Four Forgotten Giantsof Anesthesia History

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2018

Thank you for granting me the honour of presenting this opening address during the 75 th anniversary meeting of the Canadian Anesthesiologists' Society (CAS). A What would Dr. Harold Griffith, the founder of the CAS think, if he were here today (Fig. 1)? 1 I'm sure he would be feeling great pride, because he believed that ''the advance of anesthesia could best be achieved by communication''. 2 Just as he envisioned, CAS has become our collective home, a place where we communicate our dreams and aspirations, and a place where we launch big ideas. Over the past 75 years, there have been remarkable advances: the discovery of safer anesthetic drugs and improved monitoring systems, and the development of anesthesiology as a profession. All of these innovations have dramatically reduced anesthetic-related mortality. Over the next few days, we will celebrate our rich heritage. As we look back, we will see that time and time again, science and innovation have been at the heart of our achievements. That is because discovery changes us. It changes us as individuals, because new truths force us to abandon old, outdated assumptions. Discovery also changes us as a professional society, because armed with new knowledge, we can work together to conquer seemingly insurmountable problems. Finally, discovery changes us as citizens, because it enriches the fabric of our everyday lives and helps to position Canada on the world stage. My goal in speaking with you today is to remind all of us that we have a responsibility to carry this rich heritage forward. Yes, let's reflect back on our history and accomplishments, but let's also think hard about what it means to be anesthesiologists today, in the 21 st century. My key message is that we will best serve not only our patients, but also ourselves as professionals and society at large by embracing science and innovation. These words-science and innovation-sometimes conjure up images of test tubes, math equations, and laboratory animals. But today, we are referring more broadly to new methods and big ideas, new processes and products that create a positive impact. I will illuminate this message using three historic examples, followed by two modern-day, contemporary examples. The three historic examples of discovery have something in common: initially, they appeared to be only small wins that produced local impact. This scenario will probably seem familiar-we all sometimes feel that our discoveries are small. But what I hope to show in telling these stories is that even small wins have the potential to be international game-changers. Discovery creates a ripple effect that over time can change the course of patient care, our profession, even the course of history. I therefore encourage you to celebrate your own small wins, because that is how every major discovery begins.

Increasingly, we are being asked to provide anesthesia or heavy sedation for patients undergoing procedures outside of the operating room. This represents a clinical, staffing, and financial challenge to most anesthesiology departments. While provision of anesthesia services within an operating room environment has been associated with increasing safety over the past several decades, settings outside of the operating room may present unique challenges. For these reasons, it is important the Anesthesiology Clinics address this important topic. In this issue, three major areas of care are addressed: financial implications, optimal care paradigms for specific patients, and locations and priorities with respect to all out-of-operating-room settings.

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2012

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2012

Anesthesiology is on the cusp of an important transformation. To meet the growing demand for greater patient throughput, more efficient use of resources, and improved perioperative outcomes, the profession is adopting a new mandate. The goal this new mandate is to oversee perioperative clinical care-from preoperative assessment until discharge-and seamlessly integrate clinical and scientific discovery. The following three stories illustrate how this new mandate is being adopted. The first two address clinical care and research. The third is a tale from my own laboratory that illustrates the dynamic interplay between bench research and clinical practice. This notion of anesthesiologists providing comprehensive perioperative care founded on scientific discovery is not new but the time has come for this new mandate to be broadly implemented. Story 1: Rising to the challenge The extraordinary Canadian physician who convinced me that my life's work would be anesthesiology was Dr. Vincent Hughes (Fig. 1). Sadly, Dr. Hughes passed away unexpectedly in May 2011. I met Dr. Hughes in 1980 while working as a medical student at St. Jude Hospital in Vieux Fort, St. Lucia. Several days before I arrived in St. Lucia, the island was ravaged by Hurricane Allen, a category 5 storm. With winds of up to 300 kmÁhr-1 , the hurricane devastated the Caribbean region (Fig. 2), and the small town of Vieux Fort was particularly hard hit. The destruction was overwhelming: villages were destroyed, the death toll was high, and dead livestock contaminated the rivers that supplied water to the towns. St. Jude Hospital, which serves the entire southern region of St. Lucia, was severely damaged (Fig. 3). Airports and seaports were closed, and most of the country was left without power. The British Navy had moored a ship, the HMS Glasgow, in Vieux Fort harbour. The marines had established a command centre in the hospital cafeteria and were slowly opening the roads and transporting the injured back to St. Jude Hospital. At the time of my arrival, Dr. Hughes, a Canadian-trained anesthesiologist, was the only doctor available to treat the injured at the hospital. He rose to the challenge and worked tirelessly for several weeks. Each morning, he administered anesthesia in the operating rooms. From there, he went to the outpatient clinic to assist where needed and then wandered the wards to help in whatever way he could. On the pediatric wards, he started intravenous fluid therapy if required. On the surgical wards, he assisted the visiting surgeons, many of whom were unaccustomed to working in such limited medical facilities. After completing his clinical duties, he

O 2 , a waste gas, accumulates in the presence of respiratory failure and has characteristically been thought of as a gas to be excreted. Like other waste products, many practitioners thought the less present the better. 1 Perhaps because end-tidal CO 2 monitoring is now mandatory, anesthesiologists are now continuously aware on a second-to-second basis, of some measure of CO 2 flux in their patients. This monitoring imperative, coupled with new insights into oxygenation and carbon dioxide exchange, in addition to the increasing knowledge of the importance of ventilatory technique, means that the anesthesiologist is faced with contemplating "carbon dioxide" issues on a continuous basis.

