Leo Fabian: A Life of Accomplishment.

Leo Fabian played a role in many anesthesia firsts: the first halothane anesthetics in the United States, the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. As was common for men of his generation, Fabian's first taste of medicine came during World War II, as a pharmacist's mate aboard the U.S.S. Bountiful. Afterward, he pursued his medical education before joining Dr. C. Ronald Stephen and the anesthesiology department at Duke. There he helped to create one of the first inhalers for halothane, the Fabian Newton Stephen (F-N-S) Fluothane Vaporizer. Fabian left Duke for the University of Mississippi Medical Center, where he consistently worked with the chair of surgery, Dr. James Hardy. Together they performed the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. By the end of his time at Mississippi, Fabian and Hardy had several philosophical disagreements, and Fabian ultimately left for Washington University in St. Louis, where he rejoined Dr. Stephen. He served as Stephen's right-hand man and would oversee the department when Stephen was away. Fabian spent the final years of his career as chair of the department before his own health forced him to step down.

The Second Anesthetists' Travel Club Meeting: Bootleggers, Madison and Ralph Waters!

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.

Intravenous Regional Anesthesia: A Historical Overview and Clinical Review.

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 20th 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.

How long is too long? The effect of the duration of anaesthesia on the incidence of non-urological complications after surgery.

OBJECTIVE: To examine the association between the duration of anaesthesia and non-urological complication (NUC) rates after surgery, as the increasing complexity of minimally invasive and laparoscopic procedures in urology has resulted in longer surgery and anaesthesia, and information on the effect of this on NUC rates is limited. PATIENTS AND METHODS: We identified 2196 patients who had open radical nephrectomy or nephron-sparing surgery at our institution between 1989 and 2002. Patients were subdivided into groups I, II, and III according to the duration of general anaesthesia (<4, 4-6 and > or =6 h, respectively). NUCs after surgery, and mortality during and after surgery, were evaluated. RESULTS: There were 1340, 723, and 133 patients in groups I, II and III, respectively. The incidences of any NUC were 3.1%, 5.8% and 13.5%, respectively. The odds ratios for the likelihood of a NUC were 1.91 (P = 0.004) and 4.84 (P < 0.001) for groups II and III, respectively. These differences remained significant even after adjusting for patient and tumour characteristics. Perioperative mortality was highest in group III, at 2.3%, vs 0.4% in groups I and II. CONCLUSIONS: Longer anaesthesia is associated with an increase in the incidence of perioperative complications and mortality, especially when the duration of anaesthesia is >6 h. This increase appears to be independent of patient's preoperative health status, tumour extent and blood loss.

Exploring origins: was John Bonica's model of modern-day pain management influenced by John Lundy's earlier work?

Contemporary pain medicine is a multimodality and multidisciplinary field. Many of the current ideas and styles of practice that influence the specialty today can be traced back to John Bonica, M.D., and his model of pain management introduced more than 50 years ago. Although much of the foundation that Bonica helped form involved several original concepts, historically, other anesthesiologists who were Bonica's predecessors also laid the groundwork for what the practice of pain medicine is today. In particular, Emery Rovenstine, M.D., and John Lundy, M.D., had early block clinics to treat painful conditions. While in the army during World War II, Bonica worked closely with his Chief of Surgery, Joel Deuterman, M.D., a physician who had trained at the Mayo Clinic, where he was exposed to Lundy and his techniques. Deuterman may have influenced Bonica's ideas concerning the treatment of chronic painful conditions.

Seeing an anesthetic revolution: ocular anesthesia in history.

Each surgical procedure places unique demands on the anesthesiologist to create surgical anesthesia with minimal physiologic trespass on the patient as well as the surgical repair. In surgery of the eye, the quest for an anesthetic that does not harm the eye or the patient can be a challenge. The removal of cataracts is one of the most frequently performed operations in the United States, and the majority of patients requiring the procedure are elderly and often have other significant medical conditions.

The Anaesthetists' Travel Club: a transformation of the Society of Clinical Surgery?

There is a remarkable similarity between the purposes and formats of the Society of Clinical Surgery and the Anesthetists' Travel Club. The Travel Club's founder, John Lundy, worked closely with two charter members of the Society of Clinical Surgery,William J. and Charles Mayo.

Myocardial stunning during abdominal hysterectomy in a healthy woman.

We report a case of myocardial stunning in a healthy patient. During gynecologic surgery, two brief episodes of asystole occurred. Following resuscitation there was a short period of severe hypertension and tachycardia. Electrocardiographic changes and elevations in troponin T and creatine-kinase-MB were observed. Angiography revealed normal coronary arteries and multiple areas of hypokinesis. Within 2 weeks, all abnormal values had returned to normal and the patient underwent an uneventful surgery.