History
Anaesthetics
Anaesthetics are substances that induce a reversible loss of sensation, often used in medical procedures to alleviate pain and discomfort. The history of anaesthetics dates back to ancient times, with various natural substances and techniques being used to achieve sedation. The development of modern anaesthetics in the 19th century revolutionized surgery and medical practice, significantly improving patient outcomes.
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10 Key excerpts on "Anaesthetics"
eBook - ePubConstructing Pain
Historical, psychological and critical perspectives
- Robert Kugelmann(Author)
- 2016(Publication Date)
- Routledge(Publisher)
Halttunen (1995) writes that “in the early eighteenth century, the term ‘anesthesia’ had referred to a defective lack of feeling; by the end of the century, it had come to connote a ‘positive medical relieving of feeling, a blessing rather than a defect’” (p. 310). That meaning was further refined. According to Stanley (2003), “the term ‘anaesthesia’ seems to have been first used in 1833 when the Lancet published a translation of a French article discussing the condition of ‘diminution, or total loss, of bodily sensation’ with a view, ironically, to its cure” (p. 285). Thus, before the actual introduction of surgical anesthesia, the idea and the term were in circulation. The introduction of surgical anesthesia The introduction of surgical anesthesia in 1846 was one of those events that stand out as forever changing the human condition. Morris (1991) writes that anesthetics “transformed our cultural assumptions about pain” (p. 64). Anesthetics symbolize the rift between our experience of pain and that of those who lived before the mid-nineteenth century. The ground had, however, been long prepared, and anesthetics materialized a change in cultural evaluations of pain that had appeared earlier, with the rise of a culture of “sensibility” in the English-speaking world: “The eighteenth-century cult of sensibility redefined pain as unacceptable and indeed eradicable and thus opened the door to a new revulsion from pain, which, though later regarded as ‘instinctive’ and ‘natural,’ has in fact proved to be distinctly modern” (Halttunen, 1995, p. 304). Halttunen claims that “middle-class sensitivity to pain” “contributed to the late eighteenth-century intensification of medical efforts to discover an effective form of anesthesia” (p. 309)
eBook - PDFSurgical Revolutions
A Historical and Philosophical View
- Luis H Toledo-Pereyra(Author)
- 2011(Publication Date)
- WSPC(Publisher)
Anesthesia 41 History of Anesthesia — Early Encounters in the United States The history of anesthesia is a rather complicated one since there was no clear-cut discoverer. Several individuals claimed to be the leading pioneer in the introduction of surgical anesthesia. The introduction of anesthesia was the first great medical discovery in the United States. By the mid-19th century, the world was ready for the introduction of anesthesia. The proper technology was available, and there was significant demand. Both a climate of humanitarianism and the incentive for fame and wealth steered this invention. The ignorance of the physician, due in good part to his medical education, was a reason why anesthetics were not employed at the beginning of the 19th century. When speaking of anesthesia in the 19th century, ether was administered using the “rag and bottle” technique. This consisted of placing a piece of gauze over the patient’s nose and mouth and allowing drops of liquid ether or chloroform to drip onto the gauze and evaporate into a mixture of gas and air, which the patient inhaled. Owsei Temkin, noted medical historian, has written, “Sociologists of science have cited in evidence for social causation the multiple appearance of the same discovery, ‘multiples’ in the language of Robert Mergon.” The lack of a systematic effort to discover a method to alleviate pain may be explained by the fact that medical research at this time was based on autop-sies, where pain is nonexistent. As science and society progressed, the stage was set for the introduction of anesthesia. The demonstration of ether in 1846 led Ulrich Trohler to write, “It can be seen as a heroic landmark in the history of modern surgery.” 1,8,9 The work of many scientists and physicians prepared science and med-icine for the introduction of anesthesia. By most historical accounts, four major contributors (Long, Morton, Wells, and Jackson) are usually cred-ited with the introduction of anesthesia.
