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The incremental interchange of ideas across the specialties of anesthesia and surgery demonstrates the collaborative nature of science in general and medicine in particular. Many surgeons contributed to the growth in anesthesia; more comprehensive anesthesia, in turn, allowed more complex surgery to develop.
The role of the anesthesiologist has expanded to become the perioperative physician. The anesthesiologist evaluates the patient preoperatively, provides the anesthetic, and is involved in postoperative pain relief.
New and improved airway and intubation devices, such as the laryngeal mask airway and the video laryngoscope, along with the American Society of Anesthesiologists’ airway management algorithm, have led to improved management and control of routine and difficult airways.
The specialties of critical care medicine and pain medicine have grown out of the expanded field of anesthesiology. The postanesthesia care unit gave rise to the intensive care unit; the treatment of acute and chronic pain syndromes by anesthesiologists contributed to the growth of pain medicine as a specialty.
The study of proteomics will lead to anesthetics tailored to individuals, maximizing effects and reducing side effects of various anesthetic drugs.
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The discipline of anesthesia embodies control of three great concerns of humankind: consciousness, pain, and movement. The field of anesthesiology combines the administration of anesthesia with the perioperative management of the patient’s concerns, pain management, and critical illness. The fields of surgery and anesthesiology are truly collaborative and continue to evolve together, enabling the care of sicker patients and rapid recovery from outpatient and minimally invasive procedures.
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BRIEF HISTORY OF ANESTHESIA
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The discovery of anesthesia is one of the seminal American contributions to the world. Along with infection control and blood transfusion, anesthesia has enabled surgery to occupy its fundamental place in medicine. Before the advent of modern anesthesia in the 1840s, many substances and methods were tried in the search for pain relief and better operating conditions. Opium, alcohol, exposure to cold, compression of peripheral nerves, constriction of the carotid arteries to produce unconsciousness, and hypnosis (mesmerism) all proved less than satisfactory and dictated rapid and crude surgical procedures. Patients had to be restrained by several attendants, and only the most stoic could tolerate the screams heard in the operating theater. Charles Darwin, who witnessed two such operations, “rushed away before they were completed. Nor did I ever attend again, for hardly any inducement would have been strong enough to make me do so; this being long before the blessed days of chloroform. The two cases fairly haunted me for many a long year.”1
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Although Humphrey Davy (1778–1829) suggested using nitrous oxide for the relief of pain in surgical procedures in 1800, this was not pursued until 1844 by dentist Horace Wells (1815–1848). Wells astutely observed that a man who was injured after inhaling nitrous oxide during an exhibition of the “laughing gas”displayed no ...