[The Stadium analgeticum - Historical Highlights on the Ether Rush]. / Das Stadium analgeticum ­ historische Streiflichter zum Ätherrausch.

For decades, the term ether rush was synonymous with the practice of short-term anaesthesia, among patients and doctors. The term was first used shortly after the discovery of the anaesthetic properties of ether by Hamburg-based physician Elias Salomon Nathan in an article about the newly discovered ether anaesthesia. Decades later, the surgeon Paul Sudeck, who also worked in Hamburg, also described an anaesthetic technique he practiced as an ether rush and met with great approval from his surgical colleagues, as well as for his anaesthetic mask developed for carrying out the ether rush and the anaesthetic dropper, specified for this purpose.Sudeck did not want to be regarded as the inventor of the special anaesthetic technique and repeatedly pointed out that his procedure had already been described and applied before him, but was forgotten again. Nevertheless, Sudeck's ether rush remained a well-known, widespread analgesic method in German-speaking countries until the end of the 1940s, and it proved its worth many times during the World War. After 1945, when ether lost its pre-dominant role as an inhalation anaesthetic and was replaced by other, new agents and short-acting i. v. administered analgesics, the ether rush was also fell into oblivion and was no longer used.Against the background of the first successfully performed ether anaesthesia on October 16th, 1846 - 175 years ago - at the Massachusetts General Hospital in Boston, the description of the ether rush should be recalled in this context.

Anesthesia and World War II: When the Battlefield Becomes a Research Field-A Bibliometric Analysis of the Influence of World War II on the Development of Anesthesiology.

At the outbreak of World War II (WWII), anesthesiology was struggling to establish itself as a medical specialty. The battlefield abruptly exposed this young specialty to the formidable challenge of mass casualties, with an urgent need to provide proper fluid resuscitation, airway management, mechanical ventilation, and analgesia to thousands. But while Europe was suffering under the Nazi boot, anesthesia was preparing to rise to the challenge posed by the impending war. While war brings death and destruction, it also opens the way to medical advances. The aim of this study is to measure the evolution of anesthesia owing to WWII. We conducted a retrospective observational bibliometric study involving a quantitative and statistical analysis of publications. The following 7 journals were selected to cover European and North American anesthesia-related publications: Anesthesia & Analgesia, the British Journal of Anaesthesia, Anesthesiology, Schmerz-Narkose-Anaesthesie, Surgery, La Presse Médicale, and The Military Surgeon (later Military Medicine). Attention was focused on journal volumes published between 1920 and 1965. After reviewing the literature, we selected 12 keywords representing important advances in anesthesiology since 1920: "anesthesia," "balanced anesthesia," "barbiturates," "d-tubocurarine," "endotracheal intubation," "ether," "lidocaine," "morphine," "spinal anesthesia," "thiopental," "transfusion," and "trichloroethylene." Titles of original articles from all selected journals editions between 1920 and 1965 were screened for the occurrence of 1 of the 12 keywords. A total of 26,132 original article titles were screened for the occurrence of the keywords. A total of 1815 keywords were found. Whereas Anesthesia & Analgesia had the highest keyword occurrence (493 citations), Schmerz-Narkose-Anaesthesie had the lowest (38 citations). The number of publications of the 12 keywords was significantly higher in the postwar than in the prewar period (65% and 35%, respectively; P < .001). Not surprisingly, the anesthesiology journals have a higher occurrence of keywords than those journals covering other specialties. The overall occurrence of keywords also showed peaks during other major conflicts, namely the Spanish Civil War (1936-1939), the Korean War (1950-1953), and the Vietnam War (1955-1975). For the first time, this study demonstrates statistically the impact of WWII on the progress of anesthesiology. It also offers an objective record of the chronology of the major advances in anesthesiology before and after the conflict. While the war arguably helped to enhance anesthesiology as a specialty, in return anesthesiology helped to heal the wounds of war.

