Chapter 10

### INTRODUCTION

In 1516, Peter Martyr D’Anghera (1457–1526) described in his book, De Orbo Novo (The New World) the effects of poisoned arrows (proven later to contain crude curare) used by South American Indians for hunting and for fighting their enemies.1 His description clearly demonstrates the use of curare. He stated “Despite their nakedness, it must be admitted that in some places, the natives have exterminated entire groups of Spaniards, for they are ferocious and are armed with poisoned arrows.” D’Anghera then goes to give more details such as, “It was discovered that their poisoned arrows contained a kind of liquid which oozed out when the point broke.” Referring to the time course of the effect of curare, he reported, “Hojeda, under the influence of the poison, saw his strength ebbing … away” and stated that, “ .….…. the strength of the poison is such, that the mere odor of it, while compounding almost kills its makers. Whoever is wounded by one of these poisoned arrows dies, but not instantly, and no Spaniard has yet found a remedy for such wounds.”1 In 1596, Sir Walter Raleigh in his book, The Discoverie [sic] of the Large, Rich and Bewtiful Empyre [sic] of Guiana2 reported on this strong native arrow poison and referred to it as “Tupara, curare or ourari.” This poison was later found to be derived from the rubber plant Chondodendron tomentosum. During the 19th century, the paralyzing effect of curare on skeletal muscles3,4 and the antagonistic effects of physostigmine5 were studied in several animal experiments.

The clinical utility of curare was first explored in 1912 by Arthur Läwen, a German surgeon from Leipzig, who administered 0.8 mg of curarine intramuscularly to provide relaxation for intraperitoneal surgery.6 However, due to the lack of supplies of curarine, Läwen could not develop its clinical applications further. In 1935, King successfully extracted tubocurarine from crude curare and determined its chemical structure.7 In 1942, Harold Griffith and Enid Johnson were the first clinicians to use curare (Intocostrin), on some 25 patients.8

A few years later, Dr R.E. Pleasance, in his Presidential Address to the Society of Sheffield Anaesthetists on January 15, 1948, described his clinical experience using curare.9 Pleasance never mentioned the need for antagonizing the residual effects of curare in his patients. In fact, he stated that, during recovery, “there is no evidence that curare has any latent toxicity. It is completely and fairly rapidly eliminated.” It should be noted, however, that when curarization was initially introduced, tracheal intubation was the exception in routine surgical practice, and most patients undergoing anesthesia were breathing spontaneously.

It is interesting to note that the Intocostrin package insert in 1943 stated, “When dangerous respiratory embarrassment occurs, resuscitation by.….…. artificial respiration may be expected to carry the patient through the paralysis. Particularly one should be certain that an airway exists. Prostigmin ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more