麻醉学的发展历程及未来

Anesthesiology,Yesterday,TodayandTomorrowAdolphH.GieseckeMD.RetiredJenkinsProfessorandFormerChairman,AnesthesiologyandPainManagement,UTXSouthwesternMedicalCenter,DallasTX.TheFirstAnesthesiologist.1"AndtheLordGodcausedadeepsleeptofalluponAdam,andheslept."Genesis2:21.

ManagingPainBeforeAnesthesiaLocalapplicationofcoldwater,iceorpressure.Plantsandextracts.Cocaleaveschewedandsalivadrippedintoinjuredareasoropenwounds-IncaShamans.Alcoholor/withopiumorhemp–“soporificsponge.”HypnosisMostcommon,Opiumpoppy,Papaversomniferum,

MandragoraormandrakefromAtropamandragora,belladonnafromtheMorningGlory,marijuanaorCannabisindica.OpiumInthose“dark”daysmanypatientsapproachedsurgeryasthroughfacingexecution,

anoftenappropriateassessmentofuncontainedrisks,includingpain,hemorrhage,shockandpostoperativeinfection.Theeasiestpaintobearissomeoneelse’s.SeishuHanaoka,1760-1835.2“AngelofMedicine.”Dutytorelievepain.“Tsusensan”1805.Motherandwifevolunteered.Breastcancerremovedwithtsusensan10/13/1805. Hanaoka1805GoldenEpochsofAnesthesiology

I.Inhalationanesthesia,1846.II.Regionalanesthesia,1884.III.Intravenousanesthesia, 1932.IV.Neuromuscularblockers,1942.V.Precisionanesthesia,1986.GoldenEpochsofAnesthesiology

I.Epochofinhalationanesthesia,1846.ETHERDAY.3Successfulpublicdemonstration10/16/1846atMGH.EtherDome,nowanationalshrine.WilliamThomasMorton1819-68.3Clothingmerchant,swindler,dentist,medicalstudent.AttendedWells’demonstrationofN2Oin1845.Ideaofmorepotentagent,etherfromJackson.Patented“Letheon.”Ether“Sweetvitriol”discovered1275bySpanishchemistRaymundusLullius.1540,synthesisofetherdescribedbyGermanscientist,ValeriusCordus.SwissphysicianandalchemistParacelsusdiscoveredthehypnoticeffectsofether.CrawfordWilliamsonLong

(1815-1878).4Firsttouseetherforsurgery.“Discovererofanesthesia?”

03/30/1842painlessremovalofnecktumorafterdroppingetheronacloth(anesthesiafee0.25).Discoveryunpublished,predatesMorton’spublicdemonstrationby4years.TheanniversaryofLong’sgreataccomplishment,March30th,iscelebratedintheUnitedStatesas“Doctor’sDay”,andallmedicalspecialtiesarehonored.SirHumphreyDavy(1778-1829)SuperintendentofThomasBeddoes'sPneumaticInstitute.

Rxpulmonarytuberculosisbyinhalingvariousgases,N2O,H2,O2,andCO2.

HumphreyDavy.4

1800Researches,ChemicalandPhilosophical:ChieflyConcerningNitrousOxide.HedescribedinhalingN2Ohimselfandobtainingrelieffromapainfulcondition.HesuggestedN2Omightbeusedforsurgery,44yearsbeforeHoraceWells.

Drawingfromthe18thcenturydepictingtherecreationaluseofnitrousoxide

-laughinggas

HoraceWells(1815-1848).5

AttendedademonstrationofN2OconductedbyQuincyColton,12/10/1844.NoticedthatamanintoxicatedbyN2Olaceratedhisleg,andfeltnopainorrecall.

Thenextday,WellsaskedColtontoadministerN2O,whileanassociateextractedatooth.DemonstratedN2OatHarvard01/1845,patientcried,studentshissed“Humbug.”Addictedtochloroform.Arrestedforthrowingacidonprostitutes,committedsuicideinjail.Pushedaknowntoxintounconsciousness.HoraceWells.Inhalationlandmarks JohnSnow(1813-58),preventivemedicine,firstfulltimeanesthesiologist.JamesSimpson(1811-70),ChairofMidwiferyEdinburgh,OBanesthesia01/1847,chloroform1847.HenryBoyle,firstanesthesiamachine1917.RalphWaters,CO2absorbtion1924.IvanMagill,endotrachealintubation1920.GoldenEpochsofAnesthesiology

II.Epochofregionalanesthesia,1884.KarlKoller1857-1944OphthalmologistinVienna.DissatisfiedwithGAforeyesurgery.Restlessandcoughingduringsurgery,vomitingandpainpostop.1884withSigmundFreudintroducedcocainefromErythroxyloncoca.LandmarksinRegionalAnesthesiaWilliamHalstead,nerveblocksoffaceandarm1886,addictedtococaine.AugustBier,spinalanesthesia1898.VirginiaApgarpromotesregionalanalgesiainchildbirth1930.VirginiaApgar1909-1974.6Devisedasystemforgradingthenewborn’scondition,“ApgarScore.”PromotedR.A.whichrelievedlaborpainwithoutinterferingwiththebaby.FeaturedonUSPostagestamp.GoldenEpochsofAnesthesiology

III.Epochofintravenousanesthesia,1932.JohnS.Lundy,1894-19731903BarbitonesynthesisbyFischer,Berlin,NobelPrize.1932EvipanusedIVbyWeeseSchraff,&Rheinoff.1934Lundy,MayoClinicusedSodiumPentothal.GoldenEpochsofAnesthesiology

IV.Epochofneuromuscularblockers,1942.NeuromuscularBlockingDrugs 1942CurarefirstusedclinicallybyGriffithandEnidJohnsoninMontreal.PaleopharmacologyofcurarePaleopharmacologyofcurareNMBAs1812Watertonbrought“woorara”fromGuianatoEngland,inoculated3donkeys,2died,onesurvivedwithtracheostomyandIPPV.1857ClaudeBernardpublishedthatcurareblockedtheNMJ.1940Bennettusedcuraretomodifyseizuresinducedbymetrozol.ClaudeBernard,1857GoldenEpochsofAnesthesiology

V.Epochofprecisionanesthesia,1986.EllisonPierceMD,Pres.ASA1984.ABC20/20,“TheDeepSleep,6000willsufferbraindamage”4/22/1982.StandardsforBasicAnestheticMonitoringASAHouseofDelegates10/21/1986.AnesthesiaPatientSafetyFoundation1984.HarveyCushing,1869-1939PulseOximetry,1973,1983.ModernAnesthesiaMachine.AnesthesiaMortality.71:1000in1960.1:240,000in2002GoldenEpochsofAnesthesiology

I.Inhalationanesthesia,1846.II.Regionalanesthesia,1884.III.Intravenousanesthesia, 1932.IV.Neuromuscularblockers,19