2. Objectives
• To know about means of anesthesia before
1846
• To know about notable historical inhalational,
intravenous, local and regional anesthetic
agents and equipments
• To know about notable personalities in the
history of anesthesia
• To know about history of anesthesia in Nepal
6. Anesthesia Practice …. Before 1846
• Compression of nerve.
For eg: compression on antecubital fossa for
operation on hand
• Application of cold with snow, ice
• “Mesmerism” – hypnosis
• Bloodletting – (which probably worked by
reducing consciousness)
7. Before 1846
Dioscorides first use the
term “anesthesia ‘’ to
denote “defect of
sensation “ or “
privation of senses”
Mandragora - prepared
for leaves and bark of
mandrake plant
8. Sporofic sponge
Mandrake leaves + black
nightshade+ poppies +
other herbs )
Alcohol
• Laudanum = alcohol
based solution of opium
• Abused or misused
9. Anesthesia
• Oliver Wendell Holmes
– first propose to use
the term “anesthesia “
to denote state of
analgesia , amnesia and
narcosis.
Amnesia
Narcosis
Analgesia
11. The tragedy !!!
• Colton and Horace Wells are credited for the
first use of nitrous oxide for dental extraction.
• Demonstrated it’s use at Boston – failed …….
• later committed suicide
12. Inhalational Anesthesia Contd..
Ether
• Was known as sulfuric
ether
• Used for frivolous
purpose “Ether frolics”
• Crawford W. Long and
William E. Clark
independently used it on
patients for surgery and
dental extraction,
respectively however
didn’t publish.
13. 1846 (16th October )
• Anesthetist
William T.G Morton
• Agent
Ether
• Patient
Gilbert Abort
• Procedure
Excision of tumor under
jaw
• Surgeon
John Collin Warren
• Place
Massachusetts General
Hospital(Boston, USA)
The Ether Dome
14.
15. Inhalational Anesthesia Contd..
Chloroform
• introduced into clinical
practice by the Scot Sir
James Simpson
• administered to relieve
labor pain
16. • Jon Snow
Used chloroform to
deliver the two children of
Queen Victoria
17. Others inhalational agents
• Nitrous oxide revived : Edmund Andrews
administered it with 20% oxygen
• Cyclopropane – rivaled ether safety and
popularity
• Introduction of fluorinated hydrocarbons –
halothane , methoxyflurane, enflurane,
isoflurane , sevoflurane , desflurane
18. Local and Regional anesthesia
• Cocaine – isolated from
coca leaves
• Carl Koller
demonstrated topical
anesthesia in eye
• William Halsted
used cocaine for
intradermal infiltration
and nerve blocks (facial,
brachial plexus, posterior
tibial )
19. Local and regional anesthesia
• First spinal anesthestic was
administered by – August
Bier
• also described Total
Intravenous Regional
Anesthesia – Bier’s block in
1908
• Added epinephrine to local
anesthetics -Heinrich Braun
20. Local and regional anesthesia
• In 1944, Nils Löfgren
and Bengt Lundquist
developed Lidocaine
• Need of longer acting
local anesthestics grew
• Bupivacaine introduced
in 1965
• immediate popularity
because of its
potency,
rapid onset,
decreased incidence of
allergic reactions,
and effectiveness for all
types of regional
anesthetic blocks
21. Intravenous Anesthesia
• Development of hypodermic
needle- Dr Alexander wood
• First intravenous anesthetic
agent – choral hydrate
• Morphine + scopolamine ,
chloroform + ether were also
tried
• No improvement over inhaled
anesthetics
22. Intravenous Anesthesia contd.
• Barbituates
phenobarbiturates and derivatives –
protacted action
Hexobarbital
• Short acting , Short induction time
• Widely used for minor procedures
23. Intravenous Anesthesia contd
• Thiopentone replaced oxybarbiturates
• Ketamine synthesized – Dr Calvin Stevans in
1962
• “dissociative anesthesia”
neologism created by Guenter Corrsen and
Edward Domino
24. Intravenous Anesthesia contd
• Propofol
- synthesized by Imperial Chemical
Industries and tested clinically in 1977
- induction and antiemetic action made it
popular
- severe anaphylactic reaction- Cremephor El
the solvent in which it was created
- reintroduced with formulations of egg lecithin,
glycerol , soyabean oil
25. Neuromuscular blocking agents
• Curare- the first known
neuromuscular blocking
agent
• Earliest clinical use – to
treat muscle spasm of
tetanus
• Dr Harold Griffith and Enid
Johnson – first administer
curare in surgery
• Succinylcholine was
prepared – Novel Laureate
Daniel Bovet in 1949
26. Airway Management and Equipments
• Airway control
Dr Joseph Clover
• Jaw thrust
-to overcome obstruction
of the upper airway by the
tongue
-First to use cricothyroid
canula Fig. RCoA crest
27. • Oral intubation
First undertaken by Scottish
surgeon Willaim Macewan
• In 1895 by Alfred Kirstein
in Berlin, who devised the
first direct vision
laryngoscope.
