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Oxygen is good, right? But through the lungs, please. A century ago, the apparatus shown here provided subcutaneous and/or IV oxygen. The Intravenous dose for trench foot was 10-20 cc/ of oxygen/minute 😫😫 (Brit Med J, 1: 1917).
The prominent regional anesthetists from the past thought about blocks in ways that we might think trivial. Achille Dogliotti and Gaston Labat for example have detailed (full page) descriptions of why and how to raise a wheel prior to the insertion of the block needle (image).
Bartering for curare is still possible along the Tributaries of the Amazon in Eastern Ecuador. The poison is purchased (with bead) from river guides who trade with the Huaorani deep in the Oriente.
The word "frenemy" dates back over 50 years, but was rarely used until recently. Anesthesiologists need each other but there is often competition, thus a frenemy relationship can develop. A. Guedel and J. Lundy were famous anesthesiologists but were also frenemies (letter)
Many of our drugs originated from plants and the active ingredient was modified by chemists. Einhorn recognized that the local anesthetic activity of cocaine resided in benzoic acid. Procaine, tetracaine and chlorprocaine were derived from that structure and were less toxic.
Daniel C. Moore, M.D. listed several "rules" in his many books on regional anesthesia. "All needles should be checked for patency prior to insertion". This image is an example: A Tuohy needle with a bone plug.. just after an encounter with bone on the first pass.
This Sicilian immigrant paid his way through medical school by wrestling professionally. He directed the anesthesia department at the University of Washington and established first multidisciplinary pain clinic. Image: A visual biography of John J. Bonica, M. D. (1917-1994).
A 50-year-old study by John Bonica illustrates the problem of using a neuraxial block in a hypovolemic patient. The subjects had 10cc/kg of blood removed. Then a lumbar epidural was initiated (20 cc). Volunteer subjects either had dangerous hypotension or sinus arrest (image).
Here is a new word: Dodransbicentennial. It means the 175th anniversary. In 2021 the specialty of Anesthesiology is celebrating its Dodransbicentennial year. The specialty has changed in 175 years. This figure by Dan Sessler appeared on the cover of Anesthesiology.
In 1967 the Hippies celebrated the "Summer of Love" in San Francisco's Golden Gate Park. Only one mile away at UCSF, these two young anesthesiologists (John Severinghaus [L] and Ted Eger [R]) were transforming the practice of anesthesia (from UCSF Archives).
Before there were ET tubes and LMAs there was your (usually) left hand. It held the chin and mask for hours. H. Parry-price quotes this anonymous poem in his 1946 book - "Practical Anesthesia".
Sometimes a seed is planted but it doesn't germinate. Thoracic spinal anesthesia was described in "Handbook of Thoraco-Abdominal Nerve Block" by Jordan Katz and Hans Renck (1987). Does anyone do that? Torsten Gordh called their book the "bible of regional anesthesia".
Henry Beecher kept detailed records during his service in WW2. He noted that critically wounded soldiers at the Anzio Beachhead did not complain of severe pain. But they suffered from relentless thirst until they could receive IV fluids in a "shock tent" (Image by Benny - 1944).
Every day greenhouse gases are being released into the atmosphere from anesthesia machines. But closed anesthetic systems have been available for a century. With the Waters to-and-fro apparatus there was no waste gas (Anes. and Analg. 3:20,1924).
A few of Labat's rules (from 1922): 1. Raise a wheal with a tiny needle. 2. Inject local anesthetic while passing through subcutaneous. 3. Deposit local anesthetic on the periosteum. 4. Never exert lateral pressure on the needle. 5. Watch the patient and avoid the word "pain".
50 years ago Melvin Belli successfully litigated many cases against anesthesiologists ($$$). Privately he advised anesthesia providers to never say: "I guarantee you will be okay". The monetary incentives for malpractice attorneys in California were changed by law in 1975.
Beecher took part in the gory US invasion of Italy in 1943. He learned to inject morphine into the distal portion of an extremity. As the shocked soldier was resuscitated, morphine was released into the circulation. Overdose could be averted by tightening a proximal tourniquet
Why should residents know the history of their profession? There are many reasons - (Image is from Davidson, "History of Anesthesia"). You want to impress an interviewer? Answer each question by summarizing the history of the issue, then answer the question.
In his book "Nitrous Oxide Anesthesia" (1951) F. W. Clement shows how to give anesthesia for a colon resection. Induce with 100 % nitrous oxide, maintain with 80% nitrous. During closure, use 90% nitrous with intermittent 100 % for relaxation. His note: "Slow recovery"😫😫.