Anesthesia Student Survival Guide.pdf - Index of

history of AnesthesiA And introduction to the speciAlty ● 19
popularized the use of chloroform for obstetric anesthesia. He was one of the
first physicians to study and calculate dosages for the use of ether and chloroform,
and personally administered chloroform to Queen Victoria when she
gave birth to the last two of her nine children.
By the end of the nineteenth century, many other advances in the field
of anesthesia followed, as shown in Table 2.1. With the discovery of the local
anesthetic properties of cocaine, infiltration anesthesia, nerve blocks, spinal,
and epidural techniques were introduced. By the turn of the century, there
were many advances in the area of airway management, such as orotracheal
tubes used for intubation, laryngoscopes, and bag-mask ventilation devices.
Soon, various intravenous induction agents were introduced, allowing
patients to go off to sleep quickly, resulting in a more pleasant experience.
Newer and better muscle relaxants became widely available, followed by safer
and more clinically useful inhalational agents. Today, anesthesia is very safe,
with mortality as low as 4–5 deaths per million of anesthetic administrations.
This improvement in safety is in large part due to better patient monitoring,
modern anesthetic drugs and equipment, and constant vigilance by the anesthesia
provider.
Monitors
The earliest monitor was simply a finger on the pulse. Virginia Apgar (an
anesthesiologist at Columbia who developed the now famous Apgar Score
for newborns) had a case where she didn’t realize that the pulse she was
feeling was her own, and the patient unfortunately had a poor outcome.
When ECG machines came into being, they were not available in every
room. One hospital in Sheffield, England had to borrow one from the university
hospital a mile down the road – and someone to interpret the ECG
as well!
When President Kennedy was brought into the Parkland emergency room
after being fatally shot, Buddy Giesecke (who later became Chairman of Anesthesia
at the University of Texas) had to go to the anesthesia workroom to get
the ironically named “bullet” cardioscope, which required him to push needle
electrodes into the President. At the same time, Jim Carrico (a surgery resident
who had just finished an anesthesia rotation) intubated the President’s
trachea, but had neither pulse oximetry nor capnography at his disposal. Pepper
Jenkins (who was Chair of Anesthesiology at UT Southwestern in Dallas
at the time) helped recreate these scenes in Oliver Stone’s movie JFK, where
Jenkins plays himself.