History of anesthesia

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History of anesthesia : 

History of anesthesia By : Vishal Thakur V-09-04-45

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Anesthesia: traditionally meant the condition of having sensation (including the feeling of pain) blocked or temporarily taken away. It is a pharmacologically induced and reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes or decreased stress response, or all simultaneously. An alternative definition is a "reversible lack of awareness," including a total lack of awareness (e.g. a general anesthetic) or a lack of awareness of a part of the body such as a spinal anesthetic. The word anesthesia was coined by Oliver Wendell Holmes, Sr. in 1846.

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The Need for Anesthesia Relieve from painful surgery. Need of unconsciousness. Need of muscle relaxation.

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In many surgeries, several burly men were needed to hold down patients and surgeons had to make themselves numb to patients. Alcohol and opium were used at times,mandragora and some other herbs, which worked a little, but not terribly well. In large doses they had secondary problems, if sufficiently sedated, possibly inhale some of the vomit, causing aspiration pneumonitis.

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The Invention of Ether In 1275 by Spanish chemist Raymundus Lullius. As a product of the action of sulfuric acid on alcohol. (Back then sulfuric acid was called vitriol). Re-distilling the product of vitriol and alcohol generated what Lullius called "sweet vitriol."

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So ether was noted again in 1540 by German scientist Valerius Cordus. at the same time, Swiss physician and alchemist Paracelsus commented briefly on the hypnotic effects of ether. Later, in 1730, German scientist W.G. Frobenius changed the name of sweet vitriol to “ether.”

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The Invention of Nitrous Oxide This simple chemical was first manufactured in 1772 by Joseph Priestly in England.

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In 1799 Humphrey Davy discovered anesthetic properties of nitrous oxide (N20)---also known as "laughing gas."

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England and James Simpson  In January, 1847, James Young Simpson (1811-1870) used ether as an aid to reduce pain in a difficult childbirth in Edinburgh, Scotland. Ether, however, was by no means an ideal anesthetic. It tended to make people cough, could feel stifling and generate struggling . It wasn't easy to use. Simpson undertook to explore the range of other possible anesthetic agents. Finally he came upon chloroform.

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Dr. John snow use chloroform as anesthetics in 1853. The use of chloroform became even more mainstream when Queen Victoria used it in 1853 to help with the birth of her son Leopold.

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chloroform: It is good, but not as safe. If there’s any adrenaline in the system, people tend to get cardiac arrest and die. severe and fatal toxicity to the liver, which leads to a distinctly uncomfortable death. Happens a bit more in kids. It took 30 years to really run the numbers but it became ever-more clear that ether was safer, with something like 3 per 1000 occasions of mortality versus 14 or so for chloroform.

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Technological Developments Further Developments: Endo-Tracheal Anaesthesia in 1878. In it the patient put to sleep with an intravenous anaesthesia. Then put in a topical spray on his  vocal cords so they don't go into spasm, and slip a tube down his windpipe a bit. There's an inflatable cuff so no fluid (saliva, vomit) can get down into the lungs. In 1885 cocain was used as local anesthetic by Sigmund Freud and Carl koller. In 1895 Heinrich Dreser finds that diluting morphine with acetyls produces a drug without the common morphine side effects. Bayer begins production of diacetylmorphine and coins the name "heroin”.

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Codman ether inhaler Codman nitrous oxide inhaler Ormsby inhaler Allis inhaler 1880s Drip inhaler Junker’s inhaler

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In 1895 Corning used spinal anaesthesia for relief of pain. In 1898 Bier used spinal anaesthesia for surgery. In 1904 procaine was used. In 1907 intra-tracheal insufflation (chloroform). In 1920 by Rowbotham used blind nasal intubation with wide bore tube. 1921 lumbar epidurals.

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In 1934 thiopental was used as anesthetic. It’s a barbiturate, water soluble alkaloid. It depress cardiac and respiratory centers. In the 1940s scientists discovered the active ingredient in South American Amazon Indian arrow poison: It's Curare. The only problem with using this stuff is that person was so relaxed that he can't breathe or swallow---but he was fully awake. This opened the “age of anesthesia”.

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In the United States, surgeon William Stewart Halstead (1852-1922) . He is the pioneer then of what is called “conduction” anesthesia. An interesting side problem: It turned out cocaine was addictid.

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Around 1946 Demerol (meperidine or pethidine) was introduced with a similar claim of being less addicting. This medicine was no better than morphine in its effectiveness and no better than morphine also in its addictive potential— and in some ways worse in its side-effect profile. In 1946 lignocaine come into use. In 1951 suxamethonium come into use.

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In 1956 Halothane were synthesized by Suckling. It depress consciousness and a potent inhalant. It has a prolong effect. Enflurane developed in 1963 by Terrell and used in 1972. Lowers the blood pressure and conduction dramatically. Isoflurane developed in 1965 by Terrell and used in 1984. Not carcinogenic. Good muscle relaxant and affect respiratory system less than that of enflurane.

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Sevoflurane and desflurane also used as anesthetics. These had minimal systemic affect. These have few side effects but expensive.

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Intravenous anesthetics: In 1695 Wren introduce opium in his dog. In 1934 thiopental used as intravenous anesthetic.

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Etomidate is used as intravenous anesthetic. Ketamine is used as intravenous anesthetic. Propofol is used as intravenous anesthetic. Benzodiazepines,diazepam are also used. lorazepam,midazolam,narcotic agonists also used.

Satisfactory anaesthesia require two standpoints : : 

Satisfactory anaesthesia require two standpoints : HUMANITARIAN gentle handling and minimal restraint Protect struggling animal from possible injury TECHNICAL EFFICIENCY Protection of personnel from bite ,kicks as well as risk of accidental or deliberate self injection with dangerous drugs Protection from inhalation anaesthetic agents



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