THE TOP 20 DOCTORS IN THE HISTORY OF ANESTHESIA

15 Jun 202221 Jun 2022THE ANESTHESIA CONSULTANT 4 Comments

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Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group

Richard Novak, MD is a Stanford physician board certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
emailrjnov@yahoo.com

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The first public demonstration of anesthesia, at the Ether Dome in Massachusetts General Hospital

Important advances in the history of anesthesia changed medicine forever. Humans have inhabited the Earth for 200,000 years, yet the discovery of surgical anesthesia was a relatively recent development in the mid-1800s. For thousands of years most surgical procedures were accompanied by severe pain, and the only strategies available to decrease pain were to give patients alcohol or opium until they were stuporous. How did our specialty advance from prescribing patients two shots of whiskey to administering safe modern anesthesia? In chronologic order, my choices for the most important doctors in the history of anesthesia are:

1842. Dr. Crawford Long, Georgia, USA. THE CO-DISCOVERER OF ETHER AS A GENERAL ANESTHETIC. Dr. Long was an American surgeon recognized for introducing the use of inhaled ether as a general anesthetic. Dr. Long administered ether for the first time on March 30, 1842, to remove a tumor from the neck of patient James Venable. Dr. Long dripped ether on a towel through which Mr. Venable inhaled. Dr. Long performed multiple surgeries using this technique, but did not publish his findings until seven years later in 1849 in The Southern Medical and Surgical Journal. As a result, there is a dispute whether Dr. Crawford Long or Dr. William Morton (below) discovered ether anesthesia first.

1846. Dr. William Morton, Boston, USA. THE FIRST PUBLIC DEMONSTRATION OF ETHER AS A GENERAL ANESTHETIC. Dr. Morton performed the first public demonstration of general anesthesia at Harvard’s Massachusetts General Hospital on October 16, 1846. Morton, a local dentist, utilized inhaled ether to anesthetize patient Gilbert Abbott for removal of a tumor on the patient’s neck. According to surgeon John Collins Warren’s account of the operation, “(the patient) said that he had felt as if his neck had been scratched; but subsequently, when inquired of by me, his statement was, that he did not experience pain at the time, although aware that the operation was proceeding.” Morton was unaware of Dr. Crawford Long’s prior work which began four years earlier in 1842. Morton published his accomplishment in the December 1846 issue of Medical Examiner. Comment: Both Dr. Long and Morton deserve recognition for the discovery and eventual application of ether as a general anesthetic drug. The invention of ether changed medical care forever, making painless surgery a reality.

1853. Dr. Alexander Wood, Scotland. THE DISCOVERY OF THE HYPODERMIC NEEDLE, THE SYRINGE, AND THE INJECTION OF MORPHINE. Dr. Wood invented a hollow needle that fit on the end of a piston-style syringe, and used the syringe and needle combination to successfully treat pain by injections of morphine. Comment: Most anesthetic drugs today are injected intravenously. Such injections would be impossible without the invention of the syringe.

1885. Dr. William Halsted, Baltimore, USA. THE DISCOVERY OF INJECTABLE COCAINE AND LOCAL ANESTHESIA. Cocaine was the first local anesthetic discovered. Dr. Halsted of Johns Hopkins University first injected 4% cocaine into a patient’s forearm and concluded that cocaine blocked sensation. The patient’s arm was numb below but not above the point of injection. Halstead became addicted to cocaine, and later to morphine. Comment: The discovery of local anesthesia gave doctors the power to block pain in specific locations. The improved local anesthetics procaine (Novocain) and lidocaine were later discovered in 1905 and 1948, respectively.

1899. Dr. August Karl Gustav Bier, Germany. THE FIRST TO PERFORM SPINAL ANESTHESIA, AND ALSO THE INVENTOR OF THE BIER BLOCK (AN INTRAVENOUS REGIONAL ANESTHESIA TECHNIQUE FOR HAND OR FOOT SURGERY). Dr. Bier was a German surgeon before the concept of an anesthesia specialist was invented. He performed the first surgery under spinal anesthesia in 1899. Dr. Bier injected cocaine through a spinal needle, which paralyzed the lower half of his patient. Dr. Bier was able to perform painless ankle surgery. The patient was fully conscious during the operation. Comment: Dr. Bier was the father of regional anesthesia, an important tool in the repertoire of a modern anesthesiologist.

