Who invented local anesthesia. A Brief History of Conduction Anesthesia
Information about the use of anesthesia during operations goes back to ancient times. There is written evidence of the use of painkillers as early as the 15th century BC. Tinctures of mandrake, belladonna, and opium were used. To achieve an analgesic effect, they resorted to mechanical compression of the nerve trunks and local cooling with ice and snow. In order to turn off consciousness, the vessels of the neck were compressed. However, the listed methods did not allow achieving the proper analgesic effect and were very dangerous for the patient’s life. Real prerequisites for the development of effective methods of pain relief began to take shape at the end of the 18th century, especially after the production of pure oxygen (Priestley and Scheele, 1771) and nitrous oxide (Priestley, 1772), as well as a thorough study of the physicochemical properties of diethyl ether (Faraday, 1818).
It is rightly believed that scientifically based pain relief came to us in the middle of the 19th century. May 30, 1842 Long first used ether anesthesia during an operation to remove a tumor from the back of the head. However, this became known only in 1852. The first public demonstration of ether anesthesia was made October 16, 1846. On this day in Boston, Harvard University professor John Warren removed a tumor in the submandibular region of the sick Gilbert Abbott under ether sedation. The patient was narcotized by dentist William Morton. The date October 16, 1846 is considered the birthday of modern anesthesiology.
With extraordinary speed, news of the discovery of pain relief spread throughout the world. In England December 19, 1846 under ether anesthesia Liston operated, soon Simpson and Snow began to use anesthesia. With the advent of ether, all other means of pain relief, used for centuries, were abandoned.
In 1847 as narcotic substance Englishman James Simpson for the first time used chloroform, etc. When using chloroform, anesthesia occurs much faster than when using ether; it quickly gained popularity among surgeons and replaced ether for a long time. John Snow first used chloroform to anesthetize labor for Queen Victoria of England when she gave birth to her eighth child. The church opposed chloroform and ether anesthesia in obstetrics. In search of arguments, Simpson declared God to be the first drug addict, pointing out that during the creation of Eve from the rib of Adam, God put the latter to sleep. Subsequently, however, the significant incidence of complications due to toxicity gradually led to the abandonment of chloroform anesthesia.
In the mid-40s of the 19th century widespread clinical experimenting with nitrous oxide, whose analgesic effect was discovered Davy in 1798year. In January 1845, Wells publicly demonstrated nitrous oxide anesthesia. during tooth extraction, but unsuccessfully: adequate anesthesia was not achieved. In retrospect, the reason for the failure can be recognized as the very property of nitrous oxide: for a sufficient depth of anesthesia, it requires extremely high concentrations in the inhaled mixture, which lead to asphyxia. The solution was found in 1868 Andrews:he began to combine nitrous oxide with oxygen.
The experience of using narcotic substances through the respiratory tract had a number of disadvantages such as suffocation and agitation. This forced us to look for other routes of administration. In June 1847 Pirogov applied rectal anesthesia with ether during childbirth.He tried to administer ether intravenously, but it turned out to be a very dangerous type of anesthesia.In 1902pharmacologist N.P. Kravkov suggested for intravenous anesthesia hedonol,for the first time applied in clinic in 1909 S.P. Fedorov (Russian anesthesia).In 1913, barbiturates were used for anesthesia for the first time., and barbituric anesthesia has been widely used since 1932 with the inclusion of hexenal in the clinical arsenal.
During the Great Patriotic War, intravenous alcohol anesthesia became widespread, but in the post-war years it was abandoned due to the complex administration technique and frequent complications.
A new era in anesthesiology was opened by the use of natural drugs curare and their synthetic analogues, which relax skeletal muscles. In 1942, Canadian anesthesiologist Griffith and his assistant Johnson first used muscle relaxants in the clinic. New drugs have made anesthesia more advanced, manageable and safe. The emerging problem of artificial pulmonary ventilation (ALV) was successfully solved, and this in turn expanded the horizons of operative surgery: it led to the creation, in fact, of pulmonary and cardiac surgery and transplantology.
The next stage in the development of pain management was the creation of a heart-lung machine, which made it possible to operate on a “dry” open heart.
Elimination of pain during major operations turned out to be insufficient to preserve the vital functions of the body. Anesthesiology was tasked with creating conditions for normalizing impaired respiratory functions, the cardiovascular system, and metabolism. In 1949, the French Laborie and Utepar introduced the concept of hibernation and hypothermia.
