Physicians as far back as the Sumerians (3000 BC) attempted to reliably sleep–and wake afterwards–patients undergoing surgery. Along the road, an array of agents and modalities useful in attenuating pain–e.g., opium, alcohol, and acupuncture were identified and added to the therapeutic war chest.* However, the desired effect–general anesthesia, i.e., the complete loss of consciousness and muscle relaxation, proved elusive to Western practitioners.
*Hanaoka Seishu (1760-1835), a Japanese surgeon of the Edo period with knowledge of Chinese herbal medicine and Western surgical techniques was the first modern physician to perform surgery under general anesthesia. He used an anesthetic potion, tsusensan, containing scopolamine, hyoscyamine, atropine, aconitine and angelicotoxin, that produces a state of general anesthesia and skeletal muscle paralysis, which allowed him to perform limb amputations and mastectomies…150 of the latter before he died in 1835.
Demonstration of anesthesiology at Massachusetts General Hospital, 1846
Anesthesiology’s watershed events hinged on inhalation anesthetics. Diethyl ether was discovered in 1275, its analgesic properties recognized in 1525. Humphry Davy (1778-1829), no slouch around the chemistry set, produced and purified nitrous oxide (laughing gas) in the late 1700s, realized its anesthetic properties and, as history records it, became addicted to it. Like a good scientist, he published his results. By the 1830s, Davy’s work was being read in the USA, which led to the so-called “ether frolics”, in which itinerant lecturers let their audiences test drive the mind-numbing effects of diethyl ether and nitrous oxide. Dentists were the first to use diethyl ether for extracting teeth. Although the primacy of the practitioner and event have been vigorously debated, William TG Morton, a dentist, is generally credited with the first public demonstration of general (inhalation) anesthesia, which took place at Mass General* on 16 October 1846, using diethyl ether.
*Massachusetts General Hospital, Boston. History shows that Crawford W Long, a physician and pharmacist, administered diethyl ether by inhalation as a general anesthetic to remove a tumor of the neck from one James Venable on 30 March 1842, but because he didn’t publish his work until 1849, lost out on the credit he deserved…you snooze, you lose…
In addition to nitrous oxide and diethyl ether, chloroform was used as an inhalation agent until its cardio- and hepatotoxicity appreciated, at which point it was shelved. By the late 19th century, the nascent field of anesthesiology was evolving along multiple fronts:
• Airway management The mandatory tracheotomy of early inhalation anesthesia gave way to orotracheal intubation (Scottish surgeon W Macewen, 1880). Shortly thereafter, Kirstein developed a laryngoscope for direct visualization of the vocal cords (1895). Mask inhalation anesthesia for oral and maxillofacial surgery, the previous standard, carried the risk of airway obstruction and pulmonary aspiration, was replaced using an improved laryngoscope which allowed direct intratracheal insufflation of volatile anesthetics (C Jackson, 1913, HH Janeway, 1913).
• Sedation The 20th century saw the development of hypnotics–e.g., barbital (Fischer, von Mering, 1902), thiopental (Volwiler, 1934), haloperidol (Janssen, 1958), fentanyl, a piperidinone-derived opioid (Janssen, 1960), and etomidate, an IV induction agent (Janssen, 1964). These agents have been used as stand-alones or for inducing general anesthesia.
• Improved inhalation agents Halothane was first synthesized in 1955 and because a mainstay general anesthetic, replacing the highly explosive diethyl ether. Side effects included arrhythmias, respiratory depression and, in rare cases (circa 1:10,000), hepatotoxicity of biblical magnitude. It has been replaced by newer agents–e.g., sevoflurane.
In the USA, physicians specialized in anesthesiology are called anesthesiologists and have trained for four years after medical school. In the UK, they are called anaesthetists and have trained for 9 years after medical school. Terms in the Modern Medical Dictionary database which are germane to anesthesiology and already tagged for searching include analgesic ladder, conscious sedation, difficult airway, 8-hour rule, extracorporeal membrane oxygenation, forced duction test, medical air, Meyer Overton rule, narcotrend index, one-lung anaesthesia, planes of anesthesia, potency, pre-emptive analgesia, stress induced analgesia, tumescent anesthesia, and vocal anesthesia. We anticipate releasing a beta encompassing these and other terms related to current anesthesia practice within the next 18 months.