In 1955, I was a Professor of Anesthesia and Head of the Division of Anesthesia at Duke University Hospital. In the division were several staff anesthesiologists, including Drs. Martin, Fabian, Hall and North, and a similar number of residents in training.
All patients having elective surgery were admitted to the hospital at least one day prior to the operation. Each patient was seen the day before surgery by a staff anesthesiologist and a resident and plans made for the anesthesia the next day.
The anesthetic drugs used in 1955 included thiopental, divinyl ether, nitrous oxide, cyclopropane, ether, succinylcholine, and d-tubocurare. Two potential difficulties were associated with these drugs:
• The surgeries were limited in the use of the cautery because both cyclopropane and ether were explosive.
• Nausea and vomiting postoperatively occurred in 20 to 25 percent of patients. An investigation was conducted in the use of Marezine™ to reduce the incidence of vomiting. In this study, Marezine appeared to reduce the incidence by about 25 percent. Chlorpromazine also was evaluated in a study but was not found to be of value for this purpose.
Clinical space for laboratory studies had been sorely needed for conducting research in anesthesia. Three years prior to 1955, in 1952, trichlorethylene had been evaluated as an analgesic to relieve the pain of labor. It had been found to be very useful, and a trilene inhaler was made so that patients could administer this drug to themselves as required for pain. A total of 50,000 of these inhalers were sold in the country, and they had been found to be useful. A sum of $2 in the sale of each inhaler was allocated to increase laboratory space in the division of anesthesia.
Clinical lectures were held three times a week for the residents on a variety of anesthesia-related topics and to help to establish where further studies might be appropriate. The actual teaching of the residents, however, occurred at the head of the table in the operating room while the resident was administering anesthesia under the care and supervision of a staff anesthesiologist. It was found to be important for the resident anesthesiologist to maintain a close watch not only on how the patient fared but on how the surgical operation progressed.
In the mid 1950s, a new suite of operating rooms was opened, and directly adjacent to it was a 10-bed recovery room for which the Division of Anesthesia was responsible. Staffed by excellent nurses, this recovery area proved to be a great boon in the safe care of patients in the immediate postoperative period.
One of the studies conducted in our expanded laboratory space concerned research in animals of a long-lasting depo-type of local anesthesia, which was called efocaine. The local anesthesia in this compound was procaine, and the solvents were propylene glycol and polyethelyene glycol. Such a compound provided excellent long-lasting local anesthesia, but it was found that the solvents themselves provided such anesthesia and, in some instances, damaged the tissue around which the compound had been placed. Further study of this compound was not undertaken.
In 1955, little did we realize the tremendous changes that would occur in 1956 and future years by the introduction of halogenated anesthetics.
This article is reprinted from a 2005 special commemorative issue of the ASA Newsletter with permission from the American Society of Anesthesiologists.
PHOTO COURTESY OF VIVIEN WEBB