William E. Clarke
January 1842, Rochester, NY
Teeth extraction of Ms. Hobbie by dentist E. Pope
Crawford W. Long
March 1842, Jefferson, Georgia
Neck tumor excision of Mr. Venable. Fee charged $2.00
James Y. Simpson
November 1847, Edinburgh, Scotland
Among the first to use ether and then chloroform for labor pain relief
Fig. 1.1
William T. G. Morton 1819–1868 (courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, Illinois)
Fig. 1.2
A replica of William Morton’s ether inhaler as used at the first public demonstration of ether anesthesia on October 16, 1846 (courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, Illinois)
The quest for a pleasant and rapid-acting inhalational agent leads to the discovery of chloroform which was first used by J. Y. Simpson for obstetric anesthesia. However, the administration of chloroform for obstetrics was brought into fame by John Snow who administered the agent for Queen Victoria’s deliveries. Ether (unpleasant) and chloroform (liver and cardiac toxicity) were replaced by ethylene gas (high concentration requirement and explosive potential), which was in turn replaced by cyclopropane (more stable). Finally, came the era of fluorinated inhalational agents (increased stability, decreased toxicity). Trifluoroethyl vinyl ether (toxic metabolite) was the first fluorinated anesthetic agent to be used which was followed by halothane (hepatitis), methoxyflurane (nephrotoxicity), enflurane (cardiac depression, convulsant properties), and finally isoflurane (synthesized by Ross Terrell in 1965, clinically used in 1971).
John Snow (1813–1858, England) was popularly known as “the first anesthesiologist” (Fig. 1.3). His research leads to the development of the concept of minimum alveolar concentration (MAC). He administered ether and chloroform in various concentrations to anesthetize animals and determined the concentration to prevent movement to a sharp stimulus. He also described the stages of ether anesthesia and invented the ether face mask. Joseph Clover (1825–1882, England) was a leading anesthesiologist in London after Snow’s death. He favored a nitrous oxide-ether sequence for anesthesia and introduced pulse monitoring during anesthesia. He designed the Clover-respirator bag (to deliver known quantities of chloroform), introduced airway management skills and use of airway cannulas, and designed a portable anesthesia machine.
Fig. 1.3
John Snow 1813–1858, the first anesthesiologist (courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, Illinois)
The Story of Nitrous Oxide
Joseph Priestly, an Englishman and one of the greatest pioneers of chemistry, first prepared nitrous oxide in 1773. Horace Wells (Fig. 1.4) of Hartford, CT, was one of the first to recognize the anesthetic potential of nitrous oxide. On December 10, 1844, while attending an exhibition where nitrous oxide was made available to the audience for inhalation, he noticed that Samuel Cooley, one of the guests, was unaware that his leg was injured while dancing. The next day Horace Wells allowed Gardner Colton, a dentist, to extract his tooth under nitrous oxide inhalation. Horace Wells described his procedure as a success. A few weeks later Wells tried to simulate the same procedure for dental extraction in a medical student in Boston. The medical student screamed and Wells was labeled as a failure. He finally committed suicide in 1848. After his death, Colton led the revival of nitrous oxide, one of the oldest anesthetic agents, which is still being used.
Fig. 1.4
Horace Wells 1815–1848 (courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, Illinois)
Intravenous Anesthetics
Phenobarbital, a barbiturate, was the first intravenous induction agent developed. It was synthesized by Emil Fischer and Joseph von Mering in 1903. Phenobarbital caused prolonged periods of unconsciousness and was associated with slow emergence. Hexobarbital, a short-acting barbiturate, was clinically introduced in 1932. This was replaced by a more potent and rapidly acting barbiturate, thiopental, which was first clinically used in 1934.
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