MEDICAL SURFARI: WHO'S BEHIND THE MASK?

Almost all of us have either had some type of surgery or have known someone who has had surgery. What would have been done for our friends or us if there were no such thing as surgery? It is practically impossible to imagine modern medicine without surgery or surgeons as many of the most remarkable, life-extending advances in health care have occurred within our lifetime.

It is even more of a stretch of our imagination to think which of these advancements in surgery would have been achieved without anesthesia.

The field of anesthesiology has long gone unaccredited for their vital part of these successes. In the mid-1800s nitrous oxide (laughing gas) was accidentally discovered to cause intoxication resulting in amusement and insensitivity to pain. Ether produced a similar intoxication and these gasses were used by traveling entertainers who would organize "ether frolics" as public demonstrations to amuse the audience rather than for their medical effects.

In 1842 Dr. Crawford Long of Georgia used ether to perform the first painless surgery. Later in 1846 Dr. William Morton, a Boston dentist, astonished his colleagues at Massachusetts General Hospital by demonstrating in a crowded amphitheater that ether vapor could douse the pain of surgery. He demonstrated this on a local newspaper printer named Gilbert Abbott as he removed a tumor from his neck.

Prior to these anesthetic gasses surgical patient relied upon prayer, hypnosis, ice compresses, herbal mixtures and other intoxicating substances, none of which produced good anesthesia. It wasn't until about the 1950's that work began on other inhalation anesthetic agents. Since that time astounding advances have been made in patient monitoring and in the development of safer, shorter acting and more effective anesthetic agents. All of this has been possible through the medical research that we support.

There are more than 25 million surgical procedures performed each year just in the United States alone and in each of these cases an anesthesiologist or nurse anesthetist makes this possible. These specialists do much more than simply administer a dose of medication to render the patient anesthetic. They regulate and monitor the patient throughout the surgery, which requires a wide range of knowledge about medications, how the body functions at a cellular level and how it responds under the conditions of certain types of disease.

These specialists begin their work before the operation by carefully assessing the patient to determine what likely will be needed for their upcoming surgery. During surgery they regulate and manage vital life functions including breathing, heart rhythm, blood pressure and brain and kidney functions. They utilize sophisticated monitors to maintain a delicate balance of these vital functions. After surgery they time the discontinuation of these medications or reverse the effects of the anesthetic medications to return the patient comfortably back to consciousness.

Anesthesia is safer today than it has ever been. Since about 1970 the number of anesthesiologists in the United States has more than doubled but the complications from anesthesia have dramatically declined. All of this has occurred during a time when surgery and anesthesia have gone beyond their prior bounds. Together we are able to perform intrauterine fetal surgery and successfully treat and support the youngest of premature infants in neonatal units. At the other end of the spectrum we have gone well beyond our prior bounds by successfully doing major surgical procedures on 100-year-old patients. The next time you have surgery be sure to recognize and thank the quiet person behind the mask.

Worldwide Web Resources

American Society of Anesthesiologists

www.asahq.org/

This is one of the more thorough web sites on the topic of anesthesia, including comprehensive information for professionals and the public, including a link to their professional journal.

How does anesthesia work?

www.usnews.com/usnews/issue/970818/18pain.htm

This is a reprint of an article from U.S. News and World Report on the topic of anesthesia.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.