Although not widely used, they played a big role in the development concepts of potentiated anesthesia(term introduced by Laborie in 1951). Potentiation is a combination of various non-narcotic drugs (neuroleptics, tranquilizers) with general anesthetics to achieve adequate pain relief at small doses of the latter, and served as the basis for the use of a new promising method of general anesthesia - neuroleptanalgesia(combination of a neuroleptic and a narcotic analgesic), proposed by de Castries and Mundeler in 1959.
As can be seen from the historical background, although anesthesiology has been carried out since ancient times, real recognition as a scientifically based medical discipline came only in the 30s. XX century. In the USA, the Council of Anesthesiologists was created in 1937. In 1935, an examination in anesthesiology was introduced in England.
In the 50s For most surgeons in the USSR, it became obvious that the safety of surgical interventions largely depended on their anesthetic support. This was a very important factor that stimulated the formation and development of domestic anesthesiology. The question arose about the official recognition of anesthesiology as a clinical discipline, and an anesthesiologist as a specialist in a special profile.
In the USSR, this issue was specifically discussed for the first time in 1952 at the V Plenum of the Board of the All-Union Scientific Society of Surgeons. As was said in the closing remarks: “We are present at the birth of a new science, and it is time to recognize that there is another branch that has developed from surgery.”
Since 1957, the training of anesthesiologists began in clinics in Moscow, Leningrad, Kyiv, and Minsk. Departments of anesthesiology are being opened at the Military Medical Academy and institutes for advanced training of doctors. Scientists such as Kupriyanov, Bakulev, Zhorov, Meshalkin, Petrovsky, Grigoriev, Anichkov, Darbinyan, Bunyatyan and many others made a great contribution to the development of Soviet anesthesiology. The rapid progress of anesthesiology at the early stage of its development, in addition to the increasing demands on it from surgery, was facilitated by the achievements of physiology, pathological physiology, pharmacology and biochemistry. The knowledge accumulated in these areas has proven to be very important in solving problems of ensuring patient safety during operations. The expansion of capabilities in the field of anesthesiological support of operations was largely facilitated by the rapid growth of the arsenal of pharmacological agents. In particular, new for that time were: fluorotane (1956), Viadril (1955), drugs for NLA (1959), methoxyflurane (1959), sodium hydroxybutyrate (1960), propanidide (1964 g.), ketamine (1965), etomidate (1970).
Preparing the patient for anesthesia
Preoperative period– this is the period from the moment the patient is admitted to the hospital until the start of the operation.
Particular attention should be paid to preparing patients for anesthesia. It begins with personal contact between the anesthesiologist and the patient. First, the anesthesiologist should familiarize himself with the medical history and clarify the indications for the operation, and he should find out all the questions that interest him personally.
During planned operations, the anesthesiologist begins examining and getting to know the patient several days before the operation. In cases of emergency interventions, the examination is carried out immediately before the operation.
The anesthesiologist is obliged to know the patient’s occupation and whether his work is related to hazardous production (nuclear energy, chemical industry, etc.). The patient's life history is of great importance: past diseases (diabetes mellitus, coronary heart disease and myocardial infarction, hypertension), as well as regularly taken medications (glucocorticoid hormones, insulin, antihypertensive drugs). Particular attention should be paid to the tolerability of medications (allergy history).
The doctor performing anesthesia must be well aware of the state of the cardiovascular system, lungs, and liver. Mandatory methods of examining the patient before surgery include: general blood and urine analysis, biochemical blood test, blood clotting (coagulogram). The blood type and Rh affiliation of the patient must be determined. Electrocardiography is also performed. The use of inhalation anesthesia makes it necessary to pay special attention to the study of the functional state of the respiratory system: spirography is performed, Stange tests are determined: the time for which the patient can hold his breath while inhaling and exhaling. In the preoperative period during planned operations, it is necessary, if possible, to correct existing homeostasis disorders. In emergency cases, preparation is carried out to a limited extent, which is dictated by the urgency of the surgical intervention.
A person who is about to have an operation is naturally worried, so a sympathetic attitude towards him and an explanation of the need for the operation is necessary. Such a conversation can be more effective than the effects of sedatives. However, not all anesthesiologists can communicate equally convincingly with patients. The state of anxiety in a patient before surgery is accompanied by the release of adrenaline from the adrenal medulla, an increase in metabolism, which makes it difficult to administer anesthesia and increases the risk of developing cardiac arrhythmias. Therefore, all patients are prescribed premedication before surgery. It is carried out taking into account the characteristics of the patient’s psycho-emotional state, his reaction to the disease and the upcoming operation, the characteristics of the operation itself, and its duration, as well as age, constitution and life history.