Anesthesiology, 2014

W E are delighted that AnEsthEsiology is publishing this special Edition, highlighting research at the harvard-affiliated departments. harvard Medical school (hMs) is unusual, perhaps unique, in that it has approximately 10,000 faculty appointees, including many physicians with additional appointments at multiple affiliated and financially independent academic hospitals that provide clinical training to hMs students, residents, and fellows, and also accommodate academic researchers. There are currently four academic hospitals with anesthesia departments that are affiliated with hMs: Boston Children's hospital, Brigham and Women's hospital, Beth israel Deaconess Medical Center, and Massachusetts general hospital (Mgh). here, we briefly review the history of the Department of Anesthesia (traditionally Anaesthesia) at hMs, essentially that of its affiliated hospital departments, and some of their collaborative initiatives that have influenced patient care, trainee education, and research. The hMs Department of Anesthesia officially came into existence with the unanimous approval of the faculty on october 16, 1969, the date chosen to coincide with Ether Day. 1 Before this, the hMs-affiliated hospitals had established autonomous anesthesia service groups, some functioning as academic departments. in 1936, Professor henry Knowles Beecher, M.D. (1904-1976) became the first anesthetist-in-chief at Mgh (established in 1811). subsequent chairs of the Mgh department have been Professor Richard

Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1986

This paper describes the outcome of a nine-year post-anaesthetic followup program in a large teaching hospital (N = 112,721 anaesthetics). Between time periods 1975-78 and 1979-83, more seriously ill patients (higher ASA physical status) were being treated. Anaesthetic practice also changed, with an increased use of balanced (multiple drug) anaesthetic procedures, a decrease in the use of halothane and an increase in the use of monitoring. Nonfatal anaesthetic complications — intraoperative, recovery room and postoperative — were rare but there was an increase in the reported complication rate over time. From 1975-78, 7.6per cent of all cases had at least one intraoperative complication and from 1979-83, this rose to 10.6 per cent of all cases. For recovery room complications, there was an increase to5.9 per cent in 1979-83 from 3.1 per cent in 1975-78. In time period 2 there was a 9.4 per cent chance of having a postoperative anaesthetic-related complication, and a 0.45 per cent chance of a significant morbidity as a result. This represents an increase over time period 1 (8.9 and 0.40 per cent respectively). It is concluded that the anaesthetic experience, while associated with low mortality rates in recent years, is still associated with significant morbidity. It is conjectural at present whether this is refiective of preoperative patient status, anaesthetic practice, or other undefined variables associated with an operative experience. Ce papier expose les résultats de neuf ans d’étude d’un programme de suivie post-anesthésique dans un grand hôpital universitaire (N = 112,721 anesthésies). Pour les périodes de 1975-78 et 1979-83 plus de patients sérieusement malades (classe ASA plus élevés) ont été traités. La pratique anesthésique a aussi changé avec un accroissement dans l’utilisation d’une anesthésie balançée (l’utilisation de plusieurs drogues) la diminution dans l’utilisation de l’halothane et une augmentation dans l’utilisation des moniteurs physiologiques. Les complications anesthésiques non léthales pour les périodes per-opératoire, en salle de réveil et en période post-opératoire étaient rares. Cependant on a observé un accroissement dans le taux de complications rapporté à travers le temps. Pour la période de 1975-78, une complication per-opératoire a été rapportée pour 7,6 pour cent des cas. De 1979-83, ce pourcentage augmenta à 10.6 pour cent. Pour les complications survenant à la salle de réveil on observa un accroissement de 5.9 pour cent en 1979-83 à partir de 3.1 pour cent en 1975-78. Dans la deuxième période étudiée le risque d’avoir des complications post-opératoire reliées à l’anesthésie était de 9.4 pour cent avec 0.45 pour cent de risque d’avoir une morbidité significative. Ceci représente un accroissement par rapport à la première période de 8.9 et 0.40 pour cent respectivement. On conclut que l’expérience anesthésique même si elle est associée avec un taux de mortalité bas dans les dernières années reste pour le moins encore associée avec une morbidité significative. Il est hypothétique actuellement de penser que ceci peut être le reflet de l’état pré-opératoire du patient, de la pratique anesthésique ou tout autre variable indéfinie associée avec une expérience chiruricale.

Best Practice & Research Clinical Anaesthesiology, 2011