An anaesthetist who missed a golden opportunity.

Richard Gordon (1921-2017) was a prolific writer of both humorous fiction and historical reviews. He trained in medicine at St Bartholomew's Hospital (Barts) in London and specialised in anaesthesia working at Hill End Hospital, St Albans (where a large proportion of Barts work took place to avoid the impact of the Blitz during the Second World War) and at the Radcliffe Infirmary, Oxford with Robert Macintosh. He published multiple papers and a book on trichlorethylene anaesthesia and edited a textbook of anaesthesia for medical students which ran for 10 editions. His gift for writing and his prominent public persona placed him in a unique position to highlight the importance of the newly emerging speciality of anaesthesia. He did the exact opposite of this and instead created a representation of an uninterested spectator to surgical activity, a representation which still persists in some quarters today.

A Century of Technology in Anesthesia & Analgesia.

Technological innovation has been closely intertwined with the growth of modern anesthesiology as a medical and scientific discipline. Anesthesia & Analgesia, the longest-running physician anesthesiology journal in the world, has documented key technological developments in the specialty over the past 100 years. What began as a focus on the fundamental tools needed for effective anesthetic delivery has evolved over the century into an increasing emphasis on automation, portability, and machine intelligence to improve the quality, safety, and efficiency of patient care.

[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.

William T. G. Morton's English Patent for Etherization: Patently Pointless?

Boston dentist William T. G. Morton secured a provisional English patent for etherization in December 1846. The full patent specification was submitted 6 months later, and the patent was sealed on June 18, 1847. The enrolled copies of the provisional and full patents, which are held in The National Archives, London, have not been previously documented in the anesthesia literature. We review the communications between Boston and London regarding the patent for etherization, the possibility that preliminary discussions and trials of etherization may have been conducted in London before the earliest known application of the discovery for a dental extraction on December 19, 1846, and the role of the American lawyer James Augustus Dorr, who was Morton's agent in the United Kingdom.

A Beautiful Friendship-and a Lesson about Friends and Colleagues: A Classic Partnership Revisited.

David Warner, M.D., and Michael Todd, M.D., first met in 1985. They began working together at the University of Iowa (Iowa City, Iowa) a year later with a shared interest in both laboratory and clinical neuroscience-and in the operative care of neurosurgical patients. That collaboration has now lasted for 35 yr, resulting in more than 70 joint publications. More importantly, they have had the privilege of working together with close to 1,000 colleagues from around the world, in a dozen medical specialties. Their careers are an example of what can be accomplished by friendship, mutual commitment, persistence, and a willingness to join with others.

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.

Vicente Antonio de Castro y Bermúdez: reconocido en su época y desconocido en la actualidad / Vicente Antonio de Castro y Bermúdez: recognized in his time and unknown at present

RESUMEN Fundamento: Vicente Antonio de Castro y Bermúdez en su juventud fue catalogado como un médico con una inteligencia poco común, con una cultura enciclopédica. Objetivo: Valorar la figura de Vicente Antonio de Castro y Bermúdez en su labor como médico, patriota y masón. Desarrollo: Incluyó una revisión documental histórica (archivos, documentos oficiales, artículos, revistas, prensa escrita y libros; se revisaron también las bases de datos SciELO regional, PubMed e Infomed) sobre la trayectoria de Vicente Antonio de Castro. El número total de documentos revisados fue de 46, de los cuales se seleccionaron 16 como referencias bibliográficas. Se destacó en su época por su importante labor como médico, floreciendo como uno de los cirujanos más importantes de la década entre 1840 y 1850, introduciendo en Cuba y América latina la anestesia. Conjuntamente fue un gran patriota y masón creando el Gran Oriente de Cuba y Las Antillas (GOCA), el cual llevó en sus filas a hombres imprescindibles de la Guerra de los Diez Años, como Carlos Manuel de Céspedes, Ignacio Agramonte, Serafín Sánchez y Antonio Maceo. Conclusiones: La vida y obra de Vicente Antonio de Castro y Bermúdez fue prolífera en la labor médica, patriótica y masónica; este dejó huellas imborrables en cada uno de estos aspectos.