On the day of surgery, the patient is not fed. Before surgery, you should empty your stomach, intestines, and bladder. In emergency cases, this is done using a gastric tube or urinary catheter. In emergency cases, the anesthesiologist must personally (or another person under his direct supervision) empty the patient's stomach using a thick tube. Failure to carry out this measure in the event of the development of such a severe complication as regurgitation of gastric contents with its subsequent aspiration into the respiratory tract, which has fatal consequences, is legally regarded as a manifestation of negligence in the performance of the doctor’s duties. A relative contraindication for tube insertion is recent surgery on the esophagus or stomach. If the patient has dentures, they must be removed.
All preoperative preparation activities are aimed mainly at
reduce the risk of surgery and anesthesia, facilitating adequate tolerance of surgical trauma;
reduce the likelihood of possible intra- and postoperative complications and thereby ensure a favorable outcome of the operation;
speed up the healing process.
We resort to medical help, feeling that not everything is in order with our health. The most obvious and understandable sign of internal problems in the body is pain. And when we come to the doctor, we first of all wait to get rid of it. However, how often the doctor’s actions intended to help the patient, against his will, cause pain!
It’s painful to set a dislocation, it’s painful to stitch up a lacerated wound, it’s painful to treat a tooth... It happens that it is the fear of pain that prevents a person from seeing a doctor on time, and he stalls for time, triggering and aggravating the disease. Therefore, at all times, doctors have strived to conquer pain, learn to manage it and pacify it. But this goal was achieved relatively recently: just 200 years ago, almost any treatment was inseparable from suffering.
Achilles bandages Patroclus' wound inflicted by an arrow. Painting of a Greek kylix. V century BC e.
But even for a person unfamiliar with medical procedures, encountering pain is almost inevitable. Pain has accompanied humanity for as many millennia as it has inhabited the Earth. And probably already a dense healer from a primitive cave tribe tried to use the means available to him to reduce or completely eliminate pain.
True, now descriptions of the first “available means” cause bewilderment and fear. For example, in ancient Egypt, before traditional circumcision surgery, the patient was rendered unconscious by squeezing the blood vessels in his neck. Oxygen stopped flowing to the brain, the person fell into unconsciousness and felt virtually no pain, but such a barbaric method of pain relief could not be called safe. There is also information that sometimes patients were subjected to prolonged bloodletting so long that the bleeding person fell into a deep faint.
The first painkillers were prepared from plant materials. Decoctions and infusions of hemp, opium poppy, mandrake, henbane helped the patient relax and reduced pain. In those corners of the globe where the necessary plants did not grow, another painkiller was in use, and also of natural origin, ethyl alcohol, or ethanol. This fermentation product of organic substances, obtained in the production of all kinds of alcoholic beverages, affects the central nervous system, reducing the sensitivity of nerve endings and suppressing the transmission of nervous excitation.
The listed drugs were quite effective in emergency situations, but during serious surgical interventions they did not help; in this case, the pain was so severe that herbal decoctions and wine could not relieve it. In addition, long-term use of these painkillers led to a sad result: dependence on them. The father of medicine, the outstanding healer Hippocrates, when describing substances that cause temporary loss of sensitivity, used the term “drug” (Greek narkotikos “leading to numbness”).
Opium poppy flowers and heads.
Ebers Papyrus.
In the 1st century n. e. The ancient Roman physician and pharmacologist Dioscorides, describing the narcotic properties of an extract from mandrake root, first used the term “anesthesia” (Greek anaesthesia “without feeling”). Addiction, dependence, is a side effect of using modern painkillers, and this problem still remains relevant and acute for medicine.
Alchemists of the Middle Ages and the Renaissance presented humanity with many new chemical compounds and found various practical options for their use. So, in the 13th century. Raymond Lull discovered ether, a colorless volatile liquid, a derivative of ethyl alcohol. In the 16th century Paracelsus described the pain-relieving properties of ether.
It was with the help of ether that full-fledged general anesthesia, artificially induced complete loss of consciousness, was first carried out. But this happened only in the 19th century. Before that, the inability to effectively anesthetize the patient greatly hampered the development of surgery. After all, a serious operation cannot be performed if the patient is conscious. Life-saving surgical interventions such as amputation of a gangrenous limb or removal of an abdominal tumor can cause traumatic shock and lead to the death of the patient.
It turned out to be a vicious circle: the doctor must help the patient, but his help is deadly... The surgeons were intensely looking for a way out. In the 17th century Italian surgeon and anatomist Marco Aurelio Severino proposed performing local anesthesia by cooling, for example, shortly before surgery, rubbing the surface of the body with snow. Two centuries later, in 1807, Dominique Jean Larrey, a French military doctor and chief surgeon of Napoleon's army, would amputate soldiers' limbs on the battlefield in subzero temperatures.