- Clive Page, Jacques Bruinvels, Michael J. Parnham(Authors)
- 2022(Publication Date)
- Academic Press(Publisher)
Chapter 11BAnalgesia up to the twentieth century
Peter Holzer and Fred LembeckChapter Outline
- 11.1 Introduction 293
- 11.2 Analgesia in pre-anaesthesia days 294
- 11.3 The rise of modern analgesics 297
- 11.3.1 Narcotic analgesics 297
- 11.3.2 Antipyretic analgesics 299
- 11.4 The discovery of anaesthesia 300
- 11.5 After the discovery of anaesthesia 305
- 11.5.1 John Snow 305
- 11.5.2 Anaesthesia apparatus 305
- 11.5.3 Endotracheal anaesthesia 306
- 11.5.4 Intravenous anaesthesia 306
- 11.5.5 Local anaesthesia 307
- 11.5.6 Anaesthesiology 309
- 11.5.7 Theory of anaesthesia 309
- 11.6 Outlook 310
- References 310
11.1 Introduction
‘Pain is a subjective experience that is interpreted as symptomatic evidence of impending or actual tissue damage’ (Bowman and Rand, 1980 ). Hence pain serves a useful function by signalling the presence of an injurious stimulus, and yet pain, particularly if it is severe and continuous and its cause is unknown, gives rise to fear and anxiety. These are important components in the perception of pain and — subjectively — the correction of the affective disturbance may be as important as relief from pain. Pain itself may be alleviated in two ways, by specific therapy of the underlying disorder or by attenuating the sensation of pain. It appears that from ancient times man has gone both ways, seeking to relieve pain by surgery and also trying to separate surgical pain from the advancing knife by the use of drugs. ‘Anthropologists tell us that there is no human culture known, from as far back as they can go, that did not instinctively, and hopefully, turn to natural products, that are not normal constituents of diet, in an attempt to alleviate its suffering. Thus, it appears that man always has taken and perhaps always will take medicines in the hope that he can put right what has gone wrong with him or that will enable him to escape mentally from his depressing surroundings, or that will heighten his religious or mystical experiences’ (Bowman, 1979
eBook - PDFFundamentals of Critical Care
A Textbook for Nursing and Healthcare Students
- Ian Peate, Barry Hill(Authors)
- 2022(Publication Date)
- Wiley-Blackwell(Publisher)
Anaesthesia is the process of inducing loss of sensation and/or awareness, and sedation can be described as the action of administering a sedative drug to produce a state of calm or sleep. The established view is that sedation allows better tolerance of invasive procedures, improves synchronisation with mechanical ventilation, facilitates tight control of physiological parameters, increases patient safety and reduces physio- logical stress for critically unwell patients (Whitehouse et al., 2014). The medications used to sedate patients produce short- term side effects including haemodynamic instability and delirium and the long-term effects of sedative drugs have been linked as causative factors to a decline in cognitive function, the incidence of post-traumatic stress disorder, depression and delirium (Aitken et al., 2018; Jones, 2010). It is therefore essential that nurses are knowledgeable and skilled in this area of practice. Sedation and anaesthetic management requires: • Knowledge of drug administration • Understanding of the pharmacological agents used for sedation • Assessment of the patient using recognised observation and sedation measurement tools • Awareness of how sedation impacts direct care and post-critical care management. Indications for sedation and anaesthesia Sedation and anaesthesia are mainstays of critical care practice, and the Intensive Care Society (ICS) (Whitehouse et al., 2014) highlight that the term ‘sedation’ is used to cover the continuum of medication prescribed to reduce anxiety (anxiolysis) to deep unresponsiveness that is similar to that of a general anaesthetic. This continuum covers the many levels of sedation that could be required by critically unwell patients and it is first essential to understand the difference between sedation and anaesthesia. Anaesthetics are a group of drugs that cause a controlled loss of sensation and/ or a loss of awareness to facilitate inter- ventions.
eBook - PDFThe Medical Imagination
Literature and Health in the Early United States
- Sari Altschuler(Author)
- 2018(Publication Date)
- University of Pennsylvania Press(Publisher)
“Anaesthe-sia” was an insistently physiological term that framed pain and feelings as problems of the body-in-motion rather than anatomical concerns. When Holmes wrote Morton to encourage him to change the name of the substance from Letheon Gas to anesthesia, he highlighted the term’s capacity to represent the actions of the drug on the living functions of the body. Holmes wrote, “Anaes-thesia . . . signifies insensibility, more generally.” 2 Terms like “anti-neuric, aneu-ric, neuro-leptic, neurolepsia, neuro-etasis, etc., seem to be anatomical; whereas the change is a physiological one.” 3 Nevertheless, it was this physiological na-ture of the problems of pain and feeling that made them so difficult to know through physical experimentation. Like other physiological processes understood to structure human health, such as circulation and sympathy, pain depended on an understanding of the body-in-motion that posed special problems for medical knowing. For a number 162 Chapter 5 of reasons, this meant pain could not be investigated particularly well through practices like physical experimentation. First, while doctors became increasingly interested in animal vivisection as a way of experimenting with the living body, many objected to the practice on moral grounds. The 1840s saw the rise of anti-vivisection reformers who sought to halt what they saw as an unethical and barbaric practice. Second, even if the practice had been un-contested, vivisection could not provide answers about pain other than what could be gleaned from interpreting the signs of distress in animals. Third, nineteenth-century doctors understood the basic epistemological problem inherent in studying the pain of another that Elaine Scarry has famously de-scribed as largely “inaccessible . . . to anyone not immediately experiencing it.” 4 One writer in the early nineteenth century highlighted the problem through evasion.
