Original Contributions of Latin-Ameri- cans to Anesthesia

More documents

Recommendations

Info

4 BULLETIN OF ANESTHESIA HISTORY Contributions. . .Continued from page 1 it was decided to amputate both. It was reported that in spite of the surgeon’s skills and expediency, the porter screamed, cried and swore throughout the first amputation so the second was postponed. On the next day, the 29th of March, Barton assisted by military surgeons Drs. Harney, Porter and Laub, proceeded to administer the first anesthetic in a war according to the technique he had been instructed on with an inhaler similar to the one Morton used in Boston six months earlier. It was noted that the porter slept through the whole operation, “without moving one muscle” under the effects of Letheon and woke up cheerful and without a complaint at the end of it. 5 John Porter wrote a treatise on military medicine 6 at the end of the war, since he apparently acquired more experience with ether during the remaining of the War his comments were not encouraging since he stated that anesthesia was dangerous and unnecessary in injured soldiers who were expected to tolerate the pain and suffering of these brief procedures. He reported several near lethal experiences in injured hypovolemic soldiers probably from overdose as ether would vaporize more readily in warm Vera Cruz in the Spring and in the Summer of 1847 in the Mexican altiplano at 7400 feet high, than at sea level in Boston, in the Winter of 1846. 5 Scott’s army moved westward to the next largest city, Xalapa where General Antonio Lopez de Santanna, by then the Mexican president, had fortified two promontories that dominated the road where the troops had to go through. On one, Cerro Gordo, seven gun batteries were in place to bombard the approaching invading army. At night an American battalion led by captain Robert E. Lee, commander of engineers, circumvented the promontories and climbed Cerro Gordo rushing the batteries and turning them against the Mexican army camped before Xalapa. A fierce battle followed in which lieutenant George B. McCleland and captain P.G.T. Beauregard distinguished themselves in action (Figure 2). Eventually the American forces entered Xalapa on April 18. Porter described that nearly a dozen of injured soldiers had surgical procedures under letheon. Of interest was the finding of a daguerreotype published in the Xalapa’s newspaper showing the Mexican military surgeon Pedro Van der Linden about to start a leg amputation in a Mexican soldier that appears asleep, while the group is taken prisoner as bayonets (supposedly in the hands of American soldiers) guard them, implying Figure 2: Civil War leaders to be, Captain Robert E. Lee, St. George B. McCleland and Captain P.G.T. Beauregard distinguished themselves at the battle of Cerro Gordo. that Van der Linden, a bright young surgeon of Dutch descent had administered ether to the soldier about to be operated 7 (Figure 3). He eventually was freed and rejoined the Mexican army caring for soldiers in the battles of Padierna , Molino del Rey and Chapultepec along with other distinguished physicians such as Jose Pablo Martinez del Rio y Miguel Jimenez who apparently also gave ether inhalation for amputations. Whether they obtained the ether from their American counterparts or they had it send from abroad, is not known, but Martinez del Rio (Figure 4) later on claimed that he had received bottles of ether and chloroform from the United Kingdom and had trained other military doctors to administer it with a handkerchief 8,9 ; though this fact has not been confirmed. Important Anesthetic Experiences in the XIX Century Initially, advances were prevalent in two countries, whether this was due to daring physicians willing to undertake new approaches or simply that the events were duly recorded either in newspapers or medical publications. Specifically in Brazil two adventurous surgical interventions presented challenges far out of the ordinary anesthetic techniques to facilitate the performance of these unusual operations. In 1866, Pacifico Pereira 10 , a surgeon in Bahia, excised a sublingual osteoma of the mandible using ether applied topically over the mucosa producing local frosting and vasoconstriction. Notoriety to medical advances came about, this time when the parents of xyphopagous sisters asked the distinguished surgeon of the times Alvaro Ramos, to separate them (Figure 5). Realizing that this was a major undertaking, Dr. Ramos requested four “narcotiza-dores” as those Figure 3: Daguerreotype of an amputation just completed on an apparently asleep injured Mexican soldier. Mexican Military Surgeon Pedro Van der Linden faces the camera and bayonets of American soldiers about to take him and his assistants prisoner.