In 1799, the English chemist Humphry Davy discovered and described the effect of nitrous oxide, or “laughing gas.” He tested the pain-relieving effect of this chemical compound on himself at the moment when his wisdom teeth were cutting. Davy wrote: “The pain completely disappeared after the first four or five inhalations, and the unpleasant sensations were replaced for a few minutes by a feeling of pleasure...”
A. Brouwer. Touch. 1635
Marco Aurelio Severino. Engraving 1653
Davy's research later attracted the interest of his compatriot, surgeon Henry Hickman. He conducted many experiments on animals and became convinced that nitrous oxide, used in the right concentration, suppressed pain and could be used in surgical operations. But Hickman was not supported by either his compatriots or his French colleagues, and he was unable to obtain official permission to test the effects of nitrous oxide on humans either in England or France. The only one who supported him and was even ready to provide himself for experiments was the same surgeon Larrey.
But a start had been made: the very idea of using nitrous oxide in surgery was expressed. In 1844, the American dentist Horace Wells attended a circus-like performance that was popular at the time: a public demonstration of the effects of laughing gas. One of the voluntary test subjects severely injured his leg during the demonstration, but upon coming to his senses, he assured that he did not feel any pain. Wells suggested that nitrous oxide could be used in dentistry. He first tested the new drug on himself and radically: another dentist removed his tooth. Convinced that laughing gas was suitable for use in dental practice, Wells tried to attract general attention to the new remedy and staged a public operation using nitrous oxide. But the operation ended in failure: the volatile gas “leaked” into the audience, the patient experienced unpleasant sensations, but the audience who inhaled the gas had a lot of fun.
T. Phillips. Portrait of Sir Humphry Davy.
A. L. Girodet-Triozon. Portrait of Dominique Jean Larrey. 1804
On October 16, 1846, the first widely known operation performed using ether anesthesia was performed at the Massachusetts Central Clinic (Boston, USA). Dr. William Thomas Green Morton euthanized the patient using diethyl ether, and surgeon John Warren then removed the patient's submandibular tumor.
Dr. Morton, the first anesthesiologist in the official history of medicine, practiced as a dentist until 1846. He often had to remove the roots of patients' teeth, which each time caused them severe pain. Naturally, Morton wondered how to alleviate this pain or avoid it altogether. At the suggestion of the physician and scientist Charles Jackson, Morton decided to try ether as an anesthetic. He experimented on animals, on himself, and successfully; All that remained was to wait for the patient to agree to anesthesia. On September 30, 1846, such a patient appeared: E. Frost, suffering from severe toothache, was ready to do anything to get rid of the pain, and Morton, in the presence of several witnesses, performed an operation on him using ether anesthesia. Frost, having regained consciousness, stated that during the operation he did not experience any unpleasant sensations. This indisputable success of the doctor for the general public, alas, went unnoticed, and therefore Morton ventured into another demonstration of his discovery, which took place on October 16, 1846.
Dr. Morton's first anesthesia.
Morton and Jackson received a patent for their invention, and thus began the triumphant and life-saving march of anesthesia throughout the world. On the monument erected in Boston to Dr. William Thomas Greene Morton, the words are inscribed: “Inventor and discoverer of anesthesia, who averted and destroyed pain, before whom surgery was always a torture, after which science controls pain.”
Doctors around the world greeted Morton's discovery with joy and enthusiasm. In Russia, the first operation using ether anesthesia was performed just six months after the demonstration in Boston. It was performed by the outstanding surgeon Fyodor Ivanovich Inozemtsev. Immediately after him, the great Nikolai Ivanovich Pirogov began to widely use ether anesthesia. Summarizing the results of his surgical activities during the Crimean War, he wrote: “We hope that from now on the ethereal device will be, just like a surgical knife, a necessary accessory for every doctor...” Pirogov was the first to use chloroform anesthesia, which had already been discovered in 1831
But the faster anesthesiology developed, the more clearly surgeons began to understand the negative aspects of anesthesia with ether and chloroform. These substances were very toxic, often causing general poisoning of the body and complications. In addition, mask anesthesia, in which the patient inhales ether or chloroform through a mask, is not always possible (for example, in patients with impaired respiratory function). There were many years of searching ahead, anesthesia with barbiturates, steroids, and the widespread introduction of intravenous anesthesia. However, any new type of anesthesia, with all its apparent initial perfection, is not without drawbacks and side effects and therefore requires constant monitoring by a specialist anesthesiologist. The anesthesiologist in any operating room is as important a character as the operating surgeon.
At the end of the 20th century. Russian scientists have developed a method for using xenon anesthesia. Xenon is a non-toxic gas, which makes it an extremely suitable means for general anesthesia. There are new developments and new discoveries ahead, new victories over man’s eternal companion, pain.
