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1、,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Anesthesiology,Yesterday,Today and Tomorrow,Adolph H.Giesecke MD.,Retired Jenkins Professor and Former Chairman,Anesthesiology and Pain Management,UTX Southwestern Medical Center,Da

2、llas TX.,The First Anesthesiologist.,1,And the Lord God caused a deep sleep to fall upon Adam,and he slept.Genesis 2:21.,Managing Pain Before Anesthesia,Local application of cold water,ice or pressure.,Plants and extracts.,Coca leaves chewed and saliva dripped into injured areas or open wounds-Inca

3、Shamans.,Alcohol or/with opium or hemp “soporific sponge.,Hypnosis,Most common,Opium poppy,Papaver somniferum,Mandragora or mandrake from,Atropa mandragora,belladonna from the Morning Glory,marijuana or,Cannabis indica,.,Opium,In those“dark days many patients approached surgery as through facing exe

4、cution,an often appropriate assessment of uncontained risks,including pain,hemorrhage,shock and postoperative infection.,The easiest pain,to bear is,someone elses.,Seishu Hanaoka,1760-1835.,2,“Angel of Medicine.,Duty to relieve pain.,“Tsusensan 1805.,Mother and wife volunteered.,Breast cancer remove

5、d with tsusensan 10/13/1805.,Hanaoka 1805,Golden Epochs of Anesthesiology,I.Inhalation anesthesia,1846.,II.Regional anesthesia,1884.,III.Intravenous anesthesia,1932.,IV.Neuromuscular blockers,1942.,V.Precision anesthesia,1986.,Golden Epochs of Anesthesiology,I.Epoch of inhalation anesthesia,1846.,ET

6、HER DAY.,3,Successful public demonstration 10/16/1846 at MGH.,Ether Dome,now a national shrine.,William Thomas Morton 1819-68.,3,Clothing merchant,swindler,dentist,medical student.,Attended Wells demonstration of N2O in 1845.,Idea of more potent agent,ether from Jackson.,Patented“Letheon.,Ether,“Swe

7、et vitriol discovered 1275 by Spanish chemist Raymundus Lullius.,1540,synthesis of ether described by German scientist,Valerius Cordus.,Swiss physician and alchemist Paracelsus discovered the hypnotic effects of ether.,Crawford Williamson Long(1815-1878).,4,First to use ether for surgery.“Discoverer

8、 of anesthesia?,03/30/1842 painless removal of neck tumor after dropping ether on a cloth(anesthesia fee 0.25).,Discovery unpublished,predates Mortons public demonstration by 4 years.,The anniversary of Longs great accomplishment,March 30th,is celebrated in the United States as“Doctors Day,and all m

9、edical specialties are honored.,Sir Humphrey Davy(1778-1829),Superintendent of Thomas Beddoess Pneumatic Institute.,Rx pulmonary tuberculosis by inhaling various gases,N2O,H2,O2,and CO2.,Humphrey Davy.,4,1800,Researches,Chemical and Philosophical:Chiefly Concerning Nitrous Oxide.,He described inhali

10、ng N2O himself and obtaining relief from a painful condition.,He suggested N2O might be used for surgery,44 years before Horace Wells.,Drawing from the 18th century depicting the recreational use of nitrous oxide -laughing gas,Horace Wells(1815-1848).,5,Attended a demonstration of N2O conducted by Q

11、uincy Colton,12/10/1844.,Noticed that a man intoxicated by N2O lacerated his leg,and felt no pain or recall.,The next day,Wells asked Colton to administer N2O,while an associate extracted a tooth.,Demonstrated N2O at Harvard 01/1845,patient cried,students hissed“Humbug.,Addicted to chloroform.,Arres

12、ted for throwing acid on prostitutes,committed suicide in jail.,Pushed a known toxin to unconsciousness.,Horace Wells.,Inhalation landmarks,John Snow(1813-58),preventive medicine,first full time anesthesiologist.,James Simpson(1811-70),Chair of Midwifery Edinburgh,OB anesthesia 01/1847,chloroform 18

13、47.,Henry Boyle,first anesthesia machine 1917.,Ralph Waters,CO2 absorbtion 1924.,Ivan Magill,endotracheal intubation 1920.,Golden Epochs of Anesthesiology,II.Epoch of regional anesthesia,1884.,Karl Koller 1857-1944,Ophthalmologist in Vienna.,Dissatisfied with GA for eye surgery.Restless and coughing

14、 during surgery,vomiting and pain postop.,1884 with Sigmund Freud introduced cocaine from Erythroxylon coca.,Landmarks in Regional Anesthesia,William Halstead,nerve blocks of face and arm 1886,addicted to cocaine.,August Bier,spinal anesthesia 1898.,Virginia Apgar promotes regional analgesia in chil

15、dbirth 1930.,Virginia Apgar 1909-1974.,6,Devised a system for grading the newborns condition,“Apgar Score.,Promoted R.A.which relieved labor pain without interfering with the baby.,Featured on US Postage stamp.,Golden Epochs of Anesthesiology,III.Epoch of intravenous anesthesia,1932.,John S.Lundy,18

16、94-1973,1903 Barbitone synthesis by Fischer,Berlin,Nobel Prize.,1932 Evipan used IV by Weese Schraff,&Rheinoff.,1934 Lundy,Mayo Clinic used Sodium Pentothal.,Golden Epochs of Anesthesiology,IV.Epoch of neuromuscular blockers,1942.,Neuromuscular Blocking Drugs,1942 Curare first used clinically by Griffith and Enid Johnson in Montreal.,Paleopharmacology of curare,Paleopharmacology of curare,NMBAs,1812 Waterton brought“woorara from Guiana to England,inoculated 3 donkeys,2 died,one survived with tra