1905. Dr. Nikolai Korotkov, Russia. THE DISCOVERY OF THE MEASUREMENT OF BLOOD PRESSURE BY BLOOD PRESSURE CUFF. Dr. Korotkov described the sounds produced during auscultation with a stethoscope over a distal portion of an artery as a blood pressure cuff was deflated. These Korotkoff sounds resulted in an accurate determination of systolic and diastolic blood pressure. Comment: Anesthesiologists monitor patients repeatedly during every surgery. A patient’s vital signs are the heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature. It would be impossible to administer safe anesthesia without blood pressure measurement. Low blood pressures may be evidence of anesthetic overdose, excessive bleeding, or heart dysfunction. High blood pressures may be evidence of inadequate anesthetic depth or uncontrolled hypertension.

1932. Dr. Arthur Guedel, Wisconsin, USA. DEVELOPMENT OF THE CUFFED ENDOTRACHEAL BREATHING TUBE. Dr. Guedel added an inflatable cuff to the distal end of a breathing tube to be inserted into a patient’s trachea. This advance allowed the use of positive-pressure ventilation into a patient’s lungs. Comment: Surgery within the abdomen and chest would be impossible without controlling the airway and breathing with a tube in the trachea. Advanced cardiac life support (ACLS) of Airway-Breathing-Circulation depends on the insertion of a cuffed endotracheal tube.

1927. Dr. Ralph Waters, University of Wisconsin, USA. THE FIRST ANESTHESIA RESIDENCY PROGRAM. Before Dr. Waters, a variety of individuals administered anesthesia. He developed the first department of anesthesia at a medical school, and established the first resident training program in anesthesia. He is considered the “father of academic anesthesia.” Dr. Waters also introduced the anesthetic gas cyclopropane into clinical use, the carbon dioxide absorption method on the anesthesia machine, and endobronchial anesthesia for thoracic surgery. Comment: Every university anesthesia residency program owes a debt to the legacy of Ralph Waters.

1934. Dr. John Lundy, Mayo Clinic, Minnesota, USA. THE INTRODUCTION OF INTRAVENOUS THIOPENTAL AND INJECTABLE BARBITURATES. Dr. Lundy of the Mayo Clinic in Rochester, Minnesota introduced the intravenous anesthetic sodium thiopental into medical practice. In 1934, Dr. Ernest Volwiler and Dr. Donnalee Tabern synthesized Pentothal, the first intravenous general anesthetic. Pentothal was first used in humans on 8 March 1934 by Dr. Ralph Waters. Three months later, Dr. John Lundy started clinical trials of thiopental at the Mayo Clinic at the request of Abbott Laboratories. Injecting Pentothal provided a more pleasant induction of anesthesia than inhaling pungent ether. Comment: This was a huge breakthrough. Almost every modern anesthetic begins with the intravenous injection of an anesthetic drug. (Propofol has now replaced Pentothal.)

1941, Dr. Robert Miller, Texas, USA. INVENTION OF THE MILLER INTUBATING LARYNGOSCOPE BLADE. The Miller straight laryngoscope blade was used to elevate the epiglottis and enabled anesthesiologists to directly view the vocal cords and the laryngeal opening in an anesthetized patient, so they could directly place an endotracheal breathing tube into the trachea. Comment: The Miller straight laryngoscope blade is the second most common blade used for direct laryngoscopy today, and my personal favorite.

1942. Dr. Harold Griffith, Montreal, Canada. THE DISCOVERY OF CURARE, THE FIRST INJECTABLE MUSCLE RELAXANT. Dr. Griffith injected the paralyzing drug curare to 25 patients during cyclopropane general anesthesia to induce muscular relaxation. Although the existence of curare was known for many years—it was used on poison arrows by South American Indians—it was not used in surgery to deliberately cause muscle relaxation until this time. Comment: Paralyzing drugs are necessary to enable the easy insertion of endotracheal tubes into anesthetized patients, and paralysis is also essential for many abdominal and chest surgeries.