Rise and decline of the barbiturate methitural for intravenous anesthesia: A systematic search and narrative synthesis.

BACKGROUND: Within the history of intravenous anesthesia, barbiturates represent a chapter of considerable importance. Although the reference barbiturate thiopental had several limitations, it dominated the scene of the intravenous anesthesia until the mid-1980s, when propofol was introduced on the market. In the meantime, several barbiturate derivatives were placed on the market and abounded. This work is aimed at evaluating the clinical impact of the barbiturate derivatives methitural, analyzing the reasons for its rapid abandonment, in the late 1950s. METHODS: A systematic methodology of the search was associated with a descriptive analysis of the bibliography found. A computer-operated search strategy using Medline and Google Scholar databases was implemented. The algorithm was composed by using the words "Diogenal" OR "Thiogenal" OR "Methitural" OR "Metigenal" OR "Neraval" including biochemical and marketed terms. A manual search of the sources was carried out, and precise inclusion and exclusion criteria were established. The narrative synthesis was conducted taken into account the historical context of anesthesia. RESULTS: The database search yielded 3645 records. Nineteen records were identified through other sources. After duplicates removing (n = 238), and exclusion of not pertinent 3027 records, 314 full-text articles were assessed for eligibility. Of those, other 225 papers were excluded and 89 articles were included in the qualitative synthesis. CONCLUSION: Although methitural could be useful in particular surgical settings such as short-acting surgery, and in patients with liver diseases, a limited advantage over thiopental, and its scarce market diffusion due to increased costs, have limited its use. Through a critical analysis of literature, the lack of high-quality studies does not allow us to draw definitive conclusions on the drug.

Servicio de Anestesiología del Hospital de Urgencia Asistencia Pública: ¿Quiénes somos? / Anesthesia in Asistencia Pública Hospital. Who are we?

The Asistencia Pública was founded on August 7, 1911. It was conceived as a public hospital focused on emergency medicine. Its first location was a building acquired from the Franciscan community located at N° 85 San Francisco street, at the intersection with San Carlos street (later renamed as Alonso Ovalle). A new building was inaugurated on December 15, 1967 and its infrastructure allowed the development of various services and units that modernized, expanded and improved emergency patient care. Recently, a new facility was incorporated, called Torre Valech, inaugurated in February 2019, housing modern facilities for the emergency service, the surgical pavilions and the intensive care unit. The year 1936 marked a milestone for the Anesthesiology, due to the work of Ernesto Frías, MD, specialist trained in United States and Argentina, who organized for the first time an annual anesthesia course, working on an basis. Nevertheless, the true founder of the Anesthesiology Service and Intensive Care Unit of the José Joaquín Aguirre Hospital, was Dr. Max Arriagada Loyola. He was also a pioneer in allowing medical students to do the work of technical assistants in the specialty, during their undergraduate studies. During the eighties, the Asistencia Publica's Anesthesiology Service added new specialists who were filling the available positions both, during the daytime and on call hours. Incorporation of new technology also allowed to offer more complex and safer anesthesia procedures. Teaching has been a fundamental part of the activities of the service since its creation. First with of Dr. Arriagada's disciples, then, with the Ministerial Training Program for Anesthesiologists which in 1999 became the Postgraduate Program in Anesthesiology and Resuscitation of the Universidad de Santiago de Chile. In 2013 the program was accredited for the first time.

