Volume 7 - History of Anaesthesia Society

'British Medica Journal' of June 1950 he reported 8 cases with 2
deaths. Rink,' Hutton and I gave the anaesthetics for 6 of the
patients (2 were operated upon in America). These patients were gravely
incapacitated with severe orthopnoea and an exercise tolerance of 5-100
yards at the most. Pre-operatively the patients sucked an amethocaine
lozenge and the larynx was sprayed with 10% cocaine imnediately prior to
intubation. The patients were premedicated with hopon and atropine,
induced slowly with thiopentone followed by cyclopropane, oxygen and
ether for intubation and then curare as required. In view of their
fragile hold on life it was felt that thiopentone, curare followed by
intubation might well produce a fatal fall in blood pressure. However
in the last case Hutton did use this technique with sEccess. In the
early fifties increasing nmbers of mitral, pulmonary and aortic valves
were operated upon. This resulted in shorter operations on much fitter
patients and anaesthesia became fairly standardised. Thiopentone,
curare (and later Scoline) were used Eor intubation followed by nitrous
oxide, oxygen with intermittent curare and thiopentone supplements as
necessary. An analgesic such as pethidine or phenoperidine was often
used instead of thiopentone.
wthenuia in cardlec surgery
The ne main advance was the introduction of hypothermia. In 1920
SigelJ5 in Toronto showed that lowering the body tmperature to 30 C
allowed the brain to be rendered anoxic for ten minutes instead, of
three. 'Ihis permitted an atrio-septal defect to be closed as a
dry
heart' was required for only 5-7 minutes. In order to obtain thls
temperature change three methods were available - surface cooling,
arterio-venous and veno-venous coolinq.
Surface cooling was first described by Swan in America using a cold
water bath. It was a long, messy method but used by Holmes-Sellors at
the Middlesex Hospital until 1960, during which time 200 cases were
operated on. We, at Guy's, preferred to anaesthetise the patient with
thiopentone, curare, nitrous oxide, oxygen, ether to produce
vasodilation, assisted by intravenous chlorpromazine (~argactil) and
then surround the patient with ice packs and fans. Temperature was
carefully measured and the patient was cooled by 1°C every 5 minutes
down to 29'C. If cooling was more rapid ventricular fibrillation was
Liable to ocxur due to temperature differentials.
Donald Ross, who came to Guy's in 1952 as cardiac research surgical
registrar, evolved the methods of arterio-venous and veno-venous
cooling. In the former, blood was pumped by the heart fran the fernoral
artery to the saphenous vein via a coiled tube passing through a
refrigerator. For veno-venous cooling the blood was hand pumped Erotr~ the
superior vena cava to the inferior vena cava via the refrigerator.
Tnese two techniques allowed much more rapid cooling as temperature
differentials do not occur. The patient was rewarmed on an electric
blanket.
Surface cooling was introduced clinically about 1952-53 and arteriovenous
and veno-venous methods in 19 4-55 at Guy's, where they were used
for the first time in man. Dred at the Westminster Hospital used