Volume 9b - History of Anaesthesia Society

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h e of the main problems in the early days of anaesthesia was during the induction period. me excitation phase of anaesthesia induction with inhalation agents could be very troublesome to those giving the anaesthetic. Young vigorous men particul?rly, could hardly be kept on the operating table during this stage. Tnis problem was fizslly resolved by the advent of intravenous anaesthesia in the thirties, but several special techniques were introduced to circumvent this excitation phase. For example the rectal amlication of sedative agents prior to the induction of amesthesia became mmmn in Heidelbery. An uncarmon, but very efficient solution to the problem was described, practised and propgated in the early 1920's by C Ritter of Dusseld rf. ?he article describing his method in detail was plblished in 1923.' He suggested temporary occlusion of both carotid arteries to enhance anaesthesia induction. Ritter described his nnnoeuvre as simply consisting of bilateral canpression of the carotid arteries with the thMs tuwards the cervical spine. Ritter's occlusive device
Effect of the technique The effect was that the breathing of the patient almost imediately became slew, quiet and snoring. Talking and mvement of the limbs stopped, and deep anaesthesia was achieved rapidly. Thus, by applying this technicpe, patients moved rapidly from excitation to deep anaesthesis during ether administration. Ritter found that this temprary occlusion of the carotid arteries during anaesthesia also reduced the requirement for anaesthetic. Transferring this concept to mdern anaesthesia, one wxld have to talk a h t the W-reducing effect of the anaemisation of the brain, and would have to add this phenomenon to tle liqt of factors which modify MAC. No pstoperatlve neurological problems were reprted by Ritter. He stated that all patients woke very early after surqery without any problems. Occlusive device As the hands would get tired, the application of pressure with the thumb ims considered unsuitable for longer anaesthetics. A device was therefore constructed which allowed occlusion of the carotid arteries without exerting digital pressure. (Figure); this was mufactured commercially by the Windier Ccmpny of Berlin. As Ritter was still exprimenting with this device, he only recamended his manwl manoeuvre for routine enhancement of anaesthesia induction. Ritter had learned this technique from A Kussmaul who had used it to demnstrate that in humans - as opposed to dogs - the vertebral arteries would not deliver an adequate blood supply to the brain during bilateral carotid occlusion. The effects of bilateral carotid occlusion in young healthy patients wzre rapid loss of consciousness, pallor and finally, collapse. Consciousness would return each time when pressure was released. A welcome positive side-effect was that the patient or volunteer had total amnesia for the time of pressure ! In his book on artificial bloodlessness2 plblished in 1922, F Mmtuq provides us with more details abut Ritterls experiments on reduction of cerebral blood volume during neurosurgery. Evidently, Ritter had used the technique of interruption of the arterial blood supply for operations on the skull and brain in three patients. Periods of ischaernia last4 up to 30 minutes, with discontinuation of anaesthesia at the moment of carotid occlusion. The first two patients did not pose any problems and woke up early after surgery. The third, however, died on t'7e operating table. References 1 Ritter C. Anan-dsierung des Gellirns m schnelleren Eintritt der Narkose. Zentrelblatt fur Chirurgie 1923; 50: 1390-1391. 2 Momburg '?.Die kunstliche Blutleere. Neue Deutsche Chirurgie, Vol 29. We, Stuttgart 1922; 56-59.
Page 1: ANAESTHESIA SOClETY *-
Page 4 and 5: Dr T B -ton (Oxford) George Washing
Page 6 and 7: He thereEore advocated very gentle
Page 8 and 9: George Washington Crile (1864-1943)
Page 10 and 11: Fhnento8, February \$, and 18,18~19
Page 12 and 13: First President of the Association
Page 14 and 15: landings, he was posted to teach ai
Page 18 and 19: Drs C Weisser & G Sprotte (Wurzburg
Page 20 and 21: Kirschner's clinical observations r
Page 22 and 23: ack to old Fakirs and yogis used au
Page 24 and 25: plblished m y articles on this appr
Page 26 and 27: Drs M Goerig, K Ayisi, J Schulte am
Page 28 and 29: Cne of the most pramin~nt and raprt
Page 30 and 31: A .€?W years later, a zmwrable in
Page 32 and 33: In &ern anaesthesia, the knzodiazep
Page 34 and 35: Dr M Kus (LYacori) An un-.rlanted s
Page 36 and 37: Dr R W Patterson (Los hgeles) Reprt
Page 38 and 39: camation of mental illness and crim
Page 40 and 41: plblic atmut the activities of tj~e
Page 42 and 43: Gmrg Hirschel Cacq rlirschel wa? ho
Page 44 and 45: Drs L Va~quez, J Carcellar, J Frent
Page 46 and 47: An appreciation fraa Dr Jean M HDrt
Page 48 and 49: Dr C K Adm Dr A K Adam3 CBE Dr C N
Page 50 and 51: Dr P J Stow Dr B ?I Q Weaver Mr B R

Volume 9b - History of Anaesthesia Society

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