Surprising Facts About the History and Safety of Anesthesia During Surgery

The History of Anesthesia

Anesthesia has come a long way since the days of knocking patients unconscious with chloroform. Modern anesthesia provides safe and effective pain prevention for surgery, but getting to this point required major medical advancements.

Horace Wells: The Pioneer of Anesthesia

In 1844, Horace Wells, a dentist in Hartford, CT attended a musical show where he witnessed a man injure his leg but continue performing unaffected. The man had inhaled nitrous oxide or laughing gas. Wells wondered if nitrous oxide could prevent pain during surgery and conducted an experiment on himself. After inhaling the gas, Wells had a colleague extract one of his teeth painlessly. However, when Wells attempted to demonstrate the effects of nitrous oxide to his colleagues at Massachusetts General Hospital in 1845, the patient still yelled in pain. This failed demonstration postponed adoption of gaseous anesthesia for years.

William Morton's Public Demonstration

In 1846, another dentist named William Morton publicly demonstrated the use of ether anesthesia at Massachusetts General Hospital. With Harvard Medical School faculty observing, Morton used an inhaler device to administer ether gas to a patient undergoing a neck tumor removal. The patient did not react to the surgeons work, proving the success of the ether. Mortons demonstration convinced doctors of the effectiveness of inhaled anesthesia gases.

Queen Victoria's Use of Chloroform

In 1853, Queen Victoria of England received chloroform during the birth of her eighth child Prince Leopold. Her use made anesthesia fashionable among the upper classes. By the end of the 1850s, anesthetics gained widespread acceptance.

Types of Anesthesia

General Anesthesia

General anesthesia puts you into a deep sleep so you do not feel any pain during surgery. It is typically used for major operations. An anesthesiologist administers anesthesia through an IV line or breathing mask. You are unconscious and unaware during the surgery with no memories afterwards.

Regional Anesthesia

Regional anesthesia numbs a large region of your body while keeping you awake. Types of regional anesthesia include:

• Epidural - injected into the epidural space around your spinal cord
• Spinal block - injected into the spinal fluid
• Peripheral nerve block - injected around specific nerves

Regional anesthesia is common for childbirth and surgeries on the arms, legs, or abdomen.

Local Anesthesia

Local anesthetics numb a small part of the body, usually by injection into the skin or tissue. Dentists often use lidocaine injections for tooth procedures. Local anesthesia allows you to remain awake during the surgery but blocks pain signals near the injection site.

Monitored Anesthesia Care (MAC)

MAC provides pain medication and sedation but does not make you fully unconscious. You may slip into a semi-conscious state where you can still respond to the anesthesiologists instructions. MAC may use mild general anesthesia drugs combined with local or regional anesthesia.

Anesthesia Allows Complex Surgeries

Anesthesia enabled the development of modern surgery in the past 150 years. Without anesthesia, few patients could tolerate the pain of invasive surgeries. Anesthesia allows operations that would otherwise be agonizing, such as:

• Open heart surgery
• Major organ transplants
• Reconstructive procedures
• Joint replacements
• Neurosurgery on the spine or brain

Surgeries requiring hours of operating time would not be possible without anesthesia to keep patients comfortable.

Anesthesia Safety Improved Dramatically

In the past, anesthesia could be dangerously unpredictable. Anesthetic gases and early IV medications had erratic effects. Patients could receive too much and stop breathing. Today, improved drugs, advanced monitoring, and anesthesia training make it much safer.

Anesthesiologists can accurately titrate drug dosages to each patient's needs. Oxygen levels, blood pressure, EKG, and other parameters are closely watched. Safer techniques like regional anesthesia avoid the risks of general anesthesia.

Anesthesia Mortality Dropped Significantly

From the 1940s to 1980s, general anesthesia mortality rates steadily improved from as high as 1 death per 1,500 cases to approximately 1 death per 10,000 to 25,000 cases. Today, anesthesia death rates are estimated at 1 per 200,000 to 300,000 cases or lower in healthy individuals.

Anesthesia Team and Process

Nurse Anesthetists

Certified registered nurse anesthetists (CRNAs) administer anesthesia under physician supervision. CRNAs have nursing training plus a graduate degree in anesthesia and certification. They work closely with anesthesiologists and surgeons before, during, and after procedures.

Anesthesiologists

Anesthesiologists are medical doctors who specialize in anesthesia, pain medicine, and critical care. After medical school, they complete a 4-year residency in anesthesia and further training. Anesthesiologists determine the optimal anesthesia plan for each patient.

Pre-Op Testing

Before surgery, you will have an appointment to assess your health. The anesthesiologist reviews your medical history and medications. You may need bloodwork, an EKG, chest x-ray, or other tests to check your heart, lungs, and overall fitness for anesthesia.

