As noted earlier, Ramón Pardo introduced spinal anesthesia in 1900 [7,8]. Cocaine, amylocaine (Stovaine), and subsequently procaine hydrochloride were the commonly used local anesthetics, until displaced by tetracaíne and lidocaine. In 1923, Leopoldo Escobar gave the first caudal anesthesia to a patient suffering from sciatica. In 1939, in Monterrey, Mexico, Rodolfo Rodriguez performed the first lumbar epidural block.

For almost two decades, obstetricians/gynecologists administered anesthesia for obstetrics, either intravenously with a combination of meperidine 50–100 mg plus promethazine 50 mg and promazine 25 mg, or as a spinal anesthetic with tetracaíne. In 1938, surgeon Isidro Espinosa de los Reyes, used a catheter to achieve a continuous caudal epidural [20]. Two other surgeons (Mateos Fournier and Jose Rabago) [21] later introduced Robert Hingson’s and Waldo Edwards’s continuous caudal analgesia technique for obstetrics In 1956, anesthesiologists Vicente García Olivera [22], Guillermo Vasconcelos [23], Fernando Rodriguez de la Fuente [24], and Carlos Martínez Redding [25] took obstetric anesthesia from the hands of the surgeons at the hospitals of the Social Security Institute. They replaced spinal (because of hypotension) and caudal (because of catheter contamination) anesthesia with lumbar epidural anesthesia. This practice, with its benefits for the parturient and the newborn, rapidly spread to other hospitals. Currently, unless contraindicated, lumbar epidural block is applied in 95–98% of obstetric cases (Marrón M. Personal Communication. Ob/Gyn Anesthesiologist. Former Director Division of Postgrade and Continuous Education in Health. Secretaría de Salud, Mexico).

Epidural or subarachnoid anesthesia had not been used in children until Melman, Marrufo, and Penuelas, working at the Children’s Hospital in Mexico City (Hospital Infantil de México), compared the effects of subarachnoid versus epidural block, and from studies in cadavers and patients, Melman, Tandazo and Arenas, determined the doses needed to reach different dermatomes [26,27]. Surgeons initially opposed the use of these techniques, but the benefits quickly overcame their reservations. Currently, at the Children’s Hospital, central neuraxial anesthesia is used in about 50% of cases and results in the earlier discharge of patients [28]. Epidural anesthesia in children is nowadays used throughout Mexico, having displaced spinal anesthesia because of the longer postoperative analgesia possible with continuous epidural anesthesia.

In 1945, Vicente García Olivera went to New York to train under E Rovenstine at the Bellevue Hospital in New York who had founded a Pain Clinic in 1936. García Olivera later attended a course at the Veterans Administration Pain Clinic in McKinney, Texas [29]. He was an enthusiast in regional anesthesia, in all its modalities, central neuraxial, sympathetic, and peripheral blocks. In 1948, he created the first center for pain treatment at the London Clinic, in Mexico City (Hospital Clínica Londres). In 1975 he organized the first Pain Clinic at the Hospital General de México. which in 1992 became the National Center for Training in Pain Therapy (Centro Nacional de Capacitación en Clínica y Terapia del Dolor) [29].

In 1934, led by physicians Emilio Varela, Federico Vollbrenthausen, Juan Morquecho, Francisco Fierro and Benjamín Bandera, the Surgical Society of the Hospital Juarez in Mexico City founded the Society of Anesthetists of Mexico (Sociedad de Anestesistas de Mexico), the first anesthesia society created in Latin America. In 1948, the Society changed its name to the Mexican Society of Anesthesiologists (MSA), appointing members from other Mexican states [30].

In 1946, the MSA organized its first National Congress of Anesthesia, holding subsequent congresses every two years until 1974, when annual meetings were instituted. The MSA participated in the founding of societies of anesthesia in other states of Mexico, such as the Society of Anesthesiology of Jalisco in 1948, and the Society of Anesthesiologists of Monterrey, in 1954. In 1960, the societies assembled into a Federation of Mexican Societies of Anesthesia (FSARM). In 1955, the MSA participated as Mexico’s representative in the creation of the World Federation of Societies of Anesthesia (WFSA), and in 1962, in the Confederation of Latin American Societies of Anesthesia (CLASA). The MSA was appointed by the FSARM to be the main organizer of the 6th World Congress of Anesthesiology held in Mexico City in 1976. In 1994 the MSA changed its name to Colegio Mexicano de Anestesiología (COMEXANE) to more effectively represent its members before government authorities [31]. The former Federation of Societies (FSARM) is now called FMCA, AC (Federación Mexicana de Colegios de Anestesia, Asociación Civil). The Mexican College of Anesthesiology, in Mexico City, has 1500 members. The total number of anesthesiologists in Mexico is approximately 12,000, with 8,000 board certified as of September 2011.

In 1960, the Society supported the founding of the Federation of Mexican Societies of Anesthesia (FSARM). State societies of anesthesia, one or two for each state for a total of 60, combined to form FSARM [32]. The Society (now College), also supported the founding and organization of societies of different anesthesia subspecialties including pediatrics (SAP), obstetrics and gynecology (SMAGO), cardiothoracic anesthesia, and pain [33].

