DA (London).
 1951 Dr.Abdul Quader ,MB,DA (London) has been in
charge,Dep’t of Anaesthesia of the Medical College
Hospital ,Dhaka.

35.  Infiltration analgesia,field blocks,regional blocks were
popular amongst the surgeons in those days.
 Procaine was the drug used for local analgesia.
 Heavy Cinchocaine(Nupercaine)was in use for spinal
analgesia.
 Chloroform,ether and ethyl chloride were the volatile
anaesthetics used for general anaesthesia.

36. Gradually,modern anaesthetic machines replaced in
most centre’s and in all of the educational institutes.
The first machine was the Boyle’s apparatus available
since 1949 at DMCH.

37.  Ether continued to be in use in opendrop method and in Boyle’s
Machines.
 Halothane was introduced in late fifties,in course of time
Halothane replaced other volatile agents.
 Suxamethonium was introduced in early sixties.
 Pancuronium Bromide was introduced in mid –eightes.
 Atracurium was introduced in late eighties.
 Vacuronium was introduced in early nineties.
 Pipecuronium was introduced in late nineties.
 Spinal anaesthesia was re –introduced and very popularly used in
most of the hospitals.
 Piped Medical gases & Vacuum was introduced in DMCH on 19th
February 1985 and are extended in many hospitals.

38.  Anaesthesia service was recorded with a very short of
trained manpower in Chittagong Medical college &
Hospital in 1956.
 Department extended in all govt.medical college
hospitals or institutes,private medical college
hospitals,
 District hospitals and upto Upazila health complexes
still with a a very short of trained manpower.

39.  Prof.S N Samad Chowdhury DA
(London).FCPS.FFARCS who was the long time
president of BSA and has great contribution for
anaesthetic expansion in Bangladesh.

40.  In 1947 there is no recognized trained
anaesthesiologist.
 In 1948 two self trained and one in 1951 ,total three
with one recognized .
 1981 gradually increased interest in this field due to
national demand with improved some dignity but still
slow.

41.  DA : First two were Dr.Fakhrun Nissa and Dr.Dilip
Kumar Das.
 MCPS :First Bangladesh MCPS is Dr M Khalilur
Rahman in 1976.
 FCPS : The First fellow was Dr.Selim M Jahangir who
was awarded fellowship in 1983.
 MD : The first MD was Dr. Md.Abdul Hai ,Chairman
of BSMMU .

42.  Bangladesh Society of Anaesthesiologists (BSA) was
formed in 1974 with Pro.K.A.S.M. Quader and
Dr.Md.Shafiqur Rasul as its President and Secretary
respectively .

43.  Peri –operative anesthetic management .
 Intensive Care
 Pain clinic
 Palliative care .
 Intensive care unit was started in DMCH in September
1985 with a six bed only.

44.  The First Journal of BSA was published in 1987 Dr.K.M
Iqbal as its Editor.Two issues of Journals per year are
published regularly.

45.  Epidural anaesthesia
 Epidural analgesia with catheter
 Caudal anaesthesia with additives
 Supraclavicular Brachial plexus block
 Interscalene Brachial plexus block
 Superficial cervical plexus block
 Femoral nerve block

46.  Now a days complicated surgical procedures like cardiac
surgery ,neuro surgery,thoracic surgery,kidney transplant
,pain management and intensive care patients have been
possible due to improvement of Anaesthesiology.
 Still we are lacking of some basic infrastructural problems
like -
 -proper placement and distribution of manpower.
 -Availabilty of equipments,
 -Standard monitors and Drugs at all levels of health
care .
 However we are very mutch hopefull awaiting a golden
future.

47. Thank You