In the first year after the successful operations of Inozemtsev and Pirogov, 690 surgical interventions under anesthesia were performed in Russia. And three hundred of them are on the account of Nikolai Ivanovich Pirogov.
I. Repin. Portrait of N. I. Pirogov. 1881
“The divine art of destroying pain” was beyond the control of man for a long time. For centuries, patients were forced to endure suffering patiently, and doctors were unable to stop their suffering. In the 19th century, science was finally able to conquer pain.
Modern surgery uses for and A who first invented anesthesia? You will learn about this as you read the article.
Anesthesia techniques in ancient times
Who invented anesthesia and why? Since the birth of medical science, doctors have been trying to solve an important problem: how to make surgical procedures as painless as possible for patients? With severe injuries, people died not only from the consequences of the injury, but also from the painful shock they experienced. The surgeon had no more than 5 minutes to perform the operations, otherwise the pain would become unbearable. The aesculapians of antiquity were armed with various means.
In Ancient Egypt, crocodile fat or alligator skin powder were used as anesthetics. An ancient Egyptian manuscript dating back to 1500 BC describes the pain-relieving properties of the opium poppy.
In ancient India, healers used substances based on Indian hemp to produce painkillers. Chinese doctor Hua Tuo, who lived in the 2nd century. AD, suggested that patients drink wine laced with marijuana before surgery.
Methods of pain relief in the Middle Ages
Who invented anesthesia? In the Middle Ages, the miraculous effect was attributed to the mandrake root. This plant from the nightshade family contains potent psychoactive alkaloids. Drugs with the addition of mandrake extract had a narcotic effect on a person, clouded consciousness, and dulled pain. However, the wrong dosage could be fatal, and frequent use caused drug addiction. The analgesic properties of mandrake were first discovered in the 1st century AD. described by the ancient Greek philosopher Dioscorides. He gave them the name “anaesthesia” - “without feeling.”
In 1540, Paracelsus proposed the use of diethyl ether for pain relief. He repeatedly tried the substance in practice - the results looked encouraging. Other doctors did not support the innovation and after the death of the inventor they forgot about this method.
To turn off a person’s consciousness to carry out the most complex manipulations, surgeons used a wooden hammer. The patient was hit on the head and temporarily fell into unconsciousness. The method was crude and ineffective.
The most common method of medieval anesthesiology was ligatura fortis, i.e. pinching of nerve endings. The measure allowed for a slight reduction in pain. One of the apologists of this practice was the court physician of the French monarchs, Ambroise Paré.
Cooling and hypnosis as methods of pain relief
At the turn of the 16th-17th centuries, the Neapolitan physician Aurelio Saverina reduced the sensitivity of the operated organs using cooling. The diseased part of the body was rubbed with snow, thus being slightly frozen. Patients experienced less suffering. This method has been described in the literature, but few people have resorted to it.
Pain relief using cold was remembered during the Napoleonic invasion of Russia. In the winter of 1812, the French surgeon Larrey carried out mass amputations of frostbitten limbs right on the street at a temperature of -20... -29 o C.
In the 19th century, during the period of the mesmerization craze, attempts were made to hypnotize patients before surgery. A when and who invented anesthesia? We'll talk about this further.
Chemical experiments of the 18th-19th centuries
With the development of scientific knowledge, scientists began to gradually approach the solution of a complex problem. At the beginning of the 19th century, the English naturalist H. Davy established, based on personal experience, that inhaling nitrous oxide vapor dulls the feeling of pain in a person. M. Faraday found that a similar effect is caused by sulfuric ether vapor. Their discoveries did not find practical application.
In the mid-40s. 19th century dentist G. Wells from the USA became the first person in the world to undergo surgical manipulation while under the influence of an anesthetic - nitrous oxide or “laughing gas”. Wells had a tooth removed, but he did not feel any pain. Wells was inspired by the successful experience and began to promote a new method. However, the repeated public demonstration of the action of the chemical anesthetic ended in failure. Wells failed to win the laurels of the discoverer of anesthesia.
Invention of ether anesthesia
W. Morton, who practiced in the field of dentistry, became interested in the study of analgesic effects. He carried out a series of successful experiments on himself and on October 16, 1846, put the first patient into a state of anesthesia. An operation was performed to painlessly remove a tumor in the neck. The event received wide resonance. Morton patented his innovation. He is officially considered the inventor of anesthesia and the first anesthesiologist in the history of medicine.
The idea of ether anesthesia was picked up in medical circles. Operations using it were performed by doctors in France, Great Britain, and Germany.
