Chapter 1. The Practice of Anesthesiology

• Oliver Wendell Holmes in 1846 was the first to propose 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”) and 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.

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 subsequently was defined in Bailey’s An Universal Etymological English Dictionary (1721) as “a defect of sensation” and again in the Encyclopedia Britannica (1771) as “privation of the senses.” Oliver Wendell Holmes in 1846 was the first to propose use of the term to denote the state that incorporates amnesia, analgesia, and narcosis to make painless surgery possible. In the United States, use of the term anesthesiology to denote the practice or study of anesthesia was first proposed in the second decade of the twentieth century to emphasize the growing scientific basis of the specialty.

Although anesthesia now rests on scientific foundations comparable to those of other 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). The specialty uniquely requires a working familiarity with a long list of other specialties, including surgery and its subspecialties, internal medicine, pediatrics, and obstetrics as well as clinical pharmacology, applied physiology, and biomedical technology. Recent advances in biomedical technology, neuroscience, and pharmacology continue to make anesthesia an intellectually stimulating and rapidly evolving specialty. Many physicians entering residency positions in anesthesiology will already have multiple years of graduate medical education and perhaps even certification in other medical specialties.