• To increase visualization
of vocal cords
Miller’s blade
Macintosh blade
Fig. Macintosh laryngoscope
Fig. Miller’s laryngoscope
28. • In 1926, Arthur Guedel -
introduction of the
cuffed tube.
• Fashioned cuffs from
the rubber of dental
dams, condoms, and
surgical gloves that
were glued onto the
outer wall of tubes.
29. Early Anesthesia Delivery System
• Morton’s Ether Inhaler –
the first anesthetic
machine
• Clover ‘s bag
Morton’s Ether Inhaler
Clover bag
30. • Complex inhalers
Nitrous oxide /ether
apparatus
Consists of : ether
vaporizer, a steel cyclinder
containing liquid nitrous
oxide , an india rubber
bag, facepiece
Clover’s nitrous oxide/ether
apparatus
31. Hewitt apparatus
• Among the first devices to
combine nitrous oxide with
oxygen
• Consists of 2 Nitrous oxide
cylinders, oxygen cylinder,
structure to support and combine
the cylinders, a double India-
rubbertube (internal and
external), a double india-rubber
bag, a stopcock and a face mask.
• Stopcock: regulate the
administration of the two gases.
32. Gwathmey Anesthesia machine
• Incoporated waterflow
meter
• Allowed oxygen, nitrous
oxide or ether to be
administered either
alone or in combination
• Fitted with lamps –
heat the gases
33. Boyles Anesthesia Machine
• Developed from Gwathmey’s basic model
• Addition of :
manometers - measure pressure in cyclinder
alcohol lamp - to prevent nitrous oxide from
freezing and thus obstructing the cyclinder
sensitive pressure reducing valves
35. Anaesthesia In Nepal
• Very little evidence
about anesthesia
practice before 1933
• Doctors, Paramedic staff
who could put drop
after drop of ether or
chloroform were
considered anesthesist
Fig. Schimmelbusch mask
36. Anesthesia In Nepal Contd.
• Dr Bhawani Bhakta
Singh Pradhan- first
post graduate diploma
holder anesthesist in
1955
• Practiced open drop
ether in Schimmelbusch
mask and spinal
anesthesia
• Introduced
endotracheal intubation Fig. Open drop ether techinque
37. • Improvised a Horlick’s
bottle with inlet orifice,
outlet orifice with
rubber tubing , oxford
inflating bellow
corrugated tubing.
• Anesthetized a patient
with this circuit and
endotracheal intubation
of intracranial surgery Fig. The Horlicks bottle vaporizer
38. Anaesthesia In Nepal Contd.
• In 1963 , Sir Robert Macintosh visited Nepal –
encouraged the use of (Epstein Macintosh
Oxford Vaporizer) EMO- a calibrated ether
vaporizer
• In 1965, Dr G P Rajlawat- used indian Boyle
Machine with Ether bottle Vaporizer for
Closed Mitral Valvotomy – “beginning of
Cardiac anesthesia”
39. • In 1966, Dr Narendra
Bahadur Rana – first use
gallamine or curare in
combination with draw
over technique using
ether to provide
balanced anesthesia
40. Anaesthesia In Nepal Contd.
• Available agents and Equipments
Inhalational agents – ether, chloroform,
trichloroethylene
Intravenous agents – thipentone sodium, curare,
suxamethonium, gallamine
Local anesthesia – procaine
First oxygen plant was established in 1972
41. Anaesthesia In Nepal Contd.
• Till late 1980’s,
Ether and EMO system usually supplemented
with halothane from an Oxford Miniature
vaporizer “OMV”
the standard equipment to provide anesthesia
42. Anaesthesia In Nepal Contd.
1970
• First clinical trial
• using ketamine
and diazepam
1984
• Training in
anesthesia began
1996
• Beginning of
MD program
1987
• Society of Anesthesiologist
(SAN) formed
• Chairman : Dr Puspa Das
Shrestha
43. References
• Barash PG. Clinical anesthesia, 8E. Philadelphia: Wolters Kluwer;
2017.
• Butterworth JF. Morgan and Mikhail’s clinical anesthesiology, 7th
edition. McGraw-Hill Education; 2022.
• Romero-ávila P, Márquez-espinós C, Cabrera JR. Historical
development of the anesthetic machine : from Morton to the
integration of the mechanical ventilator. Brazilian J Anesthesiol
(English Ed [Internet]. Sociedade Brasileira de Anestesiologia;
2021;71(2):148–61. Available from:
https://doi.org/10.1016/j.bjane.2021.02.017
• Home. Wood Library-Museum of Anesthesiology. (2023, January
27). https://www.woodlibrarymuseum.org/
• The history of Anaesthesia. The Royal College of Anaesthetists.
(n.d.). https://www.rcoa.ac.uk/about-college/heritage/history-
anaesthesia
• Amatya R. Special Article Evolution of Anesthesia in Nepal: A
historical perspective. 2014;3–6.