1943, Dr. Robert Macintosh, England. INVENTION OF THE MACINTOSH INTUBATING LARYNGOSCOPE BLADE. The Macintosh curved laryngoscope blade enabled anesthesiologists to indirectly elevate the epiglottis and view the vocal cords and the laryngeal opening in an anesthetized patient, so they could directly place an endotracheal breathing tube into the trachea. Comment: The Macintosh curved laryngoscope blade is the most common blade used for direct laryngoscopy today.

ventilating the lungs by bag-ventilation via a tracheostomy

1953. Dr. Bjorn Ibsen, Denmark. THE DEVELOPMENT OF THE FIRST INTENSIVE CARE UNIT (ICU). The origin of the ICU followed the Copenhagen polio epidemic of 1952, which caused respiratory failure in hundreds of patients. Hundreds of patients required ventilation for weeks. Dr. Ibsen organized over a thousand medical students who positive-pressure-ventilated the lungs of these patients by bag-ventilation via tracheostomies. This gathering uniting of physicians and medical students to manage sick patients led to Ibsen being considered the “father of intensive care.” Comment: In the ICU, the Airway-Breathing-Circulation management perfected in the operating room was extended to critically ill patients who were not undergoing surgery.

1956. Dr. Charles Suckling. THE DISCOVERY OF HALOTHANE, THE FIRST MODERN INHALED ANESTHETIC. British chemist Charles Suckling synthesized the inhaled anesthetic halothane. Halothane had significant advantages over ether or cyclopropane. Halothane had a more pleasant odor, a higher potency, faster onset, and was nonflammable. Halothane gradually replaced older anesthetic vapors and achieved worldwide acceptance. Comment: Halothane was the forerunner of our modern inhaled anesthetics isoflurane, desflurane, and sevoflurane. These drugs have faster onset and offset times, cause less nausea, and are not explosive like ether was. The discovery of halothane changed inhalation anesthesia forever.

Dr. John Severinghaus and the first blood gas analyzer

1957. Dr. John Severinghaus, UCSF, California, USA. THE FIRST MEASUREMENT OF ACID/BASE CHEMISTRY OF HUMAN BLOOD. Dr. Severinghaus developed the first blood gas analyzer, now on display in the Smithsonian Museum, which measured the pH, pCO2, and pO2 in a sample of arterial blood. https://www.mlo-online.com/continuing-education/article/13008466/blood-gas-testing-a-brief-history-and-new-regulatory-developments He also developed the initial methods for measuring end-tidal gas concentrations in anesthetized patients in the mid-1970s, and he worked with Dr. Eger (below) on the discovery of minimum alveolar concentration of inhaled anesthetics. He died in 2021 at the age of 99 years. Comment: Measuring blood gases in an acutely ill patient is a cornerstone of all ER and ICU medicine. Measuring blood gases is also routine in cardiac, neurosurgical, and trauma anesthesia, and the measurement of end-tidal gas concentration is a standard in general anesthetics today.

1960s. Dr. Ted Eger, UCSF, California, USA. DISCOVERY OF THE MINIMUM ALVEOLAR CONCENTRATION OF POTENT INHALED ANESTHETICS. Dr. Eger defined the science of inhaled anesthesia uptake and concentration when he characterized the Minimum Alveolar Concentration (MAC) of every gaseous anesthesia drug. Per Dr. Eger’s New York Times obituary when he died at the age of 86 in 2017, he was “a leader in the development of a now universally used technique to determine the proper dose of anesthetic gas administered in operating rooms.” Comment: Almost every general anesthetic today includes some form of an inhaled anesthetic such as sevoflurane, desflurane, or nitrous oxide. Dr. Eger’s work defined the principles of how much gas to administer to each patient.

