etherization -- 2/2/22

Today's selection -- from Anaesthesia: A Very Short Introduction by Aidan O'Donnell. A brief history of general anaesthesia:

"In the early days of anaesthesia, the mid-19th century, the term etherization was used to describe the state produced by the inhalation of ether vapor. However, it soon became clear that chloroform and other agents could produce effectively the same state as ether. Clearly, a patient could not be etherized with chloroform. To try to find one word which sufficed to describe this new state was not easy. Some of the early terms were 'clumsy, and some of the cacophonous', such as narcotism, sopor, hebetization, apathization, letheonization, and stupefaction. The American neurologist Oliver Wendell Holmes suggested the term anaesthesia in 1846 in a letter to William Morton, from the Greek meaning 'without sensation,' and this word, together with its adjective anaesthetic, caught on rapidly. By the time James Young Simpson was publishing his early results with chloroform in 1847, the term was in common use, although ungainly alternative terms such as northria or metaesthesia are still occasionally proposed. 

"The purpose of inhaling ether vapor was so that surgery would be painless, not so that unconsciousness would necessarily be produced. However, unconsciousness and immobility soon came to be considered desirable attributes of anaesthesia. John Snow, the first doctor to specialize in anaesthesia, wrote in 1872: 'Ether contributes other benefits besides ... preventing pain. It keeps patients still who otherwise would not be.' For almost a century, lying still was the only reliable sign of adequate anaesthesia. The state of unconsciousness was considered an advantageous relief from the traumatic experience of surgery.

Five surgeons participate in the amputation of a man’s leg, without anesthetic, while another oversees them. Amputation, Thomas Rowlandson, 1793.

"For nearly a century after the introduction of general anaesthesia, it was provided by a single agent in the majority of cases. Usually, this was ether or chloroform; occasionally, a mixture of the two, or switching from one to the other, was used. Since those agents did what everyone thought was required (they kept the patient unconscious and unmoving), no further consideration was needed. however, the introduction of intravenous agents, muscle relaxants, and other adjuncts led to a discussion of the more specific components of general anaesthesia. 

"In 1926, John Lundy from the Mayo Clinic introduced the term balanced anaesthesia to describe using an array of techniques (such as a sedative premedicant to cause sedation together with general anaesthesia using different agents) to obtain best results. In 1950, Gordon Jackson Rees and Cecil Gray from Liverpool proposed a 'triad' of anaesthesia: narcosis (by which they meant 'unconsciousness'), analgesia and muscle relaxation, which are often represented on a triangular diagram still taught to students. Crucially, one agent was no longer sufficient to produce all of these effects, but by using (for example) halothane for unconsciousness, morphine for analgesia, and tubocurarine for muscle relaxation, safe and reliable operating conditions could not be produced. The combination of an anaesthetic agent, an analgesic, and a muscle relaxant is still widely used, but the triad model is out of date. For a better model, a more careful consideration of the components of general anaesthesia is required." 

thank you harris



Anaesthesia: A Very Short Introduction


Aidan O'Donnell


Oxford University Press


Aidan O'Donnell 2012


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