La Asistencia Pública fue fundada el 7 de agosto de 1911, pensada como un servicio hospitalario público centrado en los pacientes de urgencia. Su primera ubicación fue un local adquirido a la comunidad franciscana ubicada en calle San Francisco N° 85 esquina de calle San Carlos (hoy Alonso Ovalle). El nuevo edificio fue inaugurado el 15 de diciembre de 1967 y su infraestructura permitió el desarrollo de varios servicios y unidades que modernizaron, ampliaron y mejoraron la atención del paciente de urgencia. Finalmente, su última ampliación, la llamada Torre Valech, fue incorporada al edificio en febrero de 2019, albergando modernas instalaciones para la urgencia, los pabellones quirúrgicos y la Unidad de Tratamiento Intensivo. El año 1936 marcó un hito en la anestesiología de la Asistencia Pública, a partir del trabajo del doctor Ernesto Frías, especializado en Estado Unidos y Buenos Aires, quien organizó en forma un curso anual de anestesia. Pero el verdadero fundador de un servicio de anestesiología y, a su vez, de la Unidad de Tratamiento Intensivo del hospital José Joaquín Aguirre, fue el Dr. Max Arriagada Loyola, quien fue iniciador de la docencia en pregrado, para que alumnos de medicina hicieral la labor de auxiliares técnicos en la especialidad. Durante la década de los 80, el desarrollo del Servicio de Anestesiología de la Posta Central significó la suma de nuevos especialistas que fueron ocupando los cargos disponibles, tanto en horario diurno como de residencia, y la incorporación de nueva tecnología que permitió ofrecer anestesias más complejas y más seguras. La docencia ha formado parte de las actividades del servicio desde su creación: primero con los discípulos del Dr. Arriagada, luego con el Programa de Formación Ministerial de Anestesiólogos y, finalmente, se convirtió en el Programa de Postgrado en Anestesiología y Reanimación de la Universidad de Santiago de Chile a partir del año 1999, acreditándose por primera vez en el año 2013.

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.

Founding Physicians of the Medical College of Georgia and Their Connections to Crawford Long and the First Surgical Anesthetic.

Milton Antony (1789-1839), an apprenticed trained physician, began educating medical apprentices in 1826 and helped to establish the Medical College of Georgia (MCG) in 1829. Antony recruited additional faculty, Louis Dugas (anatomy and physiology), and Paul Eve (surgery), and together they worked to promote the dissemination of new medical knowledge and enhance and reform medical education. As a result of their efforts, the Southern Medical and Surgical Journal (SMSJ) was established in 1836. The SMSJ became the most successful and widely read regional medical journal. Unfortunately, upon the death of Milton Antony because of the Augusta yellow fever epidemic, the SMSJ ceased publication in 1839. Paul Eve then became Dean of MCG and revived the SMSJ in 1844. Crawford Long (1815-1878) administered ether anesthesia for surgical removal of a neck tumor to James Venable in 1842. For several possible reasons, he did not publish his experience with ether until after Morton's demonstration of ether in Boston in 1846. Crawford Long did meet with Paul Eve, in Augusta at MCG, and was encouraged to publish his experiences with ether in the revived SMSJ, which he did in 1849. It is quite possible that if Milton Antony had lived, and the SMSJ had been continuously published, that Crawford Long may have published his use of ether well in advance of Morton's ether demonstration in 1846. Had that occurred, the great controversy during the mid-nineteenth century over who first used ether for surgical anesthesia would not have existed, and Crawford Long would have received appropriate credit during his lifetime.

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.

Contributions of Avicenna to surgery and anesthesiology.

Background: Avicenna, as the Persian physician has had a great contribution to the field of medical sciences, especially surgery in 10th and 11th centuries AD.Methods: In the present paper, a few translated quoted words of Avicenna were shared about his surgical practice. Indexing databases of PubMed and Google Scholar were searched using the keywords like Avicenna, surgery, and anesthesiology to find related papers and documents.Results: The first portion comprises of some most commonly used simple and compound herbal preparations to produce general and local anesthetics before the surgery and as dental anesthetic agents. In the second portion, practices regarding surgical management for skull fractures, spinal trauma, bone fracture, cataract, incurable urinary retention, bladder calculi, hemorrhoids, cancer as well as endotracheal intubation and tracheostomy have also been incorporated. Finally, it ends up with practices regarding the use of natural products as postoperative dressing for traumatic and surgical wounds and after cataract surgery.Conclusion: Findings of this review study will provide a brief insight on Avicenna's Canon of Medicine to the sciences of anesthesiology and surgery based on the recent investigations.

