History of Trauma Anesthesia and Resuscitation

Abstract

Introduction: History of trauma anesthesia and resuscitation includes management of airway, pain, shock, triage, transport, anesthesia and surgery. Discussion: Greek and Roman Eras: Hippocrates described trauma and types of head injuries. Pain relief with opium, hemlock, and mandrake. Ascepiades 1st described tracheostomy; Celsus, treated abdominal trauma, head injuries, fractures; Galen had methods to close wounds and treat bleeding. Middle Ages: pain control via "drugged" wine and "soporific" plants. Wounded were treated in monasteries. Renaissance: Wounds were cauterized with boiling oil. Analgesia was opium and direct nerve compression. 17th Century: Serverino used snow and ice for analgesia. Harvey described circulation of blood. Major 1st used IV fluid therapy; Monel tourniquets to control bleeding. 18th Century: Hale was 1st to measure blood pressure. Pugh used air pipes for newborn resuscitation. Hunter, air bellows with valves. Nairn 1st used electricity for cardiac defibrillation. 19th Century: Larrey was 1st modern military surgeon to use horse drawn "flying ambulances" for wounded rescue at start of battle and introduced triage and "First Aid." Forence Nightengale improved sanitation of hospitals. Lister introduced germ therapy. Cocaine used for local and regional anesthesia. Ether introduced by Long and Morton, N2O by Wells. Esmarch introduced his chloroform mask; first aid and rubber bandages to exsanguinate limbs. Bier described IV regional block. 20th Century, WWI: Crile developed anoci-association theory with N2O balanced anesthesia in WW1. Lansteiner classified blood into 4 groups; Robertson and Cannon developed the 1st blood bank. Guedel described stages of anesthesia. Need for specially trained anesthesia providers recognized. Uncuffed endotracheal tubes were developed by Magill and Rowbotham followed lby Guedel and Waters who added cuffs. WWII: At Pearl Harbor, pentothal effects in hypovolemic patients was recognized. Henry Beecher researched shock and resuscitation. Post WWII: New anesthetics were curare, succinylcholine, lidocaine, halothane, ketamine and opioids. Miller and Mac- Intosh laryngoscope blades introduced. Anesthesia developes into specialty with formal training, certification and organization. Korean War: Helicopter evacuation and Mobile Army Surgical Hospital (MASH) units decreased mortality. Viet Nam War: Triage and resuscitation started in field with helicopter evacuation to MASH units. "Da Nang Lung" and ARDS recognized. Persion Gulf, Iraq and Afganistan to present: Anesthesia was TIVA, propofol, inhalation draw-over vaporizers, regional, and ketamine used alone. Care of wounded brought to front line with Mobile Forward Surgical Teams (MFST). Conclusion: War involves trauma and over the ages has contributed to and been the benefit of advancements in anesthesia, critical care and resuscitation.