RESUMO
Through his visit to Spain in 1946, Robert R. Macintosh exercised considerable influence on the introduction and development of modern anesthesia in this country. This paper reviews the technical advances Mackintosh introduced and considers how his visit was one of the most important factors in unleashing the development of the profession here. Also reviewed are the other visits Mackintosh made in the course of his career. Those trips were less important, with the exception of a 1937 visit that inspired the design of the Oxford vaporizer, a technical concept based on simplicity, safety and the anesthesiologist's experience.
Assuntos
Anestesiologia/história , Anestesia por Inalação/instrumentação , Anestesiologia/instrumentação , Anestésicos Gerais/história , Curare/história , Inglaterra , Desenho de Equipamento , História do Século XX , Humanos , Serviços de Informação , Cooperação Internacional , Intubação Intratraqueal/história , Intubação Intratraqueal/métodos , Laringoscopia/história , Nebulizadores e Vaporizadores/história , Espanha , ViagemRESUMO
The introduction of curare for general anesthesia by Harold Griffith in 1942 was one of the most important moments in the development of anesthesiology. However, several years passed before curare came to be used in Spain. We review the early application of curare and the role played by Robert Macintosh, Professor of Anaesthesia at Oxford, in introducing the drug to Spain.
Assuntos
Anestesia Geral/história , Curare/história , Fármacos Neuromusculares não Despolarizantes/história , Anestesia Geral/efeitos adversos , Animais , Asfixia/induzido quimicamente , Convulsoterapia , Curare/administração & dosagem , Curare/efeitos adversos , Curare/uso terapêutico , Cães , Inglaterra , Feminino , História do Século XVI , História do Século XIX , História do Século XX , Humanos , Intubação Intratraqueal/história , Medicina Tradicional , Doenças Neuromusculares/tratamento farmacológico , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Respiração Artificial , Convulsões/induzido quimicamente , América do Sul , Espanha , Tétano/tratamento farmacológicoRESUMO
María Oliveras Collelmir (1910) was the first woman to practice anesthesiology in Catalonia and one of the first physicians to receive formal training in the specialty at the important Nuffield Department of Anaesthetics in Oxford. She pioneerèd the use of general anesthesia with tracheal intubation for neurosurgery. This article relates how Dr. Oliveras introduced general anesthesia with endotracheal intubation for neurosurgery in Catalonia and pays well-deserved homage to this enterprising woman, who overcame family obstacles and social prejudices of the time to become the first female anesthesiologist in Catalonia.
Assuntos
Anestesia Geral/história , Neurocirurgia/história , Anestesiologia/história , História do Século XX , EspanhaRESUMO
We report the clinical case of a 56 years old male suffering dystrophic ampullar epidermolysis. He underwent brachial plexus blockade to remove a right hand tumor. The patient presented bilateral pseudosyndactylia, flexion retraction of the left hand, and erosive lesions in the inferior extremities, forearm, and trunk interfered monitorization and venous catheterization. Cutaneous friction or trauma should be carefully avoided since in this patient might produce detachment of the epidermis and subsequent ampullar formation. Cutaneous electrodes without adhesive components, padded sphygmomanometers, ear pulsimeter, and venous catheter sutured to the skin were used during monitorization. Anesthetic management of patients with dystrophic ampullar epidermolysis should consider careful airway manipulation, reduction of mucocutaneous contacts, prevention of pressure or friction skin trauma, appropriate electrolyte and plasma volume reposition, and use of nonadhesive material. To avoid airway manipulation regional anesthesia should be considered in patients with ampullar epidermolysis. We recommend regional anesthesia with ketamine.
Assuntos
Anestesia , Epidermólise Bolhosa Distrófica , Plexo Braquial , Epidermólise Bolhosa Distrófica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio NervosoRESUMO
A patient with carcinoma of the lower third of esophagus suffered an extensive tracheal tear during transhiatal esophagectomy without thoracotomy, with severe impairment of ventilatory and hemodynamic status. A right thoracotomy was required for the repair of the tracheal lesion, which extended to the origin of left bronchus. During the maneuvers for bronchial intubation, the hypoxia worsened and cardiac arrest caused by ventricular fibrillation appeared. The arrhythmia was reverted. Operative mortality of transhiatal esophagectomy without thoracotomy is 8%. Pneumothorax is the most common operative complication. Tracheal laceration is reported in 1% of cases; usually it is not severe and is easily treated, although it can have significant severity and result in death as in the present case. After the operation, the patient persisted hemodynamically unstable, developing a new gasometric deterioration and bilateral pleural effusion, with impairment of coagulation. The patient died 39 hours after operation. The anesthetic management of peroperative tracheal tear is reviewed.