anesthesiology


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anesthesiology

(ăn'ĭsthē'zēŏl`əjē), branch of medicinemedicine,
the science and art of treating and preventing disease. History of Medicine
Ancient Times

Prehistoric skulls found in Europe and South America indicate that Neolithic man was already able to trephine, or remove disks of bone from, the skull
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 concerned primarily with procedures for rendering patients insensitive to pain, and for supporting life systems under the strains of anesthesiaanesthesia
[Gr.,=insensibility], loss of sensation, especially that of pain, induced by drugs, especially as a means of facilitating safe surgical procedures. Early modern medical anesthesia dates to experiments with nitrous oxide (laughing gas) by Sir Humphry Davy of England
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 and surgery. The anesthesiologist will induce unconsciousness for various clinical purposes and will perform cardiac and respiratory resuscitation when necessary.

Anesthesiology

 

the science of pain relief. Methods of pain relief were first developed, in connection with surgery, many thousands of years ago in Assyria, Egypt, China, India, and other countries. The first primitive anesthetics were manufactured from herbs, roots, and leaves in the form of infusions, decoctions, and “sleep sponges” which were impregnated with the juice of mandrake, belladonna, opium, Indian hemp, henbane, water hemlock, and so on. A sponge, soaked in warm water or set on fire, served as the source of vapors which when inhaled put patients to sleep. Pain relief was also induced by pressure on the blood vessels of the neck or extremities, heavy bloodletting, wine or alcohol, and cold. In the 11th and 12th centuries a catalog of 140–150 recipes for narcotics used for pain relief was compiled at the University of Bologna. In 1200 the Spaniard R. Lullius discovered ether, in 1540 Paracelsus described its anesthetic properties, and in 1864 the English dentist W. Morton first used it for anesthesia during an operation. In 1844 the American physician H. Wells first used nitrous oxide while extracting a tooth. In 1847 the Scottish physician J. Simpson proposed chloroform as a narcotic drug. In Russia, N. I. Pirogov used ether and chloroform narcosis starting in 1847. The further development and use of narcosis in Russia is connected with the names of A. M. Filomafitskii, F. I. Inozemtsev, S. K. Klikovich, T. A. Vantsetti, and P. I. D’iakonov. Local anesthesia developed parallel with narcosis. Rubbing with various lotions, compression of nerve trunks and extremities, and ice packs were also used. With the discovery of cocaine in 1859, works on its anesthetic properties appeared. The Russian physician V. K. Anrep proposed the use of cocaine as an anesthetic in 1879, and in 1884 the Austrian physician Keller began to perform eye operations under cocaine anesthesia. Subsequently, various preparations were proposed for anesthesia. However, a new era in the development of local anesthesia began only with the discovery of novocaine. With the introduction of novocaine solutions in practice, various methods of local anesthesia—infiltration, conduction, and medullary anesthesia—began to develop quickly. Infiltration anesthesia by the method of “creeping infiltration,” developed by the Soviet surgeon A. V. Vishnevskii, which permits the performance of any operation— even those on heart and lungs—without resort to narcosis, is most widely used, especially in the USSR.

At the end of the first half of the 20th century, anesthesiology became an independent branch of medicine concentrating on the selection of the method of anesthesia and determination of the type of anesthetic, preparation of patients for surgery, administration of narcosis, care of the patient during the operation and in the postoperative period, prophylaxis and treatment of complications connected with the operation, participation in treatment of acute cardiovascular and pulmonary insufficiencies and other diseases involving severe depression of respiration (such as tetanus, poliomyelitis), anesthesia during complicated diagnostic procedures (such as endoscopy or sounding and catheterization of heart vessels and chambers), and approval and adoption of new anesthetics and all substances used during an operation (relaxants, hypotensive drugs, preparations for stimulating respiration and cardiac activity).

Major and prolonged reconstructive operations on the hearts, lungs, esophagus, and other organs require complete control of the most subtle mechanisms regulating all the patient’s systems. This is achieved by the use of hibernation (artificial sleep), artificial hypothermia (lowering of body temperature), controlled arterial hypotonia (lowering of arterial pressure), extracorporal (that is, outside the person’s body) blood circulation, and artificial ventilation of the lungs. In order to check on the patient’s condition and control his body functions during surgery, instruments are used in anesthesiology which automatically evaluate elec-troencephalographic, electrocardiographic, electrocardio-scopic, and carboxymetric indicators, the degree of oxygen saturation of the blood, and so on, and which maintain narcosis at the necessary depth.

The production of anesthesia and the care of the patient during surgery, as well as the control of his vital functions, are effected by the physician-anesthesiologist.

Anesthesiology studies the problems of anesthesia during emergency surgery, when it is impossible to study the patient in detail and prepare him; it also studies the specifics of anesthesia in neurosurgery, ophthalmology, otorhino-laryngology, orthopedics, and traumatology and the peculiarities of narcosis use in relation to the patient’s age. Anesthesiology is concerned with the problems of reanimation (restoration of the body’s vital functions) in cases of clinical death.

The development of anesthesiology in the USSR has been facilitated by the works of P. A. Gertsen, S. P. Fedorov, Iu. Iu. Dzhanelidze, N. N. Burdenko, S. S. Iudin, I. S. Zhorov, I. I. Kazanskii, A. A. Vishnevskii, E. N. Meshalkin, B. V. Petrovskii, V. N. Shamov, V. A. Negov-skii, and others. In other countries the work of R. Macintosh and W. Mushin (England), A. Dogliotti (Italy), and H. Laborit, P. Iunegar, and I. Meer-Meia (France) is well known. In the USSR special anesthesiology divisions with staffs of physicians and nurse-anesthetists have been established and equipped with the newest medical apparatus. Physician-anesthesiologists are trained by special subdepartments of advanced-training institutes for physicians in Moscow, Novosibirsk, Leningrad, Kiev, and other cities. In June 1966 the All-Union Society of Anesthesiologists and Reanimatologists was founded. The problems and achievements of anesthesiology are elucidated in the journal Eksperimental’naia khirurgiia i anesteziologiia (published since 1956).

REFERENCES

Spravochnik po anesteziologii. Edited by V. P. Smol’nikov. Moscow, 1965.
Osnovy reanimatologii. Edited by V. A. Negovskii. Moscow, 1966.
Problemy anestezii i reanimatsii. Petrozavodsk, 1967.
Osnovy prakticheskoi anesteziologii. Edited by E. A. Damir and G. V. Guliaev. Moscow, 1967.

A. B. GALITSKII

anesthesiology

[‚an·əs‚thēz·ē′äl·ə·jē]
(medicine)
A branch of medicine dealing with the administration of anesthetics.
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