The seven professorial protégés of John Gillies.

John Gillies was the founding head of the Department of Anaesthetics at the Royal Infirmary of Edinburgh, which began in 1940. An astute educator, he was instrumental in establishing anesthesia as a medical specialty, on equal footing with surgery, from the start of the National Health Service in 1948. Gillies' kudos attracted medical graduates from the UK, USA and Canada to work in his Department. The excellence of his teaching and mentoring may be judged from the fact that no less than seven of his protégés became professors of anesthesia/anesthesiology. This paper identifies these seven professorial protégés and reviews their careers. Reasons for the successful consequences of John Gillies' tutelage are considered.

Handmaidens and pioneers: Three female anaesthetists and their contribution to anaesthesia in South Africa.

The period during and after World War II saw enormous changes in the practice and status of anaesthesia, as well as in female participation. This article offers an account of three South African (SA) women who trained in anaesthetics before and during the War and participated in these changes. By the mid-1960s, they presided over the three independent anaesthetic departments at Johannesburg's three main teaching hospitals, teaching generations of junior doctors. The first woman to register as a specialist anaesthetist in SA, Miriam (Mollie) Barlow, broke the glass ceiling in her own career by lobbying for the professional rights of medical women, although working within the constraints of the medical and political establishment. She also contributed to important SA research on malignant hyperthermia. Hilde Ginsberg collaborated with Barlow in the 1950s, reducing intraoperative and perioperative mortality at Coronation Hospital, and fought for key interventions in anaesthetic practice and policy through the South African Society of Anaesthetists (SASA), becoming its most long-serving and honoured female member. Kathleen Barbara Vetten's exemplary career in academic medicine, including pioneering animal research (developing anaesthetic techniques for open-heart surgery in dogs and protocols for liver transplantation in primates) and a successful operation to separate craniopagus twins, shows both the achievement of and limits to female achievement at the end of this period. This article also offers a short account of factors that hindered black women from entering anaesthesia training, contributing to this history before the 1990s.

Horst Otto Stoeckel: Clinician, Administrator, Researcher.

Horst Otto Stoeckel was born September 26, 1930, in Lodz, Poland, which was part of the newly founded Second Republic of Poland until it was occupied by Nazi Germany in 1939. After World War II, his family immigrated to Meiningen, Germany, where he obtained his primary and secondary education. He attended Humboldt University and the University Hospital Charité of Berlin for his medical degree. Profs Theodor Brugsch, Karl Lohmann, and Friedrich Dost were important individuals who helped develop his interest in quantitative clinical pharmacology and pharmacokinetics. Prior to anesthesiology, Stoeckel trained in surgery, internal medicine, and obstetrics and gynecology in addition to clinical anesthesiology at a community hospital in East Germany. He completed 2 years of obligatory training to become an anesthesia specialist at the Teaching Hospital Hufeland and the Research Institute for Lung Diseases at Berlin-Buch. He also received training in anesthesia at the Humboldt University of Berlin. After escaping East Berlin through the Brandenburg Gate in August 1961, he obtained a position at the University of Heidelberg and obtained his West German board certification in anesthesiology in 1962. In the following 12-year period, Stoeckel was married, was promoted, passed his "habilitation" or lectureship period, started a family, and was granted the title of "Professor." His administrative career began in February 1974 when he was selected as the first Chair of Anesthesiology at the University of Bonn, a position he held for 22 years. He also served as Dean of the medical school from 1980 to 1981. As Chair, he developed three areas: patient care, teaching, and research. He developed a long-term research program in the field of "Quantitative Clinical Pharmacology in Anesthesia and the Quantitative Modeling and Control in Anesthesia," which required an interdisciplinary team of specialists in biochemistry, physics, and modern analytical methods. Over 20 years, the group's research program led to the discovery of basic algorithms providing the foundation of the automatic regulation of dosing control by the closed-loop feedback system, which is a concept important to the target-controlled infusion of intravenous and inhalation anesthetics. Following his career as a clinician, administrator, and researcher, he pursued a second career as a collector and museum founder.

