History of pediatric regional anesthesia.

The history of local and regional anesthesia began with the discovery of the local anesthetic properties of cocaine in 1884. Shortly afterwards nerve blocks were being attempted for surgical anesthesia. Bier introduced spinal anesthesia in 1898, two of his first six patients being children. Spinal anesthesia became more widely used with the advent of better local anesthetics, stovaine and procaine in 1904-1905. Caudals and epidurals came into use in children much later. In the early years these blocks were performed by surgeons but as other doctors began to give anaesthetics the specialty of anesthesia evolved and these practitioners gradually took over this role. Specific reports of their use in children have increased as pediatric anesthesia has developed. Spinals and other local techniques had periods of greater and lesser use and have not been universally employed. Initial loss of popularity seemed to relate to improvements in general anaesthesia. The advent of lignocaine (1943) and longer acting bupivacaine (1963) and increasing concern about postoperative analgesia in the 1970-1980s, contributed to the increased use of blocks.

A history of intraspinal analgesia, a small and personal journey.

INTRODUCTION: There is a large and robust literature on the spinal use of opioids and non-opioids alike, but unless one is my age and older, very few persons know how we got here. This small history offering tells us how we got to where we are today regarding the science, clinical uses, and management of intraspinal analgesia. METHODS: I have reviewed the literature bases of Google Scholar and the National Library of Medicine using the key words: history, opium, spinal analgesia, spinal morphine, intrathecal (IT), opioid receptors, endogenous opioids, IT delivery of opioids, and IT side-effects/complications. RESULTS: In this personal review of the history of intraspinal analgesia, I relate my own early and later experiences of the science and clinical uses of intraspinal morphine, other opioids, and non-opioids alike to a historical context. This review outlines a rather small history of opium, the historical use of opium and its various compounds, and the search for and answer to the question, "why was the poppy created for wondrous medicinal uses for mankind?" This search led to the discovery of endogenous opioid like chemicals, the discovery of opiate receptors for these endogenous opioids, the first uses of intraspinal opioids in animal models and man, and, finally, our understanding of the appropriate and inappropriate clinical uses of intraspinal analgesia. Within this paper, I acknowledge the works of my colleagues and the "heroes" who have laid the foundation for our understanding of intraspinal analgesia. CONCLUSIONS: The history of the use of intraspinal analgesia is rich and guides us to advance the science and clinical use of intraspinal analgesia without reinventing the wheel.

Positive-pressure ventilation, spinal anesthesia, and Rudolph Matas: the anesthetic contributions of an inquisitive surgical legend.

Dr. Rudolph Matas, in addition to being one of the pioneering and most prestigious vascular surgeons of the 19th century, was an influential figure in the development of anesthesiology in the United States (US). His inquisitive nature and determination to understand medicine were tremendous influences in his development of innovative approaches to solve surgical and medical problems. Driven by such curiosity and determination, Dr. Matas made pivotal contributions in the historical timeline of current anesthesiological practice, including the use of spinal anesthesia and positive-pressure ventilation during thoracotomies.

Anesthesia in the late 1960s at Peter Bent Brigham Hospital, Boston: A case report.

BACKGROUND: Regional and general anesthesia were widely available in the United States in the late 1960s. The risk of permanent neurological sequelae resulting from spinal anesthesia had largely been dismissed. Although many academic departments of anesthesiology had gained independent status, a significant number operated as divisions within the department of surgery. We present a case report from Peter Bent Brigham Hospital to illustrate the state of anesthetic techniques in use during the late 1960s, and the power dynamics vis-à-vis physician anesthesiologists and surgeons. SOURCES: Hospital records and interviews with individuals familiar with the case. FINDINGS: An otherwise healthy patient underwent inguinal hernia repair. The resident anesthesiologist conducted a preoperative assessment the evening prior to surgery with the patient consenting to the spinal anesthesia, a plan agreeable to the faculty anesthesiologist. The attending surgeon was one of the most prominent surgeons in America and the chairman of their department. He disapproved of the planned anesthetic. Subsequent modifications to the anesthetic plans are discussed, as is the fallout from those actions. CONCLUSION: Spinal anesthesia remained a popular anesthetic option during the late 1960s. General anesthesia with ether, halothane, and other agents an alternative. This case highlights various aspects of perioperative management during a period when many American academic departments of anesthesiology existed as divisions within the department of surgery. It also touches upon the careers of two prominent American physicians.

Continuous spinal anesthesia.

Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a somewhat unpredictable spread and duration of effect, CSA allows titration of the block level to the patient's needs, permits a spinal block of indefinite duration, and can provide greater hemodynamic stability than single-injection spinal anesthesia.