Who invented anesthesia in Russia? The first Russian doctor who risked testing the advanced method on his patients was Fedor Ivanovich Inozemtsev. In 1847, he performed several complex abdominal operations on patients immersed in water. Therefore, he is the pioneer of anesthesia in Russia.
Contribution of N. I. Pirogov to world anesthesiology and traumatology
Other Russian doctors followed in Inozemtsev’s footsteps, including Nikolai Ivanovich Pirogov. He not only operated on patients, but also studied the effects of ethereal gas and tried different ways of introducing it into the body. Pirogov summarized and published his observations. He was the first to describe the techniques of endotracheal, intravenous, spinal and rectal anesthesia. His contribution to the development of modern anesthesiology is invaluable.
Pirogov is the one. For the first time in Russia, he began to fix damaged limbs using a plaster cast. The doctor tested his method on wounded soldiers during the Crimean War. However, Pirogov cannot be considered the discoverer of this method. Gypsum was used as a fixing material long before (Arab doctors, the Dutch Hendrichs and Matissen, the Frenchman Lafargue, the Russians Gibenthal and Basov). Pirogov only improved the plaster fixation, making it light and mobile.
Discovery of chloroform anesthesia
In the early 30s. Chloroform was discovered in the 19th century.
A new type of anesthesia using chloroform was officially presented to the medical community on November 10, 1847. Its inventor, Scottish obstetrician D. Simpson, actively introduced pain relief for women in labor to ease the process of childbirth. There is a legend that the first girl who was born painlessly was given the name Anasthesia. Simpson is rightfully considered the founder of obstetric anesthesiology.
Chloroform anesthesia was much more convenient and profitable than ether. It put a person to sleep faster and had a deeper effect. It did not require additional equipment; it was enough to inhale the vapor from gauze soaked in chloroform.
Cocaine is a local anesthetic used by South American Indians.
The ancestors of local anesthesia are considered to be South American Indians. They have been using cocaine as a painkiller for a long time. This plant alkaloid was extracted from the leaves of the native Erythroxylon coca shrub.
The Indians considered the plant a gift from the gods. Coca was planted in special fields. Young leaves were carefully picked from the bush and dried. If necessary, the dried leaves were chewed and saliva was poured over the damaged area. It lost sensitivity, and traditional healers began surgery.
Koller's research in local anesthesia
The need to provide pain relief in a limited area was especially acute for dentists. Tooth extraction and other interventions in dental tissue caused unbearable pain in patients. Who invented local anesthesia? In the 19th century, in parallel with experiments on general anesthesia, a search was carried out for an effective method for limited (local) anesthesia. In 1894, the hollow needle was invented. Dentists used morphine and cocaine to relieve toothache.
A professor from St. Petersburg, Vasily Konstantinovich Anrep, wrote in his works about the properties of coca derivatives to reduce sensitivity in tissues. His works were studied in detail by the Austrian ophthalmologist Karl Koller. A young doctor decided to use cocaine as an anesthetic during eye surgery. The experiments turned out to be successful. The patients remained conscious and did not feel pain. In 1884, Koller informed the Viennese medical community about his achievements. Thus, the results of the Austrian doctor’s experiments are the first officially confirmed examples of local anesthesia.
History of the development of endotrachial anesthesia
In modern anesthesiology, endotracheal anesthesia, also called intubation or combined, is most often practiced. This is the safest type of anesthesia for humans. Its use allows you to keep the patient’s condition under control and perform complex abdominal surgeries.
Who invented endotrochial anesthesia? The first documented case of the use of a breathing tube for medical purposes is associated with the name of Paracelsus. An outstanding doctor of the Middle Ages inserted a tube into the trachea of a dying man and thereby saved his life.
In the 16th century, Andre Vesalius, a professor of medicine from Padua, conducted experiments on animals by inserting breathing tubes into their tracheas.
The occasional use of breathing tubes during operations provided the basis for further developments in the field of anesthesiology. In the early 70s of the 19th century, the German surgeon Trendelenburg made a breathing tube equipped with a cuff.
The use of muscle relaxants in intubation anesthesia
The widespread use of intubation anesthesia began in 1942, when Canadians Harold Griffith and Enid Johnson used muscle relaxants - drugs that relax muscles - during surgery. They injected the patient with the alkaloid tubocurarine (intokostrin), obtained from the famous poison of the South American Indians, curare. The innovation made intubation procedures easier and made operations safer. Canadians are considered to be the innovators of endotracheal anesthesia.
Now you know who invented general and local anesthesia. Modern anesthesiology does not stand still. Traditional methods are successfully used, and the latest medical developments are introduced. Anesthesia is a complex, multicomponent process on which the health and life of the patient depends.