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.

Who Controls the Power over Pain? A Comparative History of Nurse Anaesthesia.

From the advent of the use of anaesthesia during surgery through the Second World War, confusion and competition over who should administer the technology - doctors or nurses - dominated gendered discussions of professional boundaries. Using information about practice in the United States, the United Kingdom, and France in this period, we find vastly different outcomes for nurse-administered anaesthesia. Differences in perceptions regarding the gendered nature of this technology and its related level of prestige largely determined who could practice it. When administering anaesthesia carried low prestige and was viewed as non-technical, it fell under the purview of women's work in medicine, that is, nursing. When the same technology gained prestige and became perceived as a technical, medical skill, doctors associated it with their masculine professional identity and worked to exclude nurses from administering anaesthesia.

Fifteen Years of Transesophageal Echocardiography in Cardiac Anesthesia in Russia.

Transesophageal echocardiography was first introduced in Russia as a component of anesthesiology monitoring in 2003 following its successful implementation in the practice of cardiac anesthesia in the United States and Western Europe. This novel opportunity for perioperative hemodynamic evaluation was enthusiastically adopted at several cardiac surgical clinics despite the presence of critical barriers. The most important of these were the lack of certification programs for anesthesiologists, limited equipment, and a lack of understanding of the responsibility of the anesthesiologist as the coordinator of perioperative therapeutic decisions. Although intraoperative transesophageal echocardiography as a part of the anesthesiology protocol has been introduced in less than 10% of Russian cardiac surgery clinics, a group of interested anesthesiologists has formed over the last 15 years. Both the technical conditions and professional mentality of anesthesiologists need to be changed substantially for successful further development of intraoperative echocardiography. This review aims to highlight the milestones, successes, and challenges in the implementation of intraoperative echocardiography in the practice of cardiac anesthesiology in Russia, which may be interesting to a wide range of cardiac anesthesiologists.

History and Pioneers of Cardiac Anesthesia in Italy.

The first use of extracorporeal circulation in Italy occurred in 1951 in Turin. In the 1960s only 12 heart surgery centers were using extracorporeal circulation to treat patients, and health professionals had to complete their training abroad. During the last 50 years, Italian cardiac anesthesia has become a branch of major importance, and it has experienced a constantly growing number of active centers and professionals. Today, about 50,000 cardiac surgeries are performed every year in approximately 100 centers. Many results have been achieved during this period, thanks to the contribution of several pioneers. In this article, the history of Italian cardiac anesthesia and the role of Italian anesthesiologists in the development of this subspecialty in Italy and Europe are reviewed.

History of Cardiac Anesthesia in New Zealand.

New Zealand has a long and proud history of innovation in cardiac surgery and anesthesia. There have been a number of prominent men and women who have contributed to the development of cardiac anesthesia in New Zealand. There are numerous ongoing challenges in providing cardiac anesthetic services to the population of New Zealand.

History and Current Status of Cardiac Anesthesiology in Russia.

Anesthesiology, the branch of medicine concerning anesthesia and management of the vital functions of patients undergoing surgery, has played an important role in the development of cardiac surgery. In the middle of the last century, medical professionals had little experience in the treatment of congenital and acquired heart diseases. Progress of cardiac anesthesiology in Russia, as well as in countries across the globe, was due to requests to increase the safety of surgical procedures and to improve survival rates for the increasing number of patients with complex heart diseases. The development of cardiac surgery and anesthesiology in Russia evolved in 2 directions simultaneously in the mid-1950s. Some surgeons widely accepted the use of perfusionless hypothermia (hypothermia caused by surface cooling without perfusion); others were in favor of cardiopulmonary bypass technology. This review focuses on major historic milestones of cardiac anesthesiology in Russia, including its current status and the major problems it faces today.