Figure 4: Dr. Jose Pablo Martinez del Rio who joined the Mexican forces when hostilities broke, claimed to have received ether and chloroform from abroad in early 1847. experienced on anesthesia were called in similarity to the German term “narcosis” attributed for anesthesia. In 1899 Rosalina and Maria underwent chloroform anesthesia for the operation. Drs. Miguel Couto and Antonio Leal anesthetized Rosalina, while Drs. Fajardo and Miguel Pereira took care of Maria. 11 Recognizing the importance to keep a record of changes of vital signs during surgery and anesthesia, a form of anesthetic record was first used in 1903 at the Hospital da Santa Casa da Misericordia in Rio de Janeiro on a patient by the name of Cristina da Costa Rezende who received a general anesthetic with sulphuric ether; there was no mention of who was the surgeon, nor who the “narcotizer” was, but it did indicate that the operation had lasted one hour and 13 minutes. 11 The other country where records have been available was Colombia. Interesting findings related to resuscitative events seem to predate others reported. Records show that D. Restrepo of Medellin, Colombia in 1882 performed the first mouth to mouth respiration on a patient anesthetized with chloroform that had stopped breathing, then proceeded to introduce a rubber catheter in the trachea, alternating mouth to tube respirations with bilateral external compression of the ribs, sternum and epigastrium. 12 The patient recovered. In 1891 a senior medical student Teodoro Castrillon 13 from Bogotá measured the barometric pressure in Bogotá and estimated the partial pressure of oxygen, noticing that the former was only 540 mmHg and the latter 108 mmHg; he then proceeded to write his thesis entitled “Anesthesia in Altitude” determining that anesthetics such as ether and chloroform should be given with oxygen or air flow in cities like Bogotá located at nearly 8000 feet high (2700 m). Later on, once graduated, Castrillon also described a case in which he was able to electrically stimulate the phrenic nerves in a patient that had become apneic under anesthesia with chloroform for a “supracondilear” amputation. The patient breathed during the apneic period and woke up as the depth of anesthesia was lightened, again with complete recovery. Also a well-known anesthetist from Medellin, Luis F. Bernal 12 proposed to set up a protocol with the following steps in case of cardiac arrest during anesthesia: a) Cease to administer the anesthetic b) Place the patient in a Trendelenburg position Figure 5: The xyphopagous sisters Rosalina and Maria separated in Rio de Janeiro by surgeon Alvaro Ramos who requested four “narcotizers” on March 30, 1899 in Sao Paulo, Brazil: Drs. F. Fajardo and Miguel Pereira anesthetized Maria and Drs Miguel Couto and Antonio Leao Rosalina with chloroform. c) Reinitiate breathing through a rubber tube placed in the trachea, 7-10/min d) Open the left chest and massage the left ventricle e) Eliminate the secretions from the airway BULLETIN OF ANESTHESIA HISTORY 5 f) Inject stimulants, like caffeine g) Administer saline solution intravenously. Undoubtedly this was an advanced protocol for 1900. The Birth of Intravenous Anesthesia by Infusion Watching the perilous inductions of ether or chloroform anesthesia in the teaching hospital “Hospital Juarez”, Miguel Garcia Marin, a 3 rd year medical student at the National University of Mexico figured that there had to be a better way. He set up to find it. Intravenous administration of fluids was being discussed as possible treatment for dehydration from diarrheas, so metal needles were available. He figured that alcohol, perhaps one of the oldest fluids that put people to sleep, could be used as a drug to produce anesthesia so surgery could be performed. In his own home he set up a small animal laboratory and began to administer intravenous infusions, using needles connected to a rubber IV tubing coming from a bifurcated “Y” one attached to a bottle containing 50% alcohol diluted in 25% glucose and the other 5% dextrose in distilled water (Figure 6). Early in the experiments he noted hematuria, which subsided when he diluted the ethanol in 25% dextrose. He established protocols to administer different rates into 90 doves, 17 hens, 72 dogs, 8 turkeys and eventually two monkeys ( Figure 7) while measuring vital signs, urine output and any other event. 14 He determined the required flow rates to produce sedation, light anesthesia and profound level of anesthesia. Eventually when Garcia Marin was on the fifth (last) year of medical school, through the recommendation of one of his professors Dr. Ulrich and his uncle who was a representative in the Mexican Congress, he was allowed to give a demonstration on a volunteer, but only a prisoner from the Lecumberri Penitenciary, who had a death sentence, was willing. With the promise of an indult if he survived, he agreed to undergo the test with IV alcohol. The young student demonstrated his abilities and the judge let the surviving prisoner go free. Next, Garcia Marin went on to give 53 anesthetics for major surgical procedures (Figure 8) while studying the effects of IV alcohol on renal and hepatic functions as well as on the vital signs. 15 Moreover, by securing an intravenous line to administer Continued on next page
Page 1 and 2: A H A VOLUME 20, NUMBER 2 Original
Page 3: BULLETIN OF ANESTHESIA HISTORY 3 Le
Page 7 and 8: Figure 8: Specimen of a hip desarti
Page 9 and 10: and children in 1975 though they se
Page 11 and 12: BULLETIN OF ANESTHESIA HISTORY 11 5
Page 13 and 14: BULLETIN OF ANESTHESIA HISTORY 13 M
Page 15 and 16: BULLETIN OF ANESTHESIA HISTORY 15

Original Contributions of Latin-Ameri- cans to Anesthesia

Create successful ePaper yourself

Delete template?

Save as template?