Pre-scientific period
The earliest attempts at pain relief are described in written sources of Ancient Egypt (3rd–5th millennia BC). The anesthetics used at that time included:
- Tinctures of opium and belladonna.
- Mandrake extract.
- Alcohol.
The effectiveness of such methods was negligible. Most patients died from pain shock even during relatively minor surgical procedures.
Emergence of inhalation anesthesia
A turning point occurred on October 16, 1846, when the American dentist W.T. Morton publicly removed a submandibular tumor using diethyl ether to put the patient to sleep. For this, Morton constructed the first prototype of an anesthetic vaporizer. This event proved the feasibility of painless surgery and is considered the starting point of modern anesthesiology.
Shortly before, in 1844, another American, H. Wells, discovered the analgesic properties of dinitrogen monoxide ("laughing gas"). However, a failed public demonstration delayed the development of the method for a long time, although today this gas is actively used in combined anesthesia.
The third classic agent was chloroform, discovered in 1847 by J. Simpson. Initially, it successfully competed with ether, but over time it was abandoned due to high toxicity and frequent complications.
Russian contribution to the development of anesthesia
Russian medical professionals played a crucial role in the evolution of pain management methods:
- F.I. Inozemtsev used ether anesthesia in Moscow as early as February 7, 1847 — less than four months after Morton.
- N.I. Pirogov laid the foundations of military-field anesthesiology. During the Sevastopol campaign (1854–1855), he performed about 10,000 surgeries under anesthesia without a single death from the drug itself. Pirogov was the first to describe anesthesia complications, used pain relief in obstetrics (1847), and developed methods for intravascular, intratracheal, and rectal administration of anesthetics.
- In 1909, intravenous hedonal anesthesia ("the Russian method"), developed by pharmacologist N.P. Kravkov and surgeon S.P. Fyodorov, achieved worldwide triumph.
Era of muscle relaxants and the modern stage
A major milestone was 1942, when Canadians Griffith and Johnson used curare during surgery. This led to the synthesis of curare-like substances (muscle relaxants) and the widespread introduction of endotracheal anesthesia with mechanical ventilation. As a result, surgeons gained access to the thoracic and abdominal cavities, as well as the central nervous system.
During the Great Patriotic War, the main methods remained mask ether anesthesia and infiltration anesthesia (according to A.V. Vishnevsky's method). In the postwar period, Russian surgeons such as A.N. Bakulev, A.A. Vishnevsky, and B.V. Petrovsky made a huge contribution to the creation of modern respiratory equipment and the organization of the specialized service.
Briefly: answers to topical questions
What is the principle of local infiltration anesthesia according to A.V. Vishnevsky?
The principle of local infiltration anesthesia according to A.V. Vishnevsky is the method of tight, layered, creeping infiltration, which combines the qualities of infiltration and conduction anesthesia.
Basic principles of the method:
- Use of weak solutions — a 0.25% novocaine solution is used.
- Layered administration — the solution is administered taking into account the "fascial sheath" structure of the body.
- Administration under pressure — tight infiltrates spread along fascial sheaths, penetrating to nerves and receptors.
The surgeon works alternately with a syringe and a scalpel, performing infiltration strictly before opening the sheath. Tight infiltration provides hydraulic preparation, pushing tissues apart with fluid and facilitating organ isolation.
What stages are distinguished in the clinical course of classical ether anesthesia?
Four stages are distinguished in the clinical course of classical ether anesthesia:
- Stage I — analgesia.
- Stage II — excitement.
- Stage III — surgical (tolerant), divided into four planes: III-1, III-2, III-3, and III-4.
- Stage IV — awakening.
Overdose is described separately: eyelids wide open, skin color pale cyanotic.
What modern groups of drugs for intravenous anesthesia exist?
Drugs for intravenous (non-inhalation) anesthesia include:
- Barbiturates — sodium thiopental and hexobarbital (hexenal).
- Ketamine — a drug for dissociative anesthesia; causes hypertension and tachycardia.
- Propanidid (sombrevin, epontol).
- Sodium oxybutyrate (GHB).
- Propofol (diprivan).
- Also mentioned in sources are baytinal and viadril.
Class and exam questions
Who is considered the creator of ether anesthesia?
Officially, W.T. Morton, his mentor C. Jackson, and H. Wells are recognized as the founders. However, historically, it is important that in 1844 in Russia, Ya.A. Chistovich published an article on amputation under sulfuric ether, anticipating Morton's discovery.
What is A. Einhorn's merit in local anesthesia?
In 1905, A. Einhorn synthesized novocaine (procaine). This discovery provided a powerful breakthrough in the development and widespread adoption of local pain management methods.
Why was chloroform anesthesia abandoned?
Chloroform possesses excessively high toxicity and a narrow therapeutic window. Its use was accompanied by frequent and severe complications.
What else to study on this topic
- Mechanism of action of diethyl ether and chloroform
- Development of intravenous anesthesia: barbiturates, sodium oxybate, and propanidid
- A.V. Vishnevsky's contribution to the development of infiltration anesthesia
- New inhalation anesthetics: halothane and cyclopropane
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Other topics in the section "CHAPTER 3. ANESTHESIA"
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