Providing Anesthesia in the Oral and Maxillofacial Surgery Office: A Look Back, Where We Are Now and a Look Ahead.

Throughout its development the practice of oral and maxillofacial surgery has been richly associated with the provision of anesthetic services. Dentists and particularly oral and maxillofacial surgeons have advanced the science associated with anesthesia especially in the outpatient setting. This article will look back on the development of anesthesia as it relates to oral and maxillofacial surgery, discuss the current mode of anesthesia in the oral surgeon's practice and look ahead to what innovations are advancing this field.

Luigi Porta's contribution to anesthesia in Europe in the 1800s.

Luigi Porta (1800-1875), an Italian physician who was well known in the field of surgery, played an important role in spreading ethereal anesthesia in Europe. Moreover, he proposed an original method to administer ethereal anesthesia, the Italian method "of the bladder of pig". This paper reminds us of the important role that this physician played in Anesthesiology.

Shifting understandings of labour pain in Canadian medical history.

While pain in childbirth is a universal, cross-cultural, biological reality, individual experiences and perceptions of this pain are historically and culturally specific. At the turn of the 20th century-a key period in terms of both the medicalisation of birth and the professionalisation of obstetrics in the Canadian context-Canadian physicians understood and conceptualised 'birth pangs' in a number of varying (and at times competing) ways. Throughout the 19th century, doctors emphasised the broader utility of pain as a diagnostic tool and a physiologically necessary part of the birthing process. With the advent of anaesthetics, including chloroform and ether, however, a growing subset of the medical profession simultaneously lauded the professional, physiological, and humanitarian benefits of pain relief. By the first decades of the 20th century, shifting understandings of labour pain-and particularly growing distinctions between 'pain' and 'contraction' in mainstream medical discourses-underscored the increasing use of obstetric anaesthesia. Drawing on a broad range of medical texts and professional literature, and focusing on a key historical moment when the introduction and adoption of a new medical technology opened up possibilities for professional debate, this paper unpacks both the micropolitics and the macropolitics of shifting understandings of labour pain in modern Canadian medical history.

A 1966 Anesthetic Administered by Robert D. Dripps, M.D., Demonstrated His Experimental Style of Clinical Care.

Robert D. Dripps, M.D. (1911 to 1973), helped found academic anesthesiology. Newly reviewed teaching slides from the University of Pennsylvania (Philadelphia, Pennsylvania) contain six anesthesia records from 1965 to 1967 that involved Dripps. They illustrate the clinical philosophy he taught-to consider administration of each anesthetic a research study. Intense public criticism in 1967 for improper experimentation on patients during anesthesia changed his clinical and research philosophies and teaching.

Of Penguins, Pinnipeds, and Poisons: Anesthesia on Elephant Island.

Although Ernest Shackleton's Endurance Antarctic expedition of 1914 to 1916 is a famous epic of survival, the medical achievements of the two expedition doctors have received little formal examination. Marooned on Elephant Island after the expedition ship sank, Drs. Macklin and McIlroy administered a chloroform anesthetic to crew member Perce Blackborow to amputate his frostbitten toes. As the saturated vapor pressure of chloroform at 0°C is 71.5 mmHg and the minimum alveolar concentration is 0.5% of sea-level atmospheric pressure (3.8 mmHg), it would have been feasible to induce anesthesia at a low temperature. However, given the potentially lethal hazards of a light chloroform anesthetic, an adequate and constant depth of anesthesia was essential. The pharmacokinetics of the volatile anesthetic, administered via the open-drop technique in the frigid environment, would have been unfamiliar to the occasional anesthetist. To facilitate vaporization of the chloroform, the team burned penguin skins and seal blubber under overturned lifeboats to increase the ambient temperature from -0.5° to 26.6°C. Chloroform degrades with heat to chlorine and phosgene, but buildup of these poisonous gases did not occur due to venting of the confined space by the stove chimney. The anesthetic went well, and the patient-and all the ship's crew-survived to return home.

[Victory over surgical pain : 170 years ago the era of modern anesthesia began - but what happened in the operating theater in the time before?] / Sieg über den Operationsschmerz : Vor 170 Jahren begann die Ära der modernen Anästhesie ­ aber was geschah in der Zeit davor im Operationssaal?

170 years ago, on 6 October 1846, the dentist William Thomas Green Morton, sucessfully demonstrated ether anesthesia in a patient undergoing surgery in the operating theater of the Massachusetts General Hospital in Boston. He thereby put an end to the unthinkable suffering of patients who had to undergo surgery when fully conscious. Before this "discovery" surgical procedures resembled a battle for life and death. Only a few documents exist illustrating the attitude of surgeons concerning their actions and which tortures patients had to tolerate. One of the first German standard operating procedures for the perioperative period was formulated in 1812 by Christian Bonifacius Zang. In her diaries and letters, the english novelist Frances Burney described her mastectomy without anesthesia on 30 September 1811. The Scottish physician and novelist John Brown, in his story of "Rab and his friends", painted a picture of the mastectomy of Ailie Noble by the famous Scottish surgeon James Syme in 1833, also without anesthesia. Finally, in his letters the Scottish scientist George Wilson described the amputation of his left foot at the ankle in January 1843, again by James Syme and again without the use of anesthesia.

