Discovery of the intoxicating effect of gases
In 1800 Devi discovered the peculiar action of nitrous oxide, calling it "laughing gas". In 1818, Faraday discovered the intoxicating and overwhelming effect of diethyl ether. Devi and Faraday suggested the use of these gases for pain relief in surgical procedures.
First operation under general anesthesia
In 1844, the dentist H. Wells used nitrous oxide for anesthesia, and he himself was the patient during the extraction (extraction) of the tooth. In the future, one of the pioneers of anesthesiology suffered a tragic fate. During a public anesthesia with nitrous oxide, conducted in Boston by H. Wells, the patient almost died during the operation. Wells was ridiculed by colleagues and soon committed suicide at the age of 33.
It should be noted that the very first operation under anesthesia (etheric) back in 1842 was performed by the American surgeon Long, but he did not report his work to the medical community.
Date of birth of anesthesiology
In 1846, the American chemist Jackson and the dentist Morton showed that inhalation of diethyl ether vapors turns off consciousness and leads to loss of pain sensitivity, and they proposed using diethyl ether for tooth extraction.
On October 16, 1846, at the Boston hospital, the 20-year-old patient Gilbert Abbott, a professor at Harvard University, John Warren, removed a tumor of the submandibular region under anesthesia (!). The patient was anesthetized with diethyl ether by the dentist William Morton. This day is considered the date of birth of modern anesthesiology, and October 16 is annually celebrated as the day of the anesthesiologist.
The first anesthesia in Russia
On February 7, 1847, the first operation in Russia under ether anesthesia was performed by Professor of Moscow University F.I. Inozemtsev. A.M. Filomafitsky and N.I. Pirogov.
V. Robinson, author of one of the most informative books on the history of anesthesiology, wrote: “Many of the pioneers of pain relief were mediocre. As a result of chance circumstances, they had a hand in this discovery. Their quarrels and petty envy left an unpleasant mark on science. But there are figures of a larger scale who participated in this discovery, and among them the largest person and researcher should be considered, first of all, N.I. Pirogov ".
In 1847, five years earlier than was done in the West, he experimentally applied anesthesia through an incision in the trachea. Only 30 years later, a special tube was created, which was first introduced into the patient's trachea, i.e. carried out endotracheal anesthesia. Later this method became widespread.
N.I. Pirogov applied anesthesia on the battlefield. This happened in 1847, when he personally performed 400 operations under ether and 300 under chloroform anesthesia in a short time. N.I. Pirogov operated on the wounded in the presence of others in order to build confidence in surgical care with anesthesia. Summing up his experience, he asserted: “Russia, ahead of Europe, shows the entire enlightened world not only the possibility of application, but also the undeniably beneficial effect of aethering over the wounded on the battlefield itself. We hope that from now on, the etheric device will constitute, just like a surgical knife, the necessary belongings of every doctor during his action on the brutal field ... "
Ether application
For the first time, ether as an anesthetic was also used in dental practice. The American physician Jackson and the dentist Morton used ether anesthesia. On the advice of Jackson, Morton first used ether inhalation on October 16, 1846 for pain relief during tooth extraction. After receiving favorable results in tooth extraction under ether anesthesia, Morton suggested that Boston surgeon John Warren try ether anesthesia for major operations. Warren removed the neck tumor under ether anesthesia, Warren's assistant amputated the breast. In October - November 1846, Warren and his assistants performed a number of large operations under ether anesthesia: resection of the lower jaw, amputation of the thigh. In all these cases, inhalation of ether provided complete anesthesia.
For 2 years in different countries, ether anesthesia entered the practice of surgeons. One of the first countries where surgeons began to widely use ether anesthesia was Russia. The leading Russian surgeons of that time (in Moscow F. I. Inozemtsev, in St. Petersburg N. I. Pirogov) in 1847 began to produce anesthesia during operations. In the same 1847, NI Pirogov was the first in the world to use ether anesthesia when providing assistance to the wounded on the battlefield during the battles near Salt (Dagestan). "Russia, ahead of Europe," wrote NI Pirogov, "shows the entire enlightened world not only the possibility in the application, but the undeniable beneficial effect of efping over the wounded on the battlefield itself."
Foreign surgeons limited themselves to the empirical use of ether anesthesia. In France, for example, in the pursuit of profit, doctors began to widely use anesthesia at home for patients, not taking into account the general condition of the patient, as a result of which in a number of cases the anesthesia caused complications and the death of the patient. Domestic scientists headed by A.M. Filomafitsky and N.I. Pirogov scientifically studied the effect of narcotic drugs.
At the suggestion of A. M. Filomafitsky, a commission was established, which, by means of experiments on animals and observations on humans, clarified the main issues concerning the dehydration of ether anesthesia.
