The knowledge of anaesthetics has not been around for very long, and the use of them is an even more recent development. Anaesthetics are used frequently in current medical practice, with most surgeries being done under some kind of anaesthesia (whether this is local or general), but the use of them only became widespread in the mid-1800s.
Anaesthetics come in a wide variety and uses from inhalation gases (such as nitrous oxide and halothane) to regional anaesthetics (lignocaine and prilocaine) so this will be a brief journey through the acceptance and discovery of some more prominent ones.
The first actual recording of anaesthetics, past the use of alcohol in ancient Mesopotamia, was in Italy where they would cover a patient’s head with a wooden bowl and bang on it until the patient lost consciousness. These methods had non-beneficial side-effects (or didn’t work to eliminate pain) along with other serious risks, meant that surgery was a painful last resort and had to performed under intense time pressures, unlike the lengthy operations seen in medicine in our age.
In general anaesthetics, the first chemical used as a widespread anaesthetic in the 1800s was chloroform. The society in Britain at the time had a moralistic outlook on anything to do with pain, with the commonly cited belief that sickness and disease were punishments given out by God, something that included childbirth pains, which was believed to be the punishment given to women as a result of Eve’s transgression. This, coupled with reports of surgical death and robbery under anaesthesia, allowed a wariness to surround the use of chloroform in a surgical setting. The way in which chloroform was discovered and the fine-tuning of dosage also created some resentment in the public as there were several deaths recorded due to incorrect doses being used particularly as chloroform can be toxic when in higher doses. The public and church’s opinion were actually swayed by the Crimean War (1853-1956) and Queen Victoria. Queen Victoria’s support of chloroform as well as the army’s increased usage of chloroform proved to the public that anaesthesia was a benefit to surgeries. Even priests were found acting as anaesthesiologists during operations.
Chloroform was soon replaced (or overtaken really as ethers were developed first) by ethers due to the safer and slightly cheaper nature of ethers. Ethers were used in medical practice for many years, before being replaced in the 1960s with the rise of the fluorinated hydrocarbons such as halothane (mentioned above), which benefits included consistent production of saliva allowing for easier intubation, as prior alternatives tended to increase the production of saliva.
Local anaesthetics – which are used in both local and regional anaesthesia – are used to numb a part of the patient’s body (in local anaesthesia this is the site of surgery, while in regional anaesthesia this is by application close to nerves but a distance away from the surgical site). They use different chemicals to general anaesthetics, mostly consisting of esters such as lignocaine and prilocaine.
The discovery of esters as a local anaesthetic came in 1884 when, after a few hundred years of struggling with controlling the pain during surgery, cocaine was discovered to have local anaesthetic properties. Cocaine became widely used in surgery and remains to this day the only natural occurring local anaesthetic. However, after the discovery of cocaine synthesis, other safer esters were found that would become the main basis of local anaesthetics. For example, procaine was used for a brief period instead of cocaine as it was found to not have the addictive traits of cocaine. This has continued advancing right up to the current day where esters such as lignocaine are used on a regular basis.
Sedation is another subsection of what people commonly mention when talking about anaesthesia. Sedation, rather than making the patient completely unresponsive and unconscious like general anaesthesia, creates a sleep-like state where patients can still respond to external stimuli (this is dependent on the extent of sedation). Sedation is safer than anaesthesia as it is simply the depression of awareness which leaves the body able to regulate things like breathing, something that needs anaesthesiologists when under general anaesthetics. The history of sedation will unfortunately have to be another article, as it is far too complex to get into here.
Today, is it undeniable that anaesthesia has revolutionised modern medicine, making surgeries safer and easier, as well as benefitting people who give birth, become so well-practised that it seems almost surprising just how much suspicion they were treated with when they were first brought into use.
