The Historical Significance of Anaesthesia Events at Pearl Harbor

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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.

2020

According to the definition of the International Association for the Study of Pain (IASP), pain is defined as: "Unpleasant subjective feeling and emotional experience associated with current or potential tissue damage of a particular localisation", which, as such, poses a challenge for epidemiological research to determine its frequency and prevalence. We have all heard the motto that surgery has experienced its unprecedented development on the wings of anaesthesia. This is most certainly the case, since it is precisely the pain that prevents any invasive procedure on the human body, hence the very elimination of pain has opened up the way for the application and development of surgery. For this reason, the skill and now the science of anaesthesia are epochal civilizational achievements, which is why it is worth remembering the attempts and successes of its application. The very beginning of mankind cannot be imagined without the humans facing some sort of pain. As long ag...

Indian Journal of Clinical Anaesthesia (IJCA) publishes definitive, peer-reviewed articles devoted to the clinical practice of anaesthesia. IJCA publishes a wide range of articles in the discipline of anaesthesiology including basic science, translational medicine, education, and clinical research to create a platform for the authors to make their contribution towards the field without restrictions/barriers of subscription and language. IJCA addresses all aspects of anaesthesia practice, including anaesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anaesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. This Journal is an Open Access journal and aims to publish research articles, reviews, case studies, commentaries, short communications, and letters to the editor on various aspects of anaesthesiology and perioperative medicine and making them freely available worldwide.

The anesthesiology profession may one day serve as a cautionary tale of how power, politics and privilege can perturb science and progress. Previous anesthesia practitioners possessed a superior understanding of physiology and pharmacology, but overenthusiastic CO2 supplementation with inadequate monitors and machines caused asphyxiation disasters that were improperly attributed to CO2 toxicity. Dr. Ralph Waters founded the anesthesiology profession on the basis of a practical new anesthetic tech- nique that introduced elective intubation and hyperventilation to eliminate CO2 toxicity, but mechanical hyperventilation dangerously depletes CO2 tissue reserves and exag- gerates morbidity and mortality. The bene ts of CO2 supplementation were forgotten, and consequent CO2 confusion has derailed research, discouraged opioid treatment, damaged patient safety, and disrupted professional progress. Anesthesiologists can no longer claim to provide superior service, and hospital administrators are replacing them with nurses. Professional membership is in decline, and professional survival is in ques- tion. Modern machines have eliminated asphyxiation, and modern monitoring enables safe and bene cial hypercarbia that complements opioid treatment and minimizes sur- gical morbidity and mortality. CO2 reform promises revolutionary advance but faces formidable opposition.

U.S. Army Medical Department journal

International Congress Series, 2002

Current Opinion in Anaesthesiology, 2012

Purpose of review Anesthesia for ambulatory surgery has come a long way since 1842 when James Venable underwent surgery for removal of a neck mass with Crawford W. Long administering ether and also being the surgeon. We examine major advances over the past century and a half. Recent findings The development of anesthesia as a medical specialty is perhaps the single most important improvement that has enabled advances in the surgical specialties. Moreover, improved equipment, monitoring, training, evaluation of patients, discovery of better anesthetic agents, pain control, and the evolution of perioperative care are the main reasons why ambulatory anesthesia remains so safe in modern times. The development of less invasive surgical techniques, economic factors, and patient preferences provided addition impetus to the popularity of ambulatory surgery. Summary Beyond the discovery in the mid-19th century that ether and nitrous oxide could be used to render patients unconscious during surgical procedures, subsequent developments in our specialty have added modestly, in a stepwise manner, to reduce mortality and morbidity associated with its use. These improvements have allowed us to safely meet the steadily increasing demand for ambulatory surgery.