In 1847, the French physiologist Flurance drew attention to chloroform, discovered by Subeirand in 1830. Using the instructions of Flurance, the English surgeon and obstetrician Simpsoy performed experiments with chloroform and proved its advantage as an anesthetic over sulfuric ether.
Facts from the history of pain relief:
In the manuscripts of ancient times and later in the Middle Ages, it is mentioned that anesthesia was carried out with the help of "sleepy sponges" as a means of inhalation anesthesia. Their composition was kept secret. The sponge recipe is found in the 9th century Vamberg collection of antidote recipes (Antidotarium) (Sigerist, 800, Bavaria). In Italy, Sudhoff (860) found a recipe for the sleepy sponge in the Monte Cassino codex. It was made as follows: the sponge was impregnated with a mixture of opium, henbane, mulberry juice (mulberry), lettuce, speckled hemlock, mandrake, ivy, and then dried. When the sponge was moistened, the vapors that were produced were inhaled by the patient. They also resorted to burning the sponge and inhaling its vapors (smoke); the sponge was moistened, its contents squeezed out and taken orally or the moistened sponge was sucked.
The Middle Ages gave birth to the idea of both general and local anesthesia. True, some of the techniques and methods of those times from today's positions cannot be seriously considered. For example, the "method of general anesthesia" was widespread by hitting the head with a heavy object.
As a result of a concussion, the patient fell into an unconscious state and remained indifferent to the surgeon's manipulations. Fortunately, this method has not gained further acceptance. Also, in the Middle Ages, the idea of rectal anesthesia arose - tobacco enemas.
In the operating room of one of the London hospitals, a bell has survived to this day, the sounds of which tried to drown out the screams of the unfortunate undergoing surgery.
For example, a description of a serious operation in the 17th century on a patient who swallowed a knife.
“On June 21, 1635, we were convinced that the analysis reported to the patient was not a figment of imagination and that the patient's strength allowed the operation, they decided to do it, giving“ an analgesic Spanish balm ”. On July 9, with a large crowd of doctors, they began gastronomy. Having prayed to God, the patient was tied to a board: the dean marked out with charcoal the places of the incision four transverse fingers long, two fingers below the ribs and stepping back to the left from the navel to the width of the palm. The surgeon opened the abdominal wall with a ligotome. Half an hour passed, fainting occurred, and the patient was again untied and tied to the board again. Attempts to remove the stomach with tweezers failed; finally, they hooked it with a hook, passed a ligature through the wall and opened it at the direction of the dean. The knife was pulled out to the applause of those present. "
October 16, 1846 - the beginning of modern anesthesiology. On this day, at the Boston Hospital (USA), a patient from Harvard University professor John Warren removed a tumor in the submandibular region. The patient was anesthetized with ether by the dentist William Morton, who was present at Wells' public demonstration. The operation was successful, in complete silence, without the usual heartbreaking screams.
As soon as etheric anesthesia was recognized as a leading discovery, a lawsuit over its priority began, which lasted for 20 years and led the people concerned to death and ruin. H. Wells committed suicide, chemistry professor W. Jackson ended up in an insane asylum, and the ambitious W. Morton, who spent all his fortune fighting for priority and patented ether as an anesthetic, became a beggar at the age of 49.
Chloroform was discovered almost simultaneously with ether. Its anesthetic properties were discovered by obstetrician J. Simpson. Once, having breathed in chloroform vapors in the laboratory, he and his assistant suddenly found themselves on the floor. Simpson was not taken aback: having come to his senses, he happily announced that he had found a remedy for pain relief in childbirth. Simpson reported his discovery to the Edinburgh Medical Society, and the first publication on the use of chloroform anesthesia appeared on November 18, 1847.
As already mentioned, the official date of birth of general anesthesia is October 16, 1846. Imagine the surprise of the scientists-researchers when in two sources they found an indication that in the newspaper "Russian Invalid" in 1844 an article by Ya.A. Chistovich "On the amputation of the thigh by means of sulfuric ether".
But, even leaving the priority of the discovery of ether anesthesia to the stubborn and ambitious Morton, we pay tribute to the Russian doctors.
The discovery of anesthesia should be attributed to the greatest achievements of the nineteenth century. Humanity will always reverently name the names of the pioneers of pain relief, including Russian scientists.
“The surgeon's knife and pain are inseparable! Making operations painless is a dream that will never come true! " - the famous French surgeon A. Velno asserted at the end of the 17th century. But he was wrong.
The variety of anesthetics and methods of their application allows performing operations of different time. Surgeons now have access to areas that were previously completely inaccessible, and this began 200 years ago.
Attempts to induce anesthesia by acting on nerve fibers were made long before the discovery. In the Middle Ages, methods of nerve blockade were developed by means of mechanical compression of the nerve trunks, exposure to cold, and acupuncture.