The establishment of several major medical institutions in Mexico City in the 1940s facilitated the development of anesthesia training programs. They included the Children’s Hospital in 1943, the National Institute of Cardiology in 1944, the Institute for Medical Sciences and Nutritional Diseases (Instituto Nacional de Ciencias Médicas y Nutrición) in 1946, and the Hospitals in the Mexican Institute for Social Security. The training programs were supported initially by the Mexican Society of Anesthesiologists (MSA) and later by the National University of Mexico (UNAM) and the Mexican Board of Anesthesiology.

In 1957, the MSA organized the first postgraduate course in anesthesia, appointing members of the Society as professors. The 24-month course was held in Mexico City at the General Hospital (Hospital General de México). Physicians taking the course and training received a monthly salary enabling them to leave their former practice and devote their entire time to anesthesia. The MSA continued to organize these courses until 1962. The anesthesiologists thus trained, and others trained in Canada and the US, initiated residency programs in anesthesia in several Mexican hospitals.

In 1966, the MSA and the National University initiated a two-year residency program [19,20]. A 3 year program was established in 1986 at the National University. This was achieved through the co-operation of the National Committee for Postgraduate Education, the Ministry of Health, the MSA’s Academic Committee in Anesthesia and the Mexican Federation of Societies of Anesthesia [21,22]. Acceptance for subspecialty training in pediatrics, neuro-anesthesia, cardiothoracic anesthesia, critical care, obstetrics/gynecology, or pain, currently requires that the appointee be certified by the Mexican Board of Anesthesia. Subspecialty credentialing demands a further 2 years of training in the designated subspecialty [33].

In 1974, members of the MSA, as advised by the National Academy of Medicine, created the Mexican Board of Anesthesia (Consejo Mexicano de Anestesiología; Archivo del Consejo Mexicano de Anestesiología 1974). Candidates were certified after 3 years of a residency program in one of the hospitals appointed as training hospitals, and after taking a written and oral examination. The Board was also responsible for approving and certifying the congresses and the courses held as part of the continuing medical education programs. The Board also determined recertification of all anesthesiologists every 5 years, granting the permit to continue to practice anesthesia. This process of accreditation and certification by the Anesthesia Board, was equivalent to the process that was carried out by the 47 specialty councils recognized by the National Committee for Medical Specialties (CONACEM).

As in many parts of the world, surgeons were the first to administer anesthesia in Mexico. However, the shortage of physicians also dictated that nurses and technicians perform these tasks. Nurses and technicians received one year tutorial courses from trained anesthesiologists; these courses ceased in the early 1970s. Finally, after a long campaign conducted by Mexican anesthesiologists, the authorities and politicians in Mexico became convinced that anesthesia was a medical specialty, best administered by trained physicians. This was incorporated into Mexican law in 1998.¹

The founding members of the MSA published the first anesthesia articles as a supplement called “Anesthesia” in the “Journal of Surgery of the Hospital Juarez” from 1936 until 1939. Subsequent anesthesia articles were published in “Medicina” [10,31].

In July 1951, the first issue of Revista Mexicana de Anestesiologia (RMA) was published, with Benjamín Bandera as the first director and Vicente García Olivera as editor [10]. It was the second anesthesia journal (after Argentina’s) published in Latin America. Since its first publication, it has appeared every three months. It is abstracted or indexed by standard databases (16 databases including Scopus, but not Medline), and is distributed to all members of the Mexican Society. It is the main anesthesia journal published in Mexico, and is the official publication of the Mexican College of Anesthesiology, (COMEXANE). The journal promotes the publication of clinical and basic research in anesthesia and perioperative medicine, critical care, and pain. The Editorial Board accepts papers submitted for publication by Mexican and Spanish speaking Latin American anesthesiologists.

Since 2006, the Colegio Mexicano de Anestesiología also edits quarterly, the Mexican Clinics of Anesthesia, with Raul Carrillo Esper as the current editor-in-chief of both publications [34]. Another Mexican journal “Anestesia”, edited by the Mexican Federation (FMCAAC), has had an irregular publication schedule; currently it is published online every 4 months.

Globalization has permitted the rapid spread of knowledge and technology. In Mexico the quality of medicine may now be comparable to that practiced in first world countries. The US Joint Commission on Health Care Accreditation, (JAHCO) has accredited several hospitals in Mexico City and other states in Mexico, as having standards comparable to those in the US (e.g., the American British Cowdray Medical Center).

Anesthesia developed unevenly in Caribbean Islands and Central American countries in the several decades after Morton’s historic demonstration in 1846 (Tables 26.2 and26.3). This remarkable observation makes one marvel at the diverse conditions that led to a virtual absence of anesthesia in some countries until the last quarter of the nineteenth century, whereas other countries benefited from anesthesia within a year of its discovery. Of course, some of the information may overestimate how long it took to incorporate anesthesia into practice, since for some drugs, little data are available, while for others (ether-chloroform) we have sufficient information. Although a good explanation for the late arrival of anesthesia in many countries is lacking, socio-cultural and economic factors probably underlie the variability in the delay, but as Sherlock Holmes said: “it is a capital mistake to theorize before one has data.”