1983. Dr. William New, Stanford University, California, USA. THE DEVELOPMENT OF PULSE OXIMETRY MONITORING. The Nellcor pulse oximeter, co-developed by Stanford anesthesiologist Dr. William New, was the first commercially available device to measure the oxygen saturation in a patient’s bloodstream. The Nellcor pulse oximeter had the unique feature of lowering the audible pitch of the pulse tone as the oxygen saturation dropped, giving anesthesiologists an audible early warning that their patient’s heart and brain were in danger of low oxygen levels. Comment: The Nellcor changed patient monitoring forever. Oxygen saturation is now monitored before, during, and after every surgery. Prior to Nellcor monitoring, the first sign of low oxygen levels was often a cardiac arrest. Following the invention of the Nellcor, oxygen saturation became the fifth vital sign, along with pulse rate, respiratory rate, blood pressure, and temperature.

1987. Dr. Archie Brain, England. DEVELOPMENT OF THE FIRST COMMERCIAL LARYNGEAL MASK AIRWAY. The Laryngeal Mask Airway (LMA) replaced the endotracheal tube as the airway device for many general anesthetics. The LMA can be inserted blindly into a patient’s mouth, does not require the patient to be paralyzed for insertion, is an easy method for securing the airway, and does not require a laryngoscope. The LMA was introduced to the United States market in 1992. Comment: The LMA revolutionized the general anesthetic technique for most extremity surgeries, some head and neck surgeries, and is used as a rescue technique in the American Society of Anesthesiologists Difficult Airway Algorithm (see below).

1990s. Dr. Jonathan Benumof, UCSD, San Diego, California, USA. DEVELOPMENT OF THE DIFFICULT AIRWAY ALGORITHM. Dr. Benumof was the main originator of the American Society of Anesthesiologists Difficulty Airway Algorithm, first published in 1996. The Difficult Airway Algorithm describes pathways to safe airway management, and its application has saved countless lives. Comment: The Difficult Airway Algorithm is the standard of care for managing patients who are difficult to intubate and/or oxygenate. All anesthesiology providers commit the algorithm to memory, because when airway disasters occur there is simply no time for them to Google the correct order of rescue procedures.

2001. Dr. John Pacey, vascular and general surgeon, University of British Columbia, Canada. INVENTION OF THE GLIDESCOPE, THE WORLD’S FIRST VIDEOLARYNGOSCOPE. Dr. Pacey introduced the GlideScope (Verathon) as the first commercially available video laryngoscope in 2001. The GlideScope combined two new technologies: the video laryngoscope and the hyper-angulated laryngoscope blade, and enabling doctors and CRNAs to “see around the corner” of the airway to place endotracheal tubes into the trachea of patients with difficult airways. Comment: Note that Dr. Pacey and several other doctors on this Top 20 List invented improvements in airway management. Failed airway management remains the most dreaded complication in anesthesia practice, as it can lead to anoxic brain damage. We are thankful to Drs. Arthur Guedel, Ralph Waters, Robert Miller, Robert Macintosh, Archie Brain, Jon Benumof, and John Pacey, whose inventions made intubation of the difficult airway . . . less difficult.

These are the top 20 doctors who made major advances in the history of anesthesia as I see them. Who will be the next successful inventor to advance our specialty? At Stanford University our department is titled the Department of Anesthesiology, Perioperative and Pain Medicine. A key question for the future of Anesthesiology is “How do anesthetics work on the brain?” A key question for the future of Pain Medicine is “How can we more effectively block pain?” In 2016 an estimated 20.4% of the adults in the United States had chronic pain, and the relief of pain remains a key unsolved problem. Anesthesiologists or scientists who develop answers to these questions will likely join The Top Doctors in the History of Anesthesia list.

AUTHOR’S NOTE: The ultimate chronicle of anesthesia history is The Wondrous Story of Anesthesia, edited by Dr. Ted Eger, Dr. Laurence Saidman, and Dr. Rod Westhorpe. It’s available on Amazon and deserves to be on the bookshelf of every medical library in the world.