In year 1799 anesthetic properties of Nitric Oxide were discovered by Humphery Davy (1778-1829) he advised that the by using nitric oxide, pain and shock of the surgical procedure can be negated. Third person who continue with Morton and Wells philosophy was Charles T. Jackson. The Fourth man who contributed to anesthetics was Thomas Mortan (Blatner, 2009). In the year 1848 James Simpson used chloroform in obstetric surgery, he used diethyl ether to anesthetize a women with a pelvic deformity for delivery (kodali, 2009) and in year 1853 John Snow did a successful induction of chloroform to her Majesty Queen Victoria at the time of Prince Leopold's Birth and also on Fenny Longfellow who wrote to her poet brother that this use of ether is certainly the greatest blessing of this era (Longfellow, 1956). In the year 1885-William Halsted introduced the nerve block. In 1891 Heinrich Quincke demonstrated the process of lumbar puncture. Successful clinical use of Spinal Anesthesia was introduced by August Bier. In the year 1909 school of anesthesia was first established in year 1909 in USA. In year 1915 carbon dioxide was used as absorber for the general anesthesia by D.F.Jackson. (Bergman, 1991)
Use of Anesthesia and Criticism / Controversies
Before giving anesthesia Pre-anesthetic medication such as Anti-Cholinergic prevents bradycardia, Antihistamines preventing allergic reactions, Barbiturates causing sedation, Antiemetic prevents aspiration of the gastric contents and nausea and vomiting after surgical procedure, Benzodiazepines to relieve stress and anxiety, Opioids that serves as analgesic and Muscle Relaxants that help in muscle relaxation and intubation are used in order to calm down the patient, relieve pain and to prevent the undesirable effects of the anesthesia. There are mainly two types of anesthesia, the General Anesthesia and Local Anesthesia. General Anesthesia causes the loss of sensation throughout the body and causing unconsciousness. General Anesthesia has further been divided into two forms Inhaled (Desflurane, Enflurane, Halothane, Isoflurane, Sevoflurane and Nitric Oxide) and Intravenous includes (Barbiturates, Benzodiazepines, Opioids, Propofol, Ketamines and Etomidate). Local Anesthesia causes loss of sensation on a particular location of the body without causing loss of consciousness. Local Anesthesia includes Bupivacaine, Lidocaine, Tetracaine and Procaine. Out of this lidocaine are frequently used. They block the nerve carrying the sensory impulses from the periphery to the CNS. The Local Anesthesia which has made the procedures extremely simple, only the particular area which requires surgery is anesthetized without affecting patient's consciousness by injecting local anesthesia drugs into the cerebrospinal fluid in the spinal cord called Spinal Anesthesia and into the epidural space called Epidural Anesthesia. This type of anesthesia allow patient to walk home safely. Anesthesia are induced after a pre-assessment of patients pharmacological, pathological and psychological state and also upon the type of Diagnostic or surgical procedure that is being conducted. There are three stages of Anesthesia: Induction, Maintenance and Recovery.
Induction is the phase from the initiation of administration of anesthesia to formation of an efficient surgical anesthesia. During the process of induction of anesthesia it is important to avoid phases of excitation (deliriums), thus general anesthesia is induced along with thiopental which is an intravenous anesthesia, and it helps in producing loss of consciousness within twenty five seconds after its administration.
Second Stage is Maintenance responsible to provide a sustained surgical procedure. This is the phase during which a patient is in surgical anesthesia. After the anesthesia has been administered it is the responsibility of anesthesiologist to carefully monitor the patient's vitals and response to different stimuli through the surgery. A careful balance should be achieved between the amounts of drug induced with the degree of anesthesia.
Third stage is the stage of Recovery which is the phase from the time the anesthesia was discontinued till physiological reflexes (such as breathing on its own) and consciousness are regained by the patient. Therefore it is important for the anesthesiologist to monitor patient closely after surgery.