ABSTRACT Background: In his youth Vicente Antonio de Castro y Bermúdez was catalogued as a physician with a non-common intelligence and an encyclopedic culture. Objective: To value Vicente Antonio de Castro y Bermudez´s work as a physician, also as a patriot and masonic. Development: It included a historical documentary review (archives, official documents, articles, magazines, written press and books; the regional SciELO, PubMed and Infomed databases were also reviewed) on the trajectory of Vicente Antonio de Castro. 46 total number of documents were reviewed, 16 selected as bibliographic references. He stood out in his time for his important work as a physician, successful as one of the most important surgeons from 1840 to 1850, who introduced anesthesia in Cuba and Latin America. He was a great patriot and masonic too, he created the Gran Oriente de Cuba y Las Antillas logde (GOCA), formed by essential men of the Ten Years' War, such as Carlos Manuel de Céspedes, Ignacio Agramonte, Serafín Sánchez and Antonio Maceo. Conclusions: Vicente Antonio de Castro y Bermudez´s medical, patriotic and Masonic life and work were prolific, he left indelible traces in all these facets.

An interview with Dr. Anne Marie Lynn, a pioneering woman in medicine.

Dr. Anne Marie Lynn (1949-present), Professor Emeritus of Anesthesiology, Pain Medicine, and Pediatrics at the University of Washington, Seattle, was one of the most influential women in pediatric anesthesiology of her generation. Dr. Lynn embodies the spirit of discovery and advancement that have created the practice of pediatric anesthesiology as we know it today. A pioneer in pain medicine pharmacology, particularly morphine and ketorolac, her research transformed pediatric anesthesia, pediatric pain medicine, and pediatric intensive care medicine. Through her journal articles, book chapters, national and international lectures, mentoring of residents, fellows, and faculty, and leadership in the Society for Pediatric Anesthesia, she inspired a generation of women and men physicians by demonstrating that gender should not be a barrier to undertaking roles once only held only by men. In 2017, for her many contributions, she was awarded the Society for Pediatric Anesthesia's Myron Yaster lifetime achievement award.

High-Impact Clinical Studies That Fomented New Developments in Anesthesia: History of Achievements, 1966-2015.

The aim of this work is to identify the most influential initial clinical studies that fomented important developments in anesthesiology over the past 50 years. Studies fomenting new development can be selected using vastly different approaches and, therefore, might provide diverse outcomes. In the present work, two basic aspects of study assessments - the stage of development (eg, generation of idea, preclinical studies, clinical trials) and the method of selection (eg, committee vote, various types of citation analysis, method of finding the invention disclosure) - were chosen according to the following model. The stage of development: the initial clinical studies demonstrating the basic advantage of an innovation for providing anesthesia. The method: a combination of two factors - the study priority in terms of the time of its publication and the degree of its acknowledgement in the form of citation impact; the time of study publication was regarded as a primary factor, but only if the study's citation count was =/>20. The initial high-impact studies were selected for 16 drug-related topics (ketamine, isoflurane, etomidate, propofol, midazolam in anesthesia, vecuronium, alfentanil, atracurium, sevoflurane, sufentanil, rocuronium, desflurane, ropivacaine, remifentanil, dexmedetomidine in anesthesia, and sugammadex), and 9 technique-related topics (ultrasound-guided peripheral nerve block, capnography in anesthesia, target-controlled intravenous anesthesia, pulse oximetry in anesthesia, total intravenous anesthesia, transesophageal echocardiography in anesthesia, combined spinal-epidural anesthesia, and bispectral index). Twenty-five studies were designated the first high-impact studies (one for each topic); 16 are drug-related and 9 are technique-related. Half of the first high-impact studies had a citation count of =/>100, (range: 100 to 555). The citation count of the other half of high-impact studies did not reach the 100-citation threshold (range: 41 to 97). If a selected first high-impact study had a citation count <100, a next-on-timeline, additional study with citation count =/>100 was also selected; (range: 100 to 344). The present results show that an initial high-impact clinical study on a new development in anesthesiology can be determined and that related citations usually vary from one hundred to five hundred.

The Historical Struggles of Modified Electroconvulsive Therapy: How Anesthesia Came to the Rescue.

The complicated history of modified electroconvulsive therapy (ECT) started back before anesthesia was incorporated when unmodified electroconvulsive therapy was not considered humane. When anesthesiologists started working with psychiatrists, ECT gradually regained acceptance by decreasing the obstacles inherent to this therapy despite the complexities of the anesthetics. However, the sociopolitical and medicolegal factors negatively impacted the use of modified ECT leading to a period of time when it was banned from use in the United States. Fortunately, as advances in anesthesia and technology continued to develop, anesthesiologists helped ECT regain widespread usage improving the safety profile, cost effectiveness, quicker onset of seizures, and ease of control despite its stained past. This allowed more accessibility, especially for high-risk medical patients, to a relatively safe and effective treatment for psychiatric diseases.