Anesthesia during surgery was first demonstrated by William Morton, a dentist at the General Hospital, Boston, on October 16, 1846. The audience where he performed the operation was later called the House of Ether, and this date was called Ether Day. In the same year, the anesthetic properties of ether were demonstrated during a meeting of the London Medical Society.
On December 21, 1846, William Squire performed the first leg amputation using ether in London, and the operation was witnessed by many witnesses; she was a success. The following year, Professor Simpson of Edinburgh first used a method in which chloroform was dripped onto a mesh covered with gauze, which was placed over the face of the person being operated on. In 1853, chloroform anesthesia was given by John Shaw to Queen Victoria during the birth of Prince Leopold.
Local anesthesia had not been scientifically described until 1844; Karl Koller accepts the offer of his friend Sigmund Freud and evaluates the effect of cocaine, subsequently describing the use of cocaine in anesthesia of the conjunctival sac, this operation is practiced in ophthalmic surgery.
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Getting rid of pain has been the dream of mankind since time immemorial. Attempts to stop the suffering of the patient were used in the ancient world. However, the methods by which doctors of those times tried to relieve pain were, by today’s standards, absolutely wild and themselves caused pain to the patient. Stunning with a blow to the head with a heavy object, tight constriction of the limbs, squeezing of the carotid artery until complete loss of consciousness, bloodletting to the point of brain anemia and deep fainting - these absolutely brutal methods were actively used in order to lose pain sensitivity in the patient.
There were, however, other ways. Even in Ancient Egypt, Greece, Rome, India and China, decoctions of poisonous herbs (belladonna, henbane) and other drugs (alcohol until unconsciousness, opium) were used as painkillers. In any case, such “gentle” painless methods brought harm to the patient’s body, in addition to a semblance of pain relief.
History contains data on amputations of limbs in the cold, which were carried out by Napoleon's army surgeon Larrey. Right on the street, at 20-29 degrees below zero, he operated on the wounded, considering freezing to be sufficient pain relief (in any case, he had no other options anyway). The transition from one wounded person to another was carried out even without first washing hands - at that time no one thought about the obligatory nature of this moment. Larrey probably used the method of Aurelio Saverino, a doctor from Naples, who back in the 16th-17th century, 15 minutes before the start of the operation, rubbed snow on those parts of the patient’s body that were then subjected to intervention.
Of course, none of the listed methods provided the surgeons of those times with absolute and long-term pain relief. The operations had to be carried out incredibly quickly - from one and a half to 3 minutes, since a person can withstand unbearable pain for no longer than 5 minutes, otherwise a painful shock would occur, from which patients most often died. One can imagine that, for example, amputation took place under such conditions by literally cutting off a limb, and what the patient experienced at the same time can hardly be described in words... Such anesthesia did not yet allow performing abdominal operations.
Further inventions of pain relief
The surgery was in dire need of anesthesia. This could give most patients who needed surgery a chance of recovery, and doctors understood this well.
In the 16th century (1540), the famous Paracelsus made the first scientifically based description of diethyl ether as an anesthetic. However, after the death of the doctor, his developments were lost and forgotten for another 200 years.
In 1799, thanks to H. Devi, a variant of pain relief using nitrous oxide (“laughing gas”) was released, which caused euphoria in the patient and gave some analgesic effect. Devi used this technique on himself during the eruption of wisdom teeth. But since he was a chemist and physicist, and not a physician, his idea did not find support among doctors.
In 1841, Long performed the first tooth extraction using ether anesthesia, but did not immediately inform anyone about it. Subsequently, the main reason for his silence was the unsuccessful experience of H. Wells.
In 1845, Dr. Horace Wells, who had adopted Devi's method of pain relief by using laughing gas, decided to conduct a public experiment: extracting a patient's tooth using nitrous oxide. The doctors gathered in the hall were very skeptical, which is understandable: at that time no one completely believed in the absolute painlessness of operations. One of those who came for the experiment decided to become a “test subject,” but due to his cowardice, he began screaming even before the anesthesia was administered. When anesthesia was finally carried out, and the patient seemed to pass out, “laughing gas” spread throughout the room, and the experimental patient woke up from a sharp pain at the moment of tooth extraction. The audience laughed under the influence of the gas, the patient screamed in pain... The overall picture of what was happening was depressing. The experiment was a failure. The doctors present booed Wells, after which he gradually began to lose patients who did not trust the “charlatan” and, unable to bear the shame, committed suicide by inhaling chloroform and opening his femoral vein. But few people know that Wells’s student, Thomas Morton, who was later recognized as the discoverer of ether anesthesia, quietly and imperceptibly left the failed experiment.