The Depth of Anesthesia has been divided into four stages, Stage I is Analgesia- that is loss sensation due to blockage of sensory transmission along spinothalamic tract. In this phase the patient is conscious and able to talk. With the onset of stage II is Excitement -- the patient undergoes Amnesia and decrease in pain awareness. The patient undergoes delirium, the blood pressure increases and become irregular, the rate of respiration increases and to avoid this patient is given thiopental prior to administration of anesthesia. Stage III is Surgical Anesthesia- in which there is a regular relaxation and respiration of skeletal muscles. The reflexes in eyes decreases, till the movement of eyes get restricted and pupils get steady. Surgery can proceed during this phase. Stage IV is Medullar Paralysis- this stage involves he depression of vasomotor and respiratory centers followed by death. (Howland and Mycek, 2006).
There has been some moral obligation on the use of Anesthesia to relief the pain and suffering. There has been some criticism that the pain and suffering inflicted on an individual should be tolerated, as was tolerated by the Christian who faced the physical torture and suffering believing by doing so they will remain faithful to their God and to their conscience as well. It is believed that the effect of anesthesia of protecting one from pain interferes the Power of God and His Will. The use of Anesthesia for child birth was also criticized by some group of people believing that it prevents one from going through pain and suffering during child birth.
Various failures and success in the field of anesthesia led to rapid research and scientific experiments. The nurses became the first group of health care providers who administered ether, in United States doing so under the surgeon's observation. In later part of 1800 nurse started to play a vital role in an operation theater which led to formation of certified registered nurse anesthetists. At this time ether was well tolerated both hemodynamic ally and by the respiratory system. Till late 1800 nurses started to play a vital role in the health care system. Almost hundred years after the Morten's public demonstration of the anesthetic effect of ether the commonly used Anesthetics continued to be in the form of inhaled gases. Initially which were ether and Nitric Oxide followed by chloroform, Cyclopropane and Halothane. The other agents beside ether compromised the respiratory and the circulatory system and, therefore, needed to be administered with care. The very first death was reported from the use of chloroform anesthesia, a small girl died due to cardiac arrest and this made the risk of anesthesia evident. These new risk that can occur in operation theater were, asphyxia, a decrease in blood pressure, aspiration of stomach contents and cardiac arrhythmias followed by death as well. In this era the health professionals were considered to be the key person involved in patient's safety. Therefore, it was advised in the research papers that the induction of anesthesia should be done by specialized doctors. With time the practitioners started to specialize in Anesthesiology. In year 1905, nine physicians who specialized in Anesthesiology were responsible to form the first physician anesthesia society called Long Island Society of Anesthesia. In 1911 there developed a New York state society of Anesthesia. In the year 1936 American Society Anesthesiologist was established. 1941 American Board of Medical Specialty identified Anesthesia as a new medical specialty. In the 1930-1940 the interest grew in order to provide a safer way to induce anesthesia. The duties of anesthesiologist became not only to induce anesthesia but also to monitor patients closely. Until 1950's this patients' monitoring included pulse, Blood Pressure, respiratory movements, eye movements, pupil and sweating. EKG monitoring started in 1950's, followed by electronic blood pressure measurement by 1970's and pulse Oximetry and carbon dioxide end tidal by year 1980's. The advancement with time in patients monitoring led to better practice of Anesthesia and enhance the safety of patients. This advancement allowed the surgeons to perform bigger procedures like open heart surgery and transplantation under the influence of anesthesia with more ease. With time it is been understood that the importance of an anesthetist to have a firm knowledge regarding medical sciences, so he can co relate the heath condition, pre-existing diseases and evaluate the outcome of patient. Then administer and manage the dose of anesthesia accordingly.
Research and experiments have revealed that anesthetic drugs are fat soluble, explaining diffusion easily through cell membrane, which contain phospholipids and cholesterol. A very high pressure of anesthesia can cause a recovery from anesthetic effect. Another important feature of anesthesia is that, there characteristic of being volatile it enters into the circulation very rapidly. Where as those anesthetics which are taken orally such as barbiturates and alcohol, absorbs into circulation slowly and has a risk of addiction. Exposure to anesthetics for long period of time can cause resistance, effect called as tolerance develops, thus increased dose are require to produce an effect. Following are some effects produce by…