THIS is the first part of a series of articles designed to promote understanding of myths about anaesthesia. Many people run away from hospitals or refuse to undergo an operation when they learn that an anaesthsia will be used.
Others fear the side-effects, while others associate it with death. Dr Arthur Kwizera discusses drugs that had, until recently, occupied an innocent but important seat in history
You might have watched the movie Awake and had your eyes opened to parts of the enigma that anaesthesia is. Anaesthesia comes from the greek words an-aesthesia meaning without feeling.
Greek philosopher Dioscorides first used the term in the first century AD to describe the narcotic-like effects of the plant, mandragora.
Bailey’s universal Etymological English Dictionary (1721) defined it as a defect of sensation, and the Encyclopedia Britannica (1771) as a privation of the senses.
The present use of the term to describe a sleeplike state that makes possible painless surgery is credited to Oliver Wendell Holmes in 1846.
It could safely be described as the branch of medicine that deals with the removal of pain, awareness, tone, anxiety and memory whilst preserving all your critical life support processes, long enough for a physician to perform an otherwise painful but lifesaving procedure.
We like to think that it was the first clinical specialty performed by God when in Genesis 2:21 He put Adam to sleep and performed surgery.
Anaesthetic practices date from ancient times. Ancient civilisations used opium, coca leaves, mandrake root, alcohol, bleeding patients to unconsciousness and carotid (arteries in the neck that carry blood to the head) pressure among others.
Because the hypodermic needle did not occur till later, the first general anaesthetics were destined to be inhalational (taken in as one breathes) agents.
Ether was originally prepared by a 25-year-old botanist, Valerus Cordus, in 1540. Initially limited to frivolous purposes, its use in anaesthesia was not until C.W. Long and W.E. Clark in 1842 and publicly by W.T.G Morton in Boston in 1846.
The famous chloroform (kalifomu) was first used in 1847, followed by nitrous oxide in 1868 (it had been tried before but certain properties had made it unpopular.
Ether is still being used in most parts of Uganda. Chloroform has since been abandoned and nitrous oxide is still being used mainly for labour analgesia (loss and ability to feel pain) albeit uncommonly.
Better inhalational anaesthetics also known as volatile agents have since come to the fore. Halothane (released 1951), isoflurane (1965) desflurane (1992) and sevoflurane (1995) are gases you might meet along the way.
The invention of the hypodermic needle in 1855 paved the way for intravenous anaesthetic drugs. Many attempts were made but in 1934 thiopental, a powerful drug that makes one calm, was first used clinically and remains the most popular induction agent to date.
The benzodiazepines-diazepam/valium (1959), lorazepam (1971) and midazolam (1976) have been extensively used for premedication, supplementation of anaesthesia and intravenous sedation.
Ketamine (1965), Etomidate (1972) and propofol, was released in 1989.
The practice of anaesthesia evolved to become a highly specialised, academically demanding and resource consuming profession.
The next article will look at the scope of anaesthesia, what anaesthesia providers do and the different skill sets they possess.
Any queries about anaesthesia maybe addressed to
doctor@newvision.co.ug.
The writer works in the
Department of Anaesthesia,
Makerere University