Anaesthetists are highly trained physicians whose area of expertise, anaesthesiology, has a relatively short history, with most advances being made in the last 100 years. Through the use of drugs to bring about partial or complete loss of sensation and consciousness, either to the body as a whole or part of it, the anesthetist’s primary role is to ensure that an unpleasant experience is as safe and as painless as possible.

Before the 1800s, patients who required surgery had to endure unbearable pain and suffering with intoxication from alcohol being the only know means of dulling the experience. It has been reported that patients were frequently strapped to the operating table, fully conscious whilst limbs were amputated and the body invaded by the surgeon’s knife. One case reported by Sir Robert Liston (a leading surgeon in the Victorian era) describes how his patient broke loose from his restraints in the middle of an abdominal operation, fled to the toilet and locked himself inside. Liston broke down the toilet door and dragged his patient back to the operating table to finish the operation. Liston was also famous for the speed in which he completed his operations, as well as for the fact that he cut off the finger of one of his assistants during his quest to complete a procedure as fast as possible.

Thankfully things have progressed considerably since the days where sickening screams erupted from the operating rooms. Marijuana, hashish, opium and acupuncture were all used in China and India as anaesthetics. Ether and chloroform became popular in western countries during the late 1800s to put patients to sleep – but complications were common, with some patients not waking up, a terminal side effect. Nitrous oxide, more commonly known as laughing gas, was also introduced around this time and is still used today. Cocaine became the next major advancement in anesthesiology – as a local anaesthetic, where only a particular area of the body could be desensitized by local infiltration of the drug or a spinal block could be used, producing lower body paralysis and loss of sensation, without having to render the patient unconscious.

Controlling a patient’s airway and breathing is a vital function for the anaesthetist. Administering a full anaesthetic used to result in cessation of breathing, meaning that the surgeon had to complete the surgery before the patient died from lack of oxygen. It was not until the 1920s that anaesthetists perfected the skill of introducing a tube into the airways, more commonly known today as endotracheal intubation. Once a tube was inserted, it made controlling respiration much easier, giving the surgeon valuable time to operate with more skill and precision.

The next major advancement came when drugs could be introduced intravenously, directly into the blood circulation, with barbiturates being used to put patients to sleep quickly, without having to rely on inhalation of the drugs which were particularly unpleasant.

Muscle relaxants were introduced in the early 1950s and then came a major advance in the form of Halothane, a revolutionary inhalation agent which was much safer and easier to use. Refinements have continued, with less potent and less toxic forms of analgesia and muscle relaxants being available to the anaesthetist today.

Anaesthesia is now very safe, with mortality rates of less than 1 in 250,000. It's also a very specialised area of medicine and we should all be thankful that amazing advances have been made to reduce what was once, to say the least, an unpleasant experience.

Peter Davison is the Manager International Services
at Phuket International Hospital.
Tel: +66 (0)76 249400. Email: info@phuketinternationalhospital.com.