Juan Evangelista Manrique, the true pioneer of spinal anesthesia in Colombia / El verdadero pionero de la raquianestesia en Colombia: Juan Evangelista Manrique

Abstract Several findings paved the way to the use of the spinal approach for anesthesia. Information about the originators and dates of their discoveries is controversial. According to personal communications, doctors Juan Bautista Montoya y Flórez, in Medellín, and Lisandro Leyva, in Bogotá, in 1904 and 1905 respectively, would appear to be the pioneers of spinal anesthesia in Colombia. Pioneering cases of this procedure carried out in 1901 by doctor Juan Evangelista Manrique and which continued to be performed by his colleagues and assistants of the medical community at the time are documented in the Corporis Fabrica dissertation collection of the National University of Colombia.

Resumen Son varios los hallazgos que contribuyeron al abordaje de la columna vertebral como vía para la administración de anestesia. Los autores y las fechas de tales descubrimientos han sido controvertidos. En Colombia, según fuentes orales, los doctores Juan Bautista Montoya y Flórez, en Medellín, y Lisandro Leyva, en Bogotá, en 1904 y 1905 respectivamente, serían los pioneros de la anestesia raquídea en Colombia. En las tesis de la Facultad de Medicina de la Universidad Nacional, Colección Corporis Fabrica, se documentan los casos pioneros de este procedimiento realizados en 1901, por el doctor Juan Evangelista Manrique y continuados enseguida por sus colegas y ayudantes de la comunidad médica de ese entonces.

Ryszard Rodzinski-A Forgotten Polish Inventor and Pioneer of Combined Spinal-Epidural Anesthesia.

Dr. Ryszard Rodzinski was a Polish surgeon who, in spite of his short life, had a productive career. His most important discovery was a safer method of performing regional anesthesia for abdominal surgery. The first description of combined spinal epidural anesthesia is generally attributed to Soresi in 1937. In the early 20th century, Rodzinski invented a novel technique, "combined lumbosacral anesthesia," which combined lumbar spinal anesthesia and sacral epidural anesthesia. During the 19th Meeting of Polish Surgeons in July 1922 in Warsaw, Rodzinski presented an article entitled "On Combined Lumbosacral Anaesthesia," in which he described this technique used in surgical clinic in Lwów since October 1921. Given this presentation, Rodzinski could be considered to have made the first known presentation of the combined spinal and epidural anesthesia.

Two surgeons who popularized spinal anesthesia.

Because of the significant mortality associated with general anesthesia in the early decades of the 20th century, two US surgeons--George Pitkin and Wayne Babcock--suggested suitable alternatives. Believing in the greater manageability and safety of regional and spinal anesthesia, each investigated these techniques, employing them for surgery and went on to popularize the rational use of regional anesthesia. Reg Anesth Pain Med 2001;26:278-282.

Edward Tuohy: the man, his needle, and its place in obstetric analgesia.

The introduction of a needle designed by Ralph Huber and Edward Tuohy made continuous epidural anesthesia for labor possible. Neither the needle nor the regional anesthetic technique evolved in a vacuum; both were the culmination of a range of ideas developed by individuals around the world.

The versatile August Bier (1861-1949), father of spinal anesthesia.

"A professor is a gentleman with a different point of view." This characteristic and sarcastic statement was often recited by August Bier (1861-1949) and can also be aptly applied to him. As the father of spinal and intravenous regional neural blockade, Bier had a tremendous impact on surgery and anesthesia. It took him only two years to become a senior lecturer in surgery (so-called "Habilitation") under the guidance of Friedrich von Esmarch. In 1899, he was appointed chairman of the Department of Surgery at the University of Greifswald. From there, he moved to the University of Bonn in 1903 and then succeeded Ernst von Bergmann in Berlin in 1907. Bier's interest in the philosophical theories of Hippocrates and Heraclitus had a significant influence on his outlook on medical practice. His surgical colleagues disapproved of this and his interest in homeopathy. On the other hand, he earned much respect as the co-author of a surgical textbook, i.e., Chirurgische Operationslehre (Operative Surgery). He had a remarkable breadth of nonmedical interests, including philosophy and forestry, and the ideas he expressed are viable even today. His publications on philosophical subjects are as up to date as his concepts in forestry. In 1932, Bier finally decided to retire, although by then he was no longer operating. From that time on, he lived out his days at his estate in Sauen, and he died in 1949 at the age of 88. In this paper we describe some previously unknown aspects of Bier's work in both surgery and research; anesthesiologists and their patients are the beneficiaries of two other of his inventions, namely, spinal and IV local anesthesia. Unfortunately, it is not possible to acknowledge all the innovations of this ingenious surgeon, who truly deserved the description "A professor is a gentleman with a different point of view."

[Continuous spinal analgesia. A review]. / Kontinuerlig spinal analgesi. En oversigt.

Continuous spinal analgesia is a recognized method of analgesia for surgical interventions which was originally described in 1907. A brief historical review is presented with a description of the current technique. Emphasis is laid on comparison with other regional techniques, particularly single-shot analgesia and epidural analgesia. A review is presented of the current knowledge about technique, particularly the equipment, analgesic agents, advantages and disadvantages and indications and contraindications. it is concluded that continuous spinal analgesia probably offers certain advantages, particularly cardiovascular stability. However, the lack of randomized comparisons of the various techniques make further clinically controlled investigations necessary to illustrate this.