Anaesthesia

A Typical Anaesthetic Sequence

Modern anaesthesia usually involves the administration of drugs for specific components of anaesthesia.

A typical sequence involves:

• intravenous injection of an anaesthetic to produce unconsciousness
• administration of a potent analgesic
• a drug to paralyse the muscles (neuromuscular blocking drug)
• a general anaesthetic to maintain unconsciousness, supplement analgesia and muscle relaxation

This combination of anaesthetics enables lower concentrations of the general anaesthetic drug to be used, which reduces the incidence and severity of side-effects associated with these drugs.

History of Anaesthesia

The first public demonstration of anaesthesia was by William Morton, a dentist at Massachusetts General Hospital on 16 October 1846.

Morton administered di-ethyl ether to render Gilbert Abbott unconscious for the painless drainage of a dental abscess. Almost immediately, Morton’s success was seen as a major advance allowing surgical procedures to take place for conditions other than those that were life-threatening or those that caused excruciating pain.

The original term to describe what Morton had done was “etherisation”. In 1847, when chloroform was found to have similar properties to ether, an alternative term to etherisation was needed. The two favourite terms that emerged were both derived from Greek:

1) “narcosis”, meaning stupor or paralysis
2) “anaesthesia”, meaning without feeling.

Is Anaesthesia Safe?

Essentially, anaesthesia is an inherently unsafe concept. That’s because it involves using drugs that could be fatal in a matter of minutes, if not administered by a trained and skilled anaesthetist.

Although anaesthesia is safer than it has ever been, it should never be taken lightly. The risk of not surviving is affected by the nature of the surgical disease, the operation required to treat it and other underlying medical problems of the patient.

Anaesthesia itself is thought to be responsible for one death in every 180,000 anaesthetics.

To put this into perspective, an anaesthetic poses a greater risk than most modern forms of transport:

An anaesthetic is approximately:
3.5 times more dangerous than a motorcycle ride.
50 times more dangerous than a flight
100 times more dangerous than travelling by car
4000 times more dangerous than a bus ride

The Anaesthetist’s Role

Despite approaching my 30th year as an anaesthetist, I still look forward to every day that I spend in an operating theatre. Anaesthesia is a specialty that will always feed a curious mind because there is so much that we don’t yet fully understand.

My interest in anaesthesia began when I was a junior hospital doctor, at the Friarage Hospital in Northallerton, North Yorkshire. I was allocated to one of the anaesthetic posts. I was surprised at how technical the role was and how important it was to work in partnership with the rest of the operating theatre team.

Nevertheless, what really interested me was the ability to apply pharmacology and physiology knowledge gained in medical school. Indeed, the role of an anaesthetist can be thought of as an applied pharmacologist, controlling a patient’s physiology on a second by second basis. It’s a challenging career but one I would never give up.