- Daniel Rodger, Kevin Henshaw, Paul Rawling, Scott Miller(Authors)
- 2022(Publication Date)
- Cambridge University Press(Publisher)
Chapter 11 Introduction to General Anaesthesia James Ip and Jo Han Gan Introduction The term anaesthesia was first used by Oliver Wendell Holmes in 1846 from the Greek ‘an- aisthesis’ [αισθησις], meaning ‘without sensation’ [1]. The aim of anaesthesia is to allow diagnostic or interventional procedures to be done with minimal to no patient discomfort and no recall of intraoperative events. Anaesthesia can broadly be divided into general, regional, and local anaesthesia. General anaesthesia is a reversible state of unconsciousness induced by pharmacological agents. Regional anaesthesia involves administering a local anaesthetic to a group of nerves or the spinal cord to render a region of the body insensate without impairing consciousness. Local anaesthesia is the infiltration of local anaesthesia to the tissue at the site of surgery to produce a localised area of numbness. General Anaesthesia Sedation and general anaesthesia can be viewed as a spectrum of unconsciousness. At one end of this spectrum, a patient may be lightly sedated to undergo a painless imaging procedure. Conversely, a patient may need to be deeply anaesthetised for major intra-cavity surgery. The transition between sedation and general anaesthesia can be vague but a useful demarcation is the loss of verbal contact and the absence of awareness or explicit recall. Increasing the depth of anaesthesia results in a progressive depression of protective and autonomic reflexes. These reflexes are essential to help maintain physiological homeostasis and avoid harm. For example, a person touching a hot dinner plate would automatically withdraw their hand very quickly. This is the withdrawal reflex, which originates from the spinal cord and serves to protect the body from injuries.
- Keith Sykes, John P Bunker(Authors)
- 2021(Publication Date)
- CRC Press(Publisher)
Part 1Anaesthesia: The first 100 years
In 1900, Sir Frederick Treves, the surgeon who later removed the appendix of King Edward VII two days before his planned Coronation, addressed the Annual Meeting of the British Medical Association in Ipswich and made these comments about the introduction of anaesthesia:‘The changes that the discovery has wrought in the personality of the surgeon, in his bearing, in his methods, and in his capabilities are as wondrous as the discovery itself. The operator is undisturbed by the harass of alarms and the misery of giving pain. He can afford to be leisurely without fear of being regarded as timorous. To the older surgeon every tick of the clock upon the wall was a mandate for haste, every groan of the patient a call for hurried action, and he alone did best who had the quickest fingers and the hardest heart. Time now counts for little, and success is no longer to be measured by the beatings of a watch. The mask of the anaesthetist has blotted out the anguished face of the patient, and the horror of a vivisection on a fellow-man has passed away. Thus it happens that the surgeon has gained dignity, calmness, confidence, and, not least of all, the gentle hand.Anaesthetics have, moreover, greatly extended the domain of surgery by rendering possible operations which before could only have been dreamt about, and by allowing elaborate measures to be carried out step by step.The introduction of Anaesthetics has not only developed surgery, but it has engendered surgeons. It has opened up the craft to many, for in the pre-anaesthetic days the qualities required for success in operating were qualities to be expected only in the few.’(Treves F. Address in surgery: the surgeon in the nineteenth century. British Medical Journal 1900;ii:284–9)
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In the beginning
Although the soporific effects of ether had been described in 1540, surgeons continued to operate on the conscious patient for a further 300 years. When anaesthesia finally arrived, it did so as an offshoot of the recreational drug culture of the time, and with the leading players hotly contesting their role in its discovery.