Fasting Rules

To prevent aspiration, you cannot eat or drink anything for 6-12 hours before receiving general anesthesia. Regional anesthesia does not require fasting. Clear liquids are allowed up to 2 hours before a scheduled C-section.

IV Line and Monitors

In the pre-op room, a nurse starts an IV line to administer medications. Sticky pads are placed on your chest for EKG monitoring of your heart rate and rhythm during surgery.

Anesthesia Options Review

The anesthesiologist or CRNA will discuss anesthesia choices with you right before the operation. This is your chance to ask questions and understand the risks and benefits.

Induction

If you are having general anesthesia, the anesthetic drugs are injected through your IV. As they take effect, you become drowsy and drift to sleep. Once you are fully unconscious, a breathing tube is inserted.

Maintenance

During the operation, additional anesthesia keeps you in a pain-free state while you are intubated and unconscious. The team adjusts the levels according to your vital signs and surgical needs.

Emergence

At the end of the surgery, the anesthetic drugs are stopped. The breathing tube is removed once you can breathe on your own. You slowly wake up in the post-anesthesia care unit.

Post-Op Care Unit

Nurses in the recovery room monitor your vital signs as you wake up from anesthesia. Once you are alert and stable, you get transferred to a regular hospital room or discharged home.

Anesthesia Side Effects and Risks

Nausea and Vomiting

Nausea and vomiting are common side effects after general anesthesia. Patients with a history of motion sickness are more prone to post-op nausea. Anti-nausea medications can reduce the risk.

Dental Injuries

Dental damage can occur during intubation for general anesthesia. Cracked teeth or crowns are the most common anesthesia-related dental injury. Wearing a mouthguard lowers this risk.

Sore Throat

A sore throat is expected after intubation from irritation of the breathing tube. It resolves within a few days after surgery. Suctioning mucus before extubation helps minimize throat discomfort.

Shivering

Shivering can happen when you emerge from anesthesia as your body temperature adjusts. Keeping you warm with blankets reduces shivering. Medications can also treat this temporary symptom.

Confusion

Some people become temporarily confused or delirious after anesthesia. Risk factors include older age, dementia, and certain medications. The confusion usually resolves within hours but rarely can persist for weeks after major surgery.

Allergic Reactions

Allergic reactions to anesthesia drugs are possible but very rare. Mild allergies cause rash, itching, or low blood pressure. Severe reactions like anaphylaxis lead to breathing difficulty, swelling, and plummeting blood pressure. Allergies are minimized by checking your medical history.

Respiratory Arrest

Very rarely, anesthesia gases can cause life-threatening breathing impairment or stop breathing entirely. Close monitoring ensures prompt response to any respiratory issues during and after surgery.

Malignant Hyperthermia

Malignant hyperthermia is an inherited disorder triggered by common anesthesia gases like isoflurane, sevoflurane, and desflurane. It causes rapid fever, muscle rigidity, and metabolic changes. Swift treatment with the drug Dantrolene is needed to prevent organ damage and death.

Preventing Anesthesia Complications

While anesthesia risks are minimal in healthy people, certain steps can further reduce your chance of problems:

• Disclose any health conditions or prior anesthesia reactions.
• Stop smoking 6-8 weeks before surgery.
• Lose weight if obese or diabetic.
• Take medications as prescribed before surgery.
• Follow fasting instructions.
• Bring a list of medications and drug allergies.

Also, arrange for someone to drive you home after receiving anesthesia.

Questions to Ask Your Anesthesiologist

Your anesthesiologist wants to address any concerns before surgery. Potential questions include:

• Do I have a choice between general and regional anesthesia?
• How will my pain be managed after the operation?
• Will I feel nauseated afterwards?
• When can I resume my normal medications?
• How soon after surgery can I eat, drink, and walk?

Discussing your anesthesia plan ahead of time will give you peace of mind.

The Future of Anesthesia

Anesthesia will continue evolving to improve patient safety and outcomes. Here are some innovations in development:

Enhanced Monitoring

New real-time monitors provide more insights into patients neurological and cardiovascular status during anesthesia. Examples include processed EEG monitors and noninvasive blood pressure sensors.

Computer-Assisted Dosing

Computer programs can recommend ideal drug doses and adjustments based on a patients characteristics and responses. This technology reduces human errors in dosing anesthesia.

Robotic Anesthesia

Engineers are experimenting with using robots to deliver anesthesia under remote human supervision. Automated anesthesia could one day allow anesthesiologists to monitor multiple operating rooms simultaneously.

Anesthesia Apps

Mobile apps are in development to track patient data before, during, and after surgery. Apps can also provide patients with information on preparing for anesthesia.

Genetics-Guided Anesthesia

Learning how genetics influence drug metabolism could enable personalized anesthesia regimens tailored to an individuals DNA. This field holds great promise to improve anesthesia safety and effectiveness.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.