The Four Chinese Characters of Katsubutsu Kyuri Express the Maxim Chosen by Seishu Hanaoka.

Koko Niida composed an epitaph for Seishu Hanaoka in 1836 and in it he employed a phrase consisting of eight Chinese characters to describe Hanaoka's medicine. The phrase reads Naigai Goitsu Katsubutsu Kyuri. Since then, the phrase has prevailed as Hanaoka's motto, even among lay people as well as medical historians. Although there are scrolls written by Hanaoka showing the four Chinese characters of Katsubutsu Kyuri, no calligraphy including the four Chinese characters of Naigai Goitsu is extant. Gencho Honma, one of the leading disciples of Hanaoka and who published Zoku Yoka Hiroku in 1859, mentioned in the preface that the phrase Katsubutsu Kyuri was the maxim that Hanaoka proposed. Considering these facts, the phrase Katsubutsu Kyuri is the very maxim chosen by Hanaoka. He appreciated the significance of skillfulness in the practice of surgery, which was difficult to acquire by reading books and listening to lectures. One of his important phrases, which reads Toku to Futoku wa Sonohito ni Ari in seven Chinese characters, is discussed, regarding how to be adept at technical skills in the practice of surgery.

Coagulation, flocculation, and denaturation: a century of research into protoplasmic theories of anesthesia.

Within two decades of the discovery of anesthesia, the physicochemical concept of colloid and the biological concept of protoplasm had emerged. Fusion of these concepts into a theoretical framework, which has been largely forgotten decades ago, promised to uncover fundamental biological truths and determined research into anesthetic mechanisms for a century after "Ether Day." Observations of optical changes in unstained tissue were condensed into a theory of anesthesia by coagulation of protoplasm in the 1870s. The underlying hypotheses, conformational changes of proteins within the protoplasm cause all behavioral effects of anesthesia, continued to be pursued well into the 20th century. The goal was to explain anesthesia using physical chemistry within a fundamental cell biological framework. This large body of work, swept aside during the decades of lipid membrane hegemony, has remained in obscurity even after proteins in excitable membranes became firmly established as mediators of the immediate anesthetic effects. This article is a reminder of the prolonged interdisciplinary research effort dedicated to "protoplasmic theories" at a time when attention is increasingly directed toward examining the nature of (un)consciousness well as noncanonical consequences of anesthetic exposure that are not easily accounted for within conventional pharmacological concepts.

The historical evolution of, and the paradigms shifts in, the therapy of convulsive status epilepticus over the past 150 years.

The evolution of the treatment of convulsive status epilepticus since the mid- nineteenth century is outlined. Therapy has been advanced not only by the use of new drugs, but also by advances in the approach to therapy. The major pharmacologic developments were the introductions of bromide, anesthetics, barbiturate, phenytoin, paraldehyde, chlormethiazole, and the benzodiazepines. Throughout this period, the emphasis of therapy was on "sedation" and anesthesia, and the development of technologies for safe anesthesia in the postwar years were an important step. Since 1970, changes to the approach to therapy have been more important than any pharmacologic advance, and it is only recently that new drugs have been introduced into the therapy of status epilepticus. We may now be on the threshold of significant new paradigm shifts.

Altered states: psychedelics and anesthetics.

The psychedelic experience has been reported since antiquity, but there is relatively little known about the underlying neural mechanisms. A recent neuroimaging study on psilocybin revealed a pattern of decreased cerebral blood flow and functional disconnections that is surprisingly similar to that caused by various anesthetics. In this article, the authors review historical examples of psychedelic experiences induced by general anesthetics and then contrast the mechanisms by which these two drug classes generate altered states of consciousness.

A history of pediatric anesthesia: a tale of pioneers and equipment.

The history of pediatric anesthesia is fascinating in terms of how inventive anesthesiologists became over time to address the needs for advances in surgery. We have many pioneers and heroes. We hope you will enjoy this brief overview and that we have not left out any of the early contributors to our speciality. Obviously there is insufficient space to include everyone.

History of anesthesia for ambulatory surgery.

PURPOSE OF REVIEW: Anesthesia for ambulatory surgery has come a long way since 1842 when James Venable underwent surgery for removal of a neck mass with Crawford W. Long administering ether and also being the surgeon. We examine major advances over the past century and a half. RECENT FINDINGS: The development of anesthesia as a medical specialty is perhaps the single most important improvement that has enabled advances in the surgical specialties. Moreover, improved equipment, monitoring, training, evaluation of patients, discovery of better anesthetic agents, pain control, and the evolution of perioperative care are the main reasons why ambulatory anesthesia remains so safe in modern times. The development of less invasive surgical techniques, economic factors, and patient preferences provided addition impetus to the popularity of ambulatory surgery. SUMMARY: Beyond the discovery in the mid-19th century that ether and nitrous oxide could be used to render patients unconscious during surgical procedures, subsequent developments in our specialty have added modestly, in a stepwise manner, to reduce mortality and morbidity associated with its use. These improvements have allowed us to safely meet the steadily increasing demand for ambulatory surgery.