eBook - PDFHealth and Performance
Health and Performance
- A. R. Smith, D. M. Jones(Authors)
- 2013(Publication Date)
- Academic Press(Publisher)
13 The Effects of Anaesthetic and Analgesic Drugs K. MILLAR I N T R O D U C T I O N : A N E A R L Y S T U D Y O F R E C O V E R Y The effects of anaesthetic and related drugs have long been of interest to psychologists. The early indulgences of William James in the 'ether frolics' of Victorian times may not have been particularly edifying for their insights, but they no doubt provided James at least with temporary relief from his chronic hypochondriasis (Knight, 1950). This was, perhaps, more relief than that granted to early surgical patients for, as Mostert (1975) points out, contemporary reports noted that it was common for the surgeon to enquire during 'anaesthesia' whether the patient was experiencing pain (Lancet, 1847). Indeed, conversation between the surgical team and the patient was as common then with so-called general anaesthesia as it is today with local or regional anaesthesia. The after-effects of anaesthesia upon cognitive or skilled performance was, understandably, less of an issue in those early years. Far greater concern was attached to simple survival, not only from the trauma of surgery but also from wound infection and over-enthusiastic application of ether or chloroform during the operation itself. With the passage of time, anaesthetic techniques became more refined and new volatile and intravenous agents were introduced to ensure that most patients would be oblivious to surgical events ( see Millar, 1989). An experiment by William McDougall during his time at the Psychological Laboratory in Oxford must stand as one of the earliest objective assessments of the influence of an anaesthetic upon the time course of its cognitive after-effects (McDougall and Smith, 1920: a report of a study conducted in 1914). McDougall studied the effects of chloroform and other drugs, including HANDBOOK OF HUMAN PERFORMANCE Copyright © 1992 Academic Press Ltd VOLUME 2 ISBN 0-12-650352-4 All rights of reproduction in any form reserved
eBook - PDF- Qassim Baker, Munther Aldoori(Authors)
- 2009(Publication Date)
- CRC Press(Publisher)
● Introduction ● Preoperative assessment ● Premedication ● General anaesthesia ● Intravenous sedation ● Regional anaesthesia ● Anatomy of the spinal cord ● Summary ● Questions ● Further reading ● INTRODUCTION The word ‘anaesthesia’ comes from the Greek roots an – (not, without) and aesthe_tos (percep-tible, able to feel). The word was coined by Oliver Wendell Holmes, Senior, in 1846. The first anaesthetic was administered by WTG Morton of Boston, MA, USA. Anaesthesia is very safe these days due to the use of modern technology in designing the machines and monitoring devices. The death rate for modern anaesthesia is one in 1 million general Anaesthetics admin-istered for a fit patient. The purpose of this chapter is to provide surgical trainees with a brief knowledge of the importance of preoperative assessment and the types of anaesthetic used – general, regional and local anaesthesia. ● PREOPERATIVE ASSESSMENT The purposes of preoperative assessment are to: ● establish rapport with the patient; ● evaluate the patient’s physical condition and any coexisting medical problems; ● optimise any coexisting medical conditions, e.g. arrhythmia; ● obtain an informed consent and to discuss the risk of anaesthesia; ● prescribe premedication and to advise the patient on stopping or continuing pre-existing med-ication during the perioperative period. Inadequate preoperative preparation of the patient may increase the morbidity and mortality in the perioperative period. Ideally, all patients coming for an operation should be seen in a pre-operative assessment clinic and the anaesthetic plan discussed well in advance, thus allowing the patient to make an informed decision regarding the whole procedure – remember that fail-ure of communication is one of the most important causes of medicolegal problems. This also gives ample time for the anaesthetist to prepare the patient for the surgery and anaesthesia and to optimise any coexisting medical conditions.
eBook - PDF- Paul Flecknell(Author)
- 1996(Publication Date)
- Academic Press(Publisher)
3 Anaesthesia To carry out surgical procedures on animals, pain perception must be completely suppressed. This can be achieved either by general anaesthe-sia, which produces loss of consciousness, or by local or regional anaesthesia. It is now recognized that whilst different agents can appear to provide similar levels of hypnosis (sleep), the degree of intraoperative analgesia provided can vary widely between agents. It is important that an anaesthetic regimen is selected that provides an appropriate degree of intra-operative analgesia. If anaesthesia is being induced simply to provide humane restraint while non-painful procedures are carried out, then only light anaesthesia, with little pain suppression, will be required. Conversely, if potentially painful surgical procedures are to be under-taken, then deep anaesthesia, with complete suppression of pain perception, is necessary. I. GENERAL ANAESTHESIA General anaesthesia can be induced using a variety of drugs and techni-ques. Often a single drug can be given to produce all the required features of general anaesthesia: loss of consciousness, analgesia, suppres-sion of reflex activity, and muscle relaxation. Alternatively, a combina-tion of agents can be given, each making a contribution to the overall effect. The advantage of such an approach is that the undesirable side-effects of anaesthetic agents can often be minimized. The side-effects of Anaesthetics are usually dose dependent. Giving several drugs in combi-nation, at relatively low dose rates, can often result in less effect on major body systems than that following induction of anaesthesia using a single anaesthetic agent. A brief review of some of the major effects of the more widely used anaesthetic agents is given below. More detailed reviews are available (Attia et al, 1987; Short, 1987). Further discussion of factors influencing the selection of a particular method of anaesthesia is included in Chapter 4.
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