T. Morton's contribution to the development of pain management
At that time, Thomas Morton, a prosthodontist, was experiencing difficulties regarding the lack of patients. People, for obvious reasons, were afraid to treat their teeth, much less remove them, preferring to endure rather than undergo a painful dental procedure.
Morton perfected the development of diethyl alcohol as a powerful pain reliever through multiple experiments on animals and his fellow dentists. Using this method, he removed their teeth. When he built an anesthesia machine that was most primitive by modern standards, the decision to conduct public anesthesia became final. Morton invited an experienced surgeon to assist him, assigning himself the role of an anesthesiologist.
On October 16, 1846, Thomas Morton successfully performed a public operation to remove a tumor on the jaw and a tooth under anesthesia. The experiment took place in complete silence, the patient slept peacefully and did not feel anything.
The news of this instantly spread throughout the world, diethyl ether was patented, as a result of which it is officially considered that Thomas Morton was the discoverer of anesthesia.
Less than six months later, in March 1847, the first operations under anesthesia were already performed in Russia.
N. I. Pirogov, his contribution to the development of anesthesiology
The contribution of the great Russian doctor and surgeon to medicine is difficult to describe, it is so great. He also made a significant contribution to the development of anesthesiology.
He combined his developments on general anesthesia in 1847 with data previously obtained as a result of experiments conducted by other doctors. Pirogov described not only the positive aspects of anesthesia, but was also the first to point out its disadvantages: the likelihood of severe complications, the need for precise knowledge in the field of anesthesiology.
It was in the works of Pirogov that the first data appeared on intravenous, rectal, endotracheal and spinal anesthesia, which is also used in modern anesthesiology.
By the way, the first surgeon in Russia to perform an operation under anesthesia was F.I. Inozemtsev, and not Pirogov, as is commonly believed. This happened in Riga on February 7, 1847. The operation using ether anesthesia was successful. But between Pirogov and Inozemtsev there were complex, strained relations, somewhat reminiscent of the rivalry between two specialists. Pirogov, after a successful operation performed by Inozemtsev, very quickly began to operate, using the same method of administering anesthesia. As a result, the number of operations he performed noticeably overlapped those performed by Inozemtsev, and thus Pirogov took the lead in numbers. On this basis, many sources name Pirogov as the first doctor to use anesthesia in Russia.
Development of anesthesiology
With the invention of anesthesia, a need arose for specialists in this field. During the operation, a doctor was needed to be responsible for the dose of anesthesia and monitor the patient’s condition. The Englishman John Snow, who began his activity in this field in 1847, is officially recognized as the first anesthesiologist.
Over time, communities of anesthesiologists began to appear (the first in 1893). Science has developed rapidly, and purified oxygen has already begun to be used in anesthesiology.
1904 - intravenous anesthesia with hedonal was performed for the first time, which became the first step in the development of non-inhalation anesthesia. It became possible to perform complex abdominal operations.
The development of drugs did not stand still: many drugs for pain relief were created, many of which are still being improved.
In the second half of the 19th century, Claude Bernard and Greene discovered that anesthesia could be improved and intensified by pre-administering morphine to calm the patient and atropine to reduce salivation and prevent heart failure. A little later, antiallergic drugs were used in anesthesia before the operation. This is how premedication began to develop as a medicinal preparation for general anesthesia.
One drug (ether) constantly used for anesthesia no longer satisfied the needs of surgeons, so S.P. Fedorov and N.P. Kravkov proposed a mixed (combined) anesthesia. The use of hedonal turned off the patient's consciousness, chloroform quickly eliminated the phase of the patient's excited state.
Now in anesthesiology, too, a single drug cannot independently make anesthesia safe for the patient’s life. Therefore, modern anesthesia is multicomponent, where each drug performs its own necessary function.
Oddly enough, local anesthesia began to develop much later than the discovery of general anesthesia. In 1880, the idea of local anesthesia was expressed (V.K. Anrep), and in 1881 the first eye surgery was performed: ophthalmologist Keller came up with the idea of performing local anesthesia using the injection of cocaine.
The development of local anesthesia began to gain momentum quite quickly:
- 1889: infiltration anesthesia;
- 1892: conduction anesthesia (invented by A.I. Lukashevich together with M. Oberst);
- 1897: spinal anesthesia.
Of great importance was the still popular method of tight infiltration, the so-called case anesthesia, which was invented by A. I. Vishnevsky. Then this method was often used in military conditions and in emergency situations.
The development of anesthesiology in general does not stand still: new drugs are constantly being developed (for example, fentanyl, anexate, naloxone, etc.), ensuring safety for the patient and a minimum of side effects.
