Clinical Anesthesia, 7e
Surgery without adequate pain control may seem cruel to the modern reader, and in contemporary practice we are prone to forget the realities of preanesthesia surgery. Fanny Burney, a wellknown literary artist from the early nineteenth century, described a mastectomy she endured after receiving a “wine cordial” as her sole anesthetic. As seven male assistants held her down, the surgery commenced: “When the dreadful steel was plunged into the breast-cutting through veins–arteries–lesh–nerves—I needed no injunction not to restrain my cries. I began a scream that lasted unintermittently during the whole time of the incision—& I almost marvel that it rings not in my Ears still! So excruciating was the agony. Oh Heaven!—I then felt the knife racking against the breast bone—scraping it! This performed while I yet remained in utterly speechless torture”.1 Burney’s description illustrates the dificulty of overstating the impact of anesthesia on the human condition. An epitaph on a monument to William Thomas Green Morton, one of the founders of anesthesia, summarizes the contribution of anesthesia: “BEFORE WHOM in all time Surgery was Agony”.2 Although most human civilizations evolved some method for diminishing patient discomfort, anesthesia, in its modern and effective meaning, is a comparatively recent discovery with traceable origins in the mid-nineteenth century. How we have changed perspectives from one in which surgical pain was terrible and expected to one in which patients reasonably assume they will be safe, pain-free, and unaware during extensive operations is a fascinating story and the subject of this chapter.
Anesthesiologists are like no other physicians: We are experts at controlling the airway and at emergency resuscitation; we are real-time cardiopulmonologists achieving hemodynamic and respiratory stability for the anesthetized patient; we are pharmacologists and physiologists, calculating appropriate doses and desired responses; we are gurus of postoperative care and patient safety; we are internists performing perianesthetic medical evaluations; we are the pain experts across all medical disciplines and apply specialized techniques in pain clinics and labor wards; we manage the severely sick and injured in critical care units; we are neurologists, selectively blocking sympathetic, sensory, or motor functions with our regional techniques; we are trained researchers exploring scientiic mystery and clinical phenomenon. Anesthesiology is an amalgam of specialized techniques, equipment, drugs, and knowledge that, like the growth rings of a tree, have built up over time. Current anesthesia practice is the summation of individual effort and fortuitous discovery of centuries.
Every component of modern anesthesia was at some point a new discovery and relects the experience, knowledge, and inventiveness of our predecessors. Historical examination enables understanding of how these individual components of anesthesia evolved. Knowledge of the history of anesthesia enhances our appreciation of current practice and intimates where our specialty might be headed.
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