John Snow: Anesthesiologist, Epidemiologist, Scientist, and Hero.

A 19th century physician was crucial to the establishment of 2 medical specialties-anesthesiology and public health. Everyone whose interest in public health has increased in the last year will be amazed at Dr John Snow's career in anesthesiology. Those who recognize him as the first full-time physician anesthetist will be struck by his development of medical mapping during the Cholera Pandemic of 1848, resulting in one of the fundamental techniques of epidemiology and public health that has continued through today. Snow's accomplishments in anesthesiology and epidemiology reflected a concatenation of science, focus, and creativity. His training in the early 19th century integrated science, medicine, and his keen interest in respiratory physiology. His early clinical exposure to colliery workers in Newcastle was likely influenced by the earlier development of pneumatic medicine. He was committed to the notion that chemistry, especially the use of medicinal gases, would be transformative for medicine. Thus, he was "primed" when the news of the American anodyne ether reached London in 1846. When the third cholera pandemic reached London shortly thereafter, in the fall of 1848, his academic and practical understanding of gas chemistry and pharmacology, respiratory physiology, and anesthetic agents led him to question the popularly promulgated miasma-based theories of transmission. His methodical investigations, research, and perseverance were mirrored in his scholarly work, numerous presentations, and public advocacy. He articulated many scientific principles essential to the early practice of anesthesia-anesthetic potency, quantitative dosing of anesthetic agents, engineering principles required for conserving the latent heat of vaporization, and minimizing the contribution of anesthetic equipment to airway resistance. He moved easily and methodically between these worlds of physiology, chemistry, engineering, clinical medicine, and public health. In his role as the first medical epidemiologist, Snow understood the power of medical mapping and the graphic presentation of data. He was a pioneer in 2 nascent fields of medicine that were historically and remain contemporarily connected.

The Origins, Evolution, and Spread of Anesthesia Monitoring Standards: From Boston to Across the World.

In the mid-1980s, the anesthesia departments at hospitals affiliated with Harvard Medical School were faced with a challenge: mounting medical malpractice costs. Malpractice insurance was provided by the Controlled Risk Insurance Company (CRICO), a patient safety and medical malpractice insurance company owned by and providing service to the Harvard medical community. CRICO spearheaded an effort to reduce these costs and ultimately found a way to decrease the risks associated with anesthesia. Here, we chronicle events that led to the dramatic changes in medical practice that resulted from the activities of a small group of concerned anesthesiologists at Harvard-affiliated hospitals. We place these events in a historical perspective and explore how other specialties followed this example, and end with current strategies that minimize the risk associated with anesthesia. We conducted interviews with principals who formulated original standards of patient monitoring. In addition, we consulted documents in the public domain and primary source material. Efforts of these pioneers resulted in the establishment of the seminal Harvard-based anesthesia monitoring standards for minimal monitoring. What followed was an unprecedented transformation of the entire field. After the implementation of these standards at Harvard-affiliated hospitals, the American Society of Anesthesiologists (ASA) adopted "Standards for Basic Anesthetic Monitoring" for use during the administration of all anesthetics in the United States. Other nations have since adopted similar guidelines and these practices have resulted in significant improvements in patient safety. Currently, we estimate mortality due to anesthesia in healthy patients to be 1:400,000-perhaps as much as 10 times lower since the early 1980s. What began as an attempt to lower medical malpractice costs in a group of university hospitals became a worldwide effort that resulted in improvements in patient safety. Other specialties have adopted similar measures. Currently, an attitude and appreciation of safety are exemplified by several practices that include among others-the adherence to these patient safety guidelines, simulator training, the promulgation of standards and guidelines by ASA, and the use of a safety checklist before induction of anesthesia.

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.

Historia de la administración de éter por vía intravenosa / History of intravenous ether administration

La anestesia con éter por vía intravenosa fue una técnica anestésica utilizada en los años iniciales del siglo XX. Tuvo una granaceptación en Alemania. En la década de los sesenta del siglo pasado fue usada en cirugía endoscópica. El éter ha sido utilizadocon éxito para estudiar los tiempos de la circulación portal. (AU)

Intravenous ether anesthesia was an anesthetic technique used in the initial years of the XX century. It was mostly used in Germany.In the sixties decade of the past century it was used for endoscopic surgery. Ether has been used successfully for the study of circulation time of portal circulation. (AU)