Anesthesia as pain relief is amazing, and we still have trouble understanding how it really works. What we do know is that it has played an important role in medicine for centuries.
This role was made uncomfortably clear to me more than 35 years ago when I had to perform an emergency cesarean section on a woman using lidocaine as my only anesthetic. There was no anesthesiologist available for this 2 a.m. emergency, and this was before the days of routine epidurals.
I was much younger then and was only one year out of training, and the parents wanted everything done for their baby. We rushed her back to the operating room, hoping the anesthesiologist would show up in time before I had to cut.
There was only one anesthesiologist in the hospital in the middle of the night. He was on another case where the patient was actually coding on another operating table on a different floor. In those days, we didn’t have dedicated anesthesiologists for labor and delivery.
The fetal heart tones were dangerously low, into the 60s (normal is 120 to 150). The baby would be severely brain damaged or die if we didn’t get the baby within minutes. The only choice we had was to operate using a local anesthetic, lidocaine.
I had only read about using local anesthesia for C-sections before then, and somehow I remembered what the toxic dose was. At least I knew how much I could use. What if she needed more? What if it didn’t work?
The seconds ticked off and the fetal heart tones remained in the low 60s. I had to make a decision. The parents begged me to do something. “Save our baby,” they pleaded. With a prayer on my lips, I started injecting lidocaine as I went along the layers, waiting a few seconds for it to work at each layer, finally getting the baby out literally in two minutes. With full anesthesia, I could have gotten the baby out in under a minute if needed. I had to wait at each level for the lidocaine to take effect.
My patient didn’t feel anything, and the baby did fine after a slow start, thank God. The anesthesiologist did show up about 10 minutes after we started and he was able to give her complete general anesthesia as I finished the surgery.
That situation most likely wouldn’t happen today, at least I hope it wouldn’t. There are a lot of stories like that, about things we used to do that wouldn’t happen today. And there are a lot of stories of what happened in the long past that show how much has changed with pain relief over recorded history.
One of the most impactful discoveries in terms of pain relief comes from the poppy. Early civilizations used poppy and other herbs to alleviate pain. The Sumerians used the poppy as early as 4000 B.C. Over the centuries, pharmaceutical companies have figured out how to derive more potent pain killers from the poppy. Early use of opium has given way to morphine, heroin, and the semi-synthetic and synthetic opioids of today. While these drugs have been abused by many, their role in pain relief is important to millions.
But the poppy isn’t the only herb used for pain relief. The Babylonians, around 2250 B.C., used henbane (Hyoscyamus niger) to treat toothaches.
A very different form of pain management comes from the Chinese use of acupuncture, which was used as early as 1600 B.C. Other pain relievers were also used. The famed Chinese doctor Hua Tuo performed surgery using mafeisan (a wine and herbal mixture) as an anesthetic around A.D. 160. It was believed that this mixture may have been either morphine or opium. Unfortunately, Hua Tuo was executed for political reasons and burned his extensive medical writings beforehand.
In more recent times, 1540 to be exact, Valerius Cordus, a German physician and botanist developed what he called the “sweet oil of vitriol,” which was synthesized diethyl ether by distilling ethanol and sulphuric acid.
Dentist William T.G. Morton gave the first public demonstration of ether for surgery in 1846 at Massachusetts General Hospital though it was actually Dr. Crawford Long who first used it in his private surgical practice in 1842 in Jefferson, Georgia.
While a lot of credit is given to Morton, there is plenty of credit to be found around the globe.
Dr. Seishu Hanaoka, in Japan, developed an oral concoction of herbs he called “Tsusen-san.” This concoction was given to induce general anesthesia in a patient before he operated to remove a cancerous breast on a 60-year-old-woman named Kan Aiya. This was successfully performed on Oct. 13, 1804. It has been documented that Hanaoka spent more than 20 years developing his Tsusen-san and experimented on his wife and 10 other subjects.
Ether was a huge success, and it was Dr. Edward Robinson Squibb who developed a chemically pure form of ether in 1856. Two years later, he founded a pharmaceutical company, Squibb and Sons. Today Squibb is one of the world’s largest pharmaceutical companies.
Joseph Priestly is best known for “discovering” oxygen, he was also the first to produce and describe nitrous oxide in 1772. Priestly was an English theologian and a self-taught chemist. Sir Humphry Davy proposed the use of nitrous oxide for pain relief many years later. It was instead used for years as a toy and entertainment as “laughing gas.” It was not until 1844 that a dentist, Dr. Horace Wells, used it as pain relief while extracting a tooth.
In 1847, chloroform, similar to ether, was used as an obstetric anesthetic for laboring women. This quickly became very popular after Dr. John Snow used chloroform on Queen Victoria of England while she gave birth to her son in 1844.
Cocaine was originally used as pain relief by Incan shamans, but was later introduced in 1884 as an anesthetic for eye surgery and is still commonly used in ophthalmic surgery. The first spinal block using cocaine as the anesthetic agent was performed in 1898 by Dr. August Bier.
The lidocaine I used on my patient some 35 years ago was developed in 1944 and is still widely used.
Oliver Wendell Holmes is sometimes credited with coining the term “anesthesia” in 1846 after reading about Morton’s public display of ether.
Today, we have two basic types of anesthesia.
Local anesthesia, such as lidocaine, is still the most common local anesthetic when placing sutures or staples to close a wound. There are many different versions of types of lidocaine with different specific properties used for specific situations. Simply put, these chemicals block the nerve transmission from the site of the pain to the brain. They work as long as the local anesthetic agent is there to disrupt what is called the sodium channel. When it wears out, the pain returns.
General anesthesia is a different animal. The patient loses awareness of any pain but still maintains (hopefully) all vital functions to stay alive. These substances block synaptic neurotransmission. Exactly how these inhalation anesthetics work isn’t fully understood even after more than 150 years of use.
Interestingly, when someone goes under general anesthesia, they don’t dream. Today’s general anesthesia is a science in which different intravenous medications are used in conjunction with inhalation gasses to provide the safest and best anesthesia for patients. Just don’t ask an anesthesiologist how it really works. If they try to give an answer, they may just be inhaling some of their own gas.