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KEY CONCEPTS
In 1846, Oliver Wendell Holmes was the first to propose the use of the term anesthesia to denote the state that incorporates amnesia, analgesia, and narcosis to make painless surgery possible.
Ether was used for frivolous purposes (“ether frolics”), but it was not used as an anesthetic agent in humans until 1842 when Crawford W. Long and William E. Clark independently used it on patients. On October 16, 1846, William T.G. Morton conducted the first publicized demonstration of general anesthesia for surgical operation using ether.
The original application of modern local anesthesia is credited to Carl Koller, at the time a house officer in ophthalmology, who demonstrated topical anesthesia of the eye with cocaine in 1884.
Curare greatly facilitated tracheal intubation and muscle relaxation during surgery. For the first time, operations could be performed on patients without the requirement that relatively deep levels of inhaled general anesthetic be used to produce muscle relaxation.
John Snow, often considered the father of the anesthesia specialty, was the first to scientifically investigate ether and the physiology of general anesthesia.
The “captain of the ship” doctrine, which held the surgeon responsible for every aspect of the patient’s perioperative care (including anesthesia), is no longer a valid notion when an anesthesiologist is present.
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The Greek philosopher Dioscorides first used the term anesthesia in the first century AD to describe the narcotic-like effects of the plant mandragora. The term was defined in 18th century references as “a defect of sensation” or as “privation of the senses.” In 1846, Oliver Wendell Holmes was the first to propose the use of the term to denote the state that incorporates amnesia, analgesia, and narcosis to make painless surgery possible. In the United States, the use of the term anesthesiology to denote the practice or study of anesthesia was first proposed in the second decade of the 20th century to emphasize the growing scientific basis of the medical specialty.
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Although anesthesia now rests on scientific foundations comparable with those of other medical specialties, the practice of anesthesia remains very much a mixture of science and art. Moreover, the practice has expanded well beyond rendering patients insensible to pain during surgery or obstetric delivery (Table 1–1). Anesthesiologists require a working familiarity with a long list of other specialties, including surgery and its subspecialties, internal medicine, pediatrics, palliative care, and obstetrics, as well as imaging techniques (particularly ultrasound), clinical pharmacology, applied physiology, safety science, process improvement, and biomedical technology. Advances in the scientific underpinnings of anesthesia make it an intellectually stimulating and rapidly evolving profession. Many physicians entering residency positions in anesthesiology will already have multiple years of graduate medical education and perhaps certification in other medical specialties.
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