The history of the anesthetist as a perioperative physician

Abstract

This essay provides exemplars contributing to the evolution of anesthesia from empiricism and technical skill to a present focus on evidence based medicine. John Snow (1813-1858) fathered modern epidemiology. He devised principles used to assess anesthetic depth, and made vaporizers that reliably controlled ether and chloroform vaporization. His analysis of anesthesia-associated deaths provided the first perioperative outcome study. Arthur Guedel (1883-1956) revived Snow's signs of anesthetic depth, and with Waters constructed the modern oral-pharyngeal airway. In 1927,Ralph Waters (1894-1979) initiated the first academic department of anesthesia based on research, teaching, and administration. John Lundy (1894-1973) developed the anesthesia department at the Mayo Clinic, helped establish the American Board of Anesthesiology, created the first blood bank, and encouraged the AMA to recognize anesthesia as a specialty. Gertie Marx (1912-2004) brought modern anesthesia into the labor ward. She championed epidural anesthesia, providing maternal pain relief while minimizing the risks of newborn aspiration and death from deep sedation. John Bonica's (1917-1994) articles and textbook inspired new techniques for treating pain. In 1960, he initiated a multi-modal approach to pain management. BjornIbsen's (1915-2007) use of artificial ventilation to support breathing during Copenhagen's 1952 polio epidemic, led to today's Intensive Care Units. Peter Safar (1924-2003) promoted closed-chest cardiopulmonary resuscitation. He established the first residency in intensive care medicine (ICM). In 1952,Henry Beecher (1904-1976) suggested the use of placebo controls in human studies. His 1954 study showed the lethality of unantagonized muscle relaxants.