Anaesthesia: Providing Relief

Have you ever wondered how it would be like to have your stomach cut open or your limbs sawed off or even having a tooth extracted while all this time being acutely aware of the procedures going on and having nothing at all to numb the obvious horrible pain that you would be feeling? It is a scary though, isn’t it?

Before the mid-nineteenth century, patients had no option but to endure such unimaginable pain because there was no real anaesthetic available. Usually, opium, cannabis or alcohol was used to somewhat numb the senses but they were not strong enough that the patient did not feel the pain altogether during surgery. Pain was an obvious association with surgical practices, whose basic aim is ironically, to provide the patients relief and respite.

The word ‘anaesthesia’ is derived from Greek where αν- an means “without” and ασθησις aisthesis means “sensation”. The word was coined by Oliver Wendell Holmes, Sr. in 1846. Since prehistoric times, men used various natural herbs or different methods to numb the pain or cure it. Poppy seed were collected in ancient Sumeria and opium was used as anaesthetic while in ancient India and China cannabis was in use. Again, in China, Taoist medical practitioners used acupuncture as an effective anaesthetic where the chilled tissue could temporarily lead the nerve fibers to stop conducting sensations. The discovery of morphine in the 19th century was an important contribution, which was invaluable to mankind and led to the foundation of modern day pharmaceutical industry. In March 1842, Dr. Crawford Long became the first surgeon to use anaesthesia during an operation, giving it to a boy (John Venables) before excising a cyst from his neck; however, he did not publicize this information until later.

Henry Hill Hickman experimented with carbon dioxide in the 1820s, while the anaesthetic qualities of nitrous oxide was discovered by the British chemist Humpry Davy about the year 1799 and reported in a paper in 1800. But initially, the use of this gas, better known as ‘laughing gas’, was restricted to providing entertainment. However, in the year 1846 the gas was used by American dentist William Thomas Green Morton to perform a painless tooth extraction upon a patient successfully. Again later that same year, he also performed the first public demonstration of diethyl ether (then called sulfuric ether) as an anesthetic agent, for a patient undergoing an excision of a vascular tumor from his neck. In a letter to Morton shortly thereafter, Oliver Wendell Holmes, Sr. proposed naming the procedure anæsthesia. He had named this compound Letheon and he went on to receive a U.S. patent for it. Even though he wanted to keep this compound a secret, news of its discovery and constituents spread far and wide among the noted surgeons of that time and, respected doctors, including Liston, Dieffenbach, Pirogoff, and Syme undertook numerous operations with ether.

However, ether had a number of drawbacks and it was quickly replaced by chloroform, introduced by James Simpson, Professor of Obstetrics in Edinburgh. Unfortunately, chloroform was not as safe an agent as ether and it led to a number of deaths when administered by unskilled and untrained practitioners. Over time, advancement in research and facilities available, safe and harmless anaesthetics were developed by the medical community.Major advances and developments include the introduction of local anaesthesia in 1877, which in turn led to the introduction of infiltration anaesthesia, nerve blocks, spinal and epidural anaesthesia. Then at the turn of the century came control of the airway using tubes placed in the trachea to help breathing.

Today we have doctors who specialise in administering anaesthesia. They are called anaesthesiologists or more popularly as anaesthesists. According to the American Society of Anesthesiologists, anesthesiologists provide or participate in more than 90 per cent of the 40 million anesthetics delivered annually. The role of the anaesthetist is changing. It is no longer limited to the operation itself. Many anaesthetists also serve as peri-operative physicians, and they contribute in looking after and improving the patient’s health before surgery (colloquially called “work-up”), performing the anaesthetic, including specialized intra-operative monitoring (like transesophageal echocardiography), following up the patient in the post-anaesthesia care unit and post-operative wards, and ensuring optimal care throughout.

So we can see that the discovery of anaesthesia was a landmark in medical history. It is only because of anaesthesia that surgeries are so frequent today, ensuring that pain and fear of suffering are no impediments on the road to recovery for a patient. Anaesthesia had changed the way people would look at surgery – elevating it from something seen as a last resort to being something quick, painless and effective. It also allowed doctors to be at ease while performing surgery, giving them time and encouraging them to undertake complex procedures with confidence. Anaesthesia is now very safe, with a mortality rate of less than 1 in 250,000 directly related to anaesthesia. And the rate at which medical advancement is taking place in the world today, we can be sure that there would be a lot of improvement upon this procedure in the near future.

Pronoti Baglary

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