Journal of Anesthesia History最新文献

Spinal Anesthesia; Procaine; Fictions

The complicated history of modified electroconvulsive therapy (ECT) started back before anesthesia was incorporated when unmodified electroconvulsive therapy was not considered humane. When anesthesiologists started working with psychiatrists, ECT gradually regained acceptance by decreasing the obstacles inherent to this therapy despite the complexities of the anesthetics. However, the sociopolitical and medicolegal factors negatively impacted the use of modified ECT leading to a period of time when it was banned from use in the United States. Fortunately, as advances in anesthesia and technology continued to develop, anesthesiologists helped ECT regain widespread usage improving the safety profile, cost effectiveness, quicker onset of seizures, and ease of control despite its stained past. This allowed more accessibility, especially for high-risk medical patients, to a relatively safe and effective treatment for psychiatric diseases.

Horace Wells is discussed in a literary manner as a classic tragic hero. Wells’ apparent failed end is not the ultimate truth concerning him. His story helps us see and confront life. Many of the scientific, personal, and social issues he grappled with are relevant to us today such as human experimentation and drug addiction. His idealism and romantic pursuit are to be admired. We benefit today from the achievements of his daring and fateful quest.

Letheon was the commercial name that Boston dentist William T. G. Morton chose for his ether-based “preparation” that was inhaled to produce insensibility during surgical and dental procedures. The multiple editions of Edward Warren's Some Account of the Letheon (1847) as well as Nathan P. Rice's Trials of a Public Benefactor (1859) provide the only known accounts of the meeting hosted by the physician Augustus A. Gould at which the name Letheon was chosen. Neither Warren nor Rice mentions when the meeting occurred. In all likelihood, it was held at some point in a three-week period from mid-November to just short of December 9, 1846, the publication date of the earliest known reference to the name. The absence of the word Letheon in Morton's public notices around the end of November 1846 or, indeed, in any document until his December 9 advertisement in The Boston Medical and Surgical Journal suggests a later date for the meeting than has been previously reported.

Background

Within the history of intravenous anesthesia, barbiturates represent a chapter of considerable importance. Although the reference barbiturate thiopental had several limitations, it dominated the scene of the intravenous anesthesia until the mid-1980s, when propofol was introduced on the market. In the meantime, several barbiturate derivatives were placed on the market and abounded. This work is aimed at evaluating the clinical impact of the barbiturate derivatives methitural, analyzing the reasons for its rapid abandonment, in the late 1950s.

Methods

A systematic methodology of the search was associated with a descriptive analysis of the bibliography found. A computer-operated search strategy using Medline and Google Scholar databases was implemented. The algorithm was composed by using the words “Diogenal” OR “Thiogenal” OR “Methitural” OR “Metigenal” OR “Neraval” including biochemical and marketed terms. A manual search of the sources was carried out, and precise inclusion and exclusion criteria were established. The narrative synthesis was conducted taken into account the historical context of anesthesia.

Results

The database search yielded 3645 records. Nineteen records were identified through other sources. After duplicates removing (n = 238), and exclusion of not pertinent 3027 records, 314 full-text articles were assessed for eligibility. Of those, other 225 papers were excluded and 89 articles were included in the qualitative synthesis.

Conclusion

Although methitural could be useful in particular surgical settings such as short-acting surgery, and in patients with liver diseases, a limited advantage over thiopental, and its scarce market diffusion due to increased costs, have limited its use. Through a critical analysis of literature, the lack of high-quality studies does not allow us to draw definitive conclusions on the drug.

John Gillies was the founding head of the Department of Anaesthetics at the Royal Infirmary of Edinburgh, which began in 1940. An astute educator, he was instrumental in establishing anesthesia as a medical specialty, on equal footing with surgery, from the start of the National Health Service in 1948. Gillies’ kudos attracted medical graduates from the UK, USA and Canada to work in his Department. The excellence of his teaching and mentoring may be judged from the fact that no less than seven of his protégés became professors of anesthesia/anesthesiology. This paper identifies these seven professorial protégés and reviews their careers. Reasons for the successful consequences of John Gillies’ tutelage are considered.

Background

In 1970, Harold James Charles Swan and William Ganz published their work on the pulmonary artery catheter (PAC or Swan-Ganz catheter). They described the successful bedside use of a flow-directed catheter to continuously evaluate the heart, and it was used extensively in the years following to care for critically ill patients. In recent decades, clinicians have reevaluated the risks and benefits of the PAC.

Aim

We acknowledge the contributions of Swan and Ganz and discuss literature, including randomized controlled trials, and new technology surrounding the rise and fall in use of the PAC.

Methods

We performed a literature search of retrospective and prospective studies, including randomized controlled trials, and editorials to understand the history and clinical outcomes of the PAC.

Results

In the 1980s, clinicians began to question the benefits of the PAC. In 1996 and 2003, a large observational study and randomized controlled trial, respectively, showed no clear benefits in outcome. Thereafter, use of PACs began to drop precipitously. New less and noninvasive technology can estimate cardiac output and blood pressure continuously.

Conclusions

Swan and Ganz contributed to the bedside understanding of the pathophysiology of the heart. The history of the rise and fall in use of the PAC parallels the literature and invention of less-invasive technology. Although the PAC has not been shown to improve clinical outcomes in large randomized controlled trials, it may still be useful in select patients. New less-invasive and noninvasive technology may ultimately replace it if literature supports it.

The introduction of gas warfare in World War One was impactful, as it both expanded the breadth of warfare and fueled the invention of techniques required to treat these new injuries. Gas injuries were responsible for 91,000 of 1.3 million deaths in World War One. Gassed soldiers had wounds which the world had never seen. They presented in large scale to medical tents and base hospitals across Europe. As gas casualties poured in, doctors and nurses had to treat these conditions in the best way they knew. Gas warfare changed how war was performed and how casualties of this attack were treated. The techniques learned from treating the multitudes of men with gas burns led to advances in the field of burn care, which have helped to improve mortality and reduce morbidity in hospitals across the world.

The definitive account of the life and work of Horace Wells, the dentist from Hartford, Connecticut, who experimented with nitrous oxide anesthesia in 1844, is that published by W Harry Archer for the centenary of Wells's work. A major source of original material was a collection of letters, by Wells and others, that Archer found in the house in Hartford, Vermont, in which Wells was born. In later support for Wells being better recognized for his role in the introduction of general anaesthesia, Richard J Wolfe and Leonard F Menczer published a collection of essays in 1994. However, their preparation was hampered by their (mis)understanding that the ‘Archer’ letters (which were lodged in the Pittsburgh University Library) were “missing”, a belief which continued, but has been disproved by a new author. Before his death, John Bunker encouraged his anthropologist daughter, Emily, to continue a project he had been planning on the history of anesthesia, and the result is a new book, “Horace and Elizabeth: Love and Death and Painless Dentistry”. First and foremost Ms Bunker has discovered that the Archer Letters are very much available, and has been greatly helped by the University of Pittsburgh Library in producing her book. She has used reproductions and transcriptions of the letters (some previously unpublished) and other contemporary documents to illustrate Wells's role in the great discovery. Some of the material, especially from before the ‘Colton’ demonstration of 1844 is remarkable; it is almost like hearing the story from Wells himself.