Journal of Anesthesia History最新文献

The second annual meeting of any organization is almost as critical as the first. A second meeting begins to assure the viability and importance of the organization. After the very successful first meeting of the Anesthetists' Travel Club in Rochester, Minnesota, in December of 1929, Ralph Waters (1883-1979) was charged with hosting the 1930 meeting at the University of Wisconsin in Madison. The meeting was held Thursday December 18th through Saturday December 20th. Dr. Waters started the meeting at 8:00 am with a tour of the operating rooms of the Wisconsin General Hospital. Lunch followed at the Memorial Union with the afternoon split between experimental surgery, and the anatomy, and physiology laboratories. There was an early dinner before the group took in the basketball game between the University of Pennsylvania and the University of Wisconsin. Friday's meeting was very similar; starting in the operating rooms at 8:00 am followed by a Union Club lunch. The afternoon was spent in the Pharmacology laboratory with a 4:00 pm lecture entitled “Demonstration Clinical Effects of Barbiturates in Neuropsychiatry”. Dinner was held at the University Club. Saturday's program followed the same lines, but with an afternoon tea and a dinner at the Waters' home. In February1931, almost a year to the date from his first note, Waters wrote to those who had attended the meeting. He followed up on the clinical cases the group had seen, and commented upon the Guedel-Waters balloons for endotracheal tubes and the spinal he had performed. He even commented upon the use of cyclopropane in obstetrics. Thus, the Anesthetists' Travel Club meeting in 1930 successfully concluded.

Used as a ventilator for assisting victims of polio, the barospirator was described by Swedish physician-scientist Torsten Thunberg in 1924. An immediate predecessor of the iron lung of Philip Drinker, the barospirator fully encased the entire body. Cyclic air-pressure changes within the chamber achieved ventilation during equilibrations of intrapulmonary and ambient pressures. Pulmonary medicine innovator Alvan Leroy Barach used a modified barospirator for lung rest as a treatment of tuberculosis in the 1940s. Adverse effects included damage to patients' tympanic membranes. Despite its limited clinical success, the barospirator was successfully used by one of Drinker's competitors, John H. Emerson, to invalidate Drinker's US patent filings.

Intravenous regional anesthesia (IVRA) is an established, safe and simple technique, being applicable for various surgeries on the upper and lower limbs. In 1908, IVRA was first described by the Berlin surgeon August Bier, hence the name “Bier’s Block”. Although his technique was effective, it was cumbersome and fell into disuse when neuroaxial and percutaneous plexus blockades gained widespread popularity in the early 20^th century. In the 1960s, it became widespread, when the New Zealand anesthesiologist Charles McKinnon Holmes praised its use by means of new available local anesthetics.

Today, IVRA is still popular in many countries being used in the emergency room, for outpatients and for high-risk patients with contraindications for general anesthesia. IVRA offers a favorable risk-benefit ratio, cost-effectiveness, sufficient muscle relaxation and a fast on- and offset. New upcoming methods for monitoring, specialized personnel and improved emergency equipment made IVRA even safer. Moreover, IVRA may be applied to treat complex regional pain syndromes.

Prilocaine and lidocaine are considered as first-choice local anesthetics for IVRA. Also, various adjuvant drugs have been tested to augment the effect of IVRA, and to reduce post-deflation tourniquet pain. Since major adverse events are rare in IVRA, it is regarded as a very safe technique. Nevertheless, systemic neuro- and cardiotoxic side effects may be linked to an uncontrolled systemic flush-in of local anesthetics and must be avoided.

This review gives a historical overview of more than 100 years of experience with IVRA and provides a current view of IVRA with relevant key facts for the daily clinical routine.

Initially devised in the 1890s, the traditional anesthetic record comprises physiological changes, crucial anesthetic or surgical events, and medications administered during the perioperative period. The timely collection of quality data facilitates situational awareness and point-of-care clinical decision making. The burgeoning volume and complexity of data in conjunction with financial incentives and the push for improved clinical documentation by regulatory bodies have prompted the transition away from paper records. Anesthesia Information Management Systems (AIMS) are specialized electronic health record networks that allow the anesthesia record to interface with hospital clinical data repositories, resulting in improvements in quality of care, patient safety, operations management, reimbursement, and translational research. Like most new technological advances, adoption was slow at first due to the challenges of integrating complex systems into daily clinical practice, questions about return on investment, and medicolegal liability. Recent technological advances, coupled with government incentives, have allowed AIMS adoption to reach an acceleration phase among US academic medical centers; widespread utilization of AIMS by 84% of US academic medical centers is expected by 2018-2020. Adoption among nonacademic US and European medical centers still remains low; information concerning Asian countries is limited to literature describing only single–hospital center experiences.

Background

New therapies are created to address specific problems and enjoy popularity as they enter widespread clinical use. Broader use can reveal unknown adverse effects and impact the life cycle significantly. Succinylcholine, a depolarizing neuromuscular blocker, was the product of decades of research surrounding the ancient compound, curare. It was introduced into practice in the 1950s by Burroughs Wellcome and Company (BW Co) and was welcomed due to its rapidly acting muscle relaxation effects. Global clinical use revealed adverse effects, both minor and major, in particular, hyperkalemia and malignant hyperthermia. We investigated when practitioners and the manufacturer became aware of these adverse effects, how information about these side effects was disseminated, and whether the manufacturer met the regulatory requirements of the time, specifically regarding the timely reporting of adverse effects.

Sources

Primary literature search using online and archived documents was conducted at the Wood Library-Museum of Anesthesiology, Schaumburg, IL. We consulted documents submitted by BW Co to federal authorities, through the Freedom of Information Act (FOIA), Food and Drug Administration (FDA) reports, promotional advertisements, package inserts, published articles, and textbooks.

Results

Initial clinical testing in humans in 1952 found no adverse effects on cardiovascular or respiratory systems. Fasciculations and myalgia were early side effects described in case reports in 1952. Large-scale clinical trials in 1953 found abnormally long recovery times among some patients; the discovery of abnormal pseudocholinesterase enzyme activity was not fully demonstrated until the early 1960s. Bradycardia was first reported in 1957 in children, and in 1959 in adults. In 1960, animal studies reported a transient increase in plasma potassium; further experiments in 1969 clearly demonstrated succinylcholine-induced hyperkalemia in burn patients. Malignant hyperthermia was first described in 1966. Similar cases of elevated temperatures and muscle rigidity were described globally but the underlying mechanism was not elucidated until the 1990s. Standard anesthesia textbooks did not report major side effects of succinylcholine until 1960 and included newly documented side effects with each edition. BW Co's packaging contained warnings as early as the 1950s but were later updated in 1962 and beyond to reflect the newly discovered hyperkalemia and malignant hyperthermia.

Conclusion

Particularly given the regulatory environment of the time, BW Co appropriately reported the adverse effects of succinylcholine after market entry; it updated promotional and packaging material in a timely manner to reflect newly discovered adverse effects. The toxicity, though al