However, these methods of obtaining anesthesia were unreliable and often dangerous. So, with insufficient compression of the nerve - anesthesia was incomplete; with a stronger one, paralysis occurred.
On October 16, 1846, in Boston at the Massachusetts General Hospital (now the Ether Dome at Massachusetts General Hospital), a public demonstration of the successful ether anesthesia conducted by William Thomas Green Morton (1819-1868) was held to facilitate surgery to remove the vascular submandibular tumor to a young patient Edward Abbott.
At the end of the operation, surgeon John Warren addressed the audience with the phrase: "Gentlemen, this is not nonsense." From this date, unofficially celebrated by our anesthesiologists as the "Day of the Anesthesiologist", the triumphal era of general anesthesia began.
However, the "chorus of enthusiastic voices and general fervor" about general anesthesia subsided somewhat when it became clear that, like any great discovery, it has its own unsightly shadow sides. There were reports of severe complications, including deaths. The first officially registered victim of general anesthesia was a young Englishwoman, Hana Greener, who attempted to remove an ingrown nail under chloroform anesthesia in Newcastle on January 28, 1848. The patient was in a sitting position and died immediately after inhaling the first doses of chloroform.
In England, the persecution of the discoverer of chloroform, James Young Simpson, 1811-1870, followed, who in his defense was forced to declare the Lord God the first drug addict, indicating that God, when creating Eve from the rib of Adam, had previously put the latter to sleep (Fig. 1.1. ).
Rice. 1.1. Meister Bertram: "The Creation of Eve" First Successful Attempt at Anesthesia Etheric anesthesia was also given, which was caused not only by a significant number of deaths and complications, but also by the fact of "deprivation of free will and self-knowledge of the patient" and his submission to the arbitrariness of the drug addict.
Francois Magendie (1783-1855), speaking at the Paris Medical Academy against ether anesthesia, called it "immoral and religious", saying that "it is unworthy to try to turn a body into an artificial corpse!"
Dangerous complications of general anesthesia, along with opposition, pushed the scientific thought not only to improve the techniques of general anesthesia, but also to search for new, safer methods of pain relief, which do not so strongly abuse the patient's mind.
It is interesting that V.S. Fesenko (2002), regarding the historical, economic and geographical reasons for the birth, the rapid surge and development of regional anesthesia in the 19th - early 20th centuries, wrote:
“At that hour, the United Kingdom and the United States had more professional anesthesiologists, and anesthesia would have to be delivered safely, so regional anesthesia was developed especially in continental Europe, especially in the general population of central Romans, children cheap zebolyuvannya ".
Indeed, the “Austrian trace” (the Habsburg empire), the “German trace” (the Hohenzollern empire), and the “Russian trace” (the Romanov empire) run as a bright thread through the history of regional anesthesia.
In the middle of the 19th century, the glass syringe (D. Fergusson, 1853) and the hollow needle of Alexander Wood (A. Wood, 1853) were already invented.
Having received a syringe and needles for the administration of drugs, society came close to the birth of regional anesthesia. The only thing left to do was to use an effective local anesthetic.
History of Anesthesia - Cocaine
- the founder of local anesthetics, has an interesting background. The conquistadors who conquered the Inca empire encountered a wonderful plant - Erythroxylon coca. A shrub plant - Erythroxylon coca, with small white flowers and red fruits that taste bitter but don't have the miraculous power of the leaves. The Indians of Bolivia and Peru cultivated coca, collected the leaves and dried them. Later, coca leaves were used as a tonic and a powerful psychostimulant, which also increased strength and endurance.
The miraculous effect was achieved during the chewing process. In the sources of the Spanish Conquista, it was also reported that inca operations were carried out using coca juice as an anesthetic. Moreover, the technique is so original that we will allow ourselves to cite it below. The unusual thing was that the surgeon himself chewed the coca leaves, trying to get his saliva containing coca juice onto the edges of the patient's wound. A double effect was achieved - a certain local anesthesia of the patient's wound and the surgeon's “high” state. Although here the surgeon played the role of an "anesthesiologist", this technique should not be adopted by our colleagues.
In 1859, the scientific leader of the Austrian round-the-world expedition Dr. Carl von Scherzer, returning from Lima (Peru), brought half a ton of raw material in the form of coca leaves, having previously tested them. He sent part of the party for research to the University of Göttingen to Professor Friedrich Woehler, who, being busy, entrusted his assistant Albert Niemann to carry out the research. Niemann, while working on the study of the chemical reaction of sulfur chloride (SCl2) with ethylene (C2H4) (again on behalf of Prof. Wöhler), obtained mustard gas (later - the infamous mustard gas).
Inhaling mustard gas during the experiments, Niemann was poisoned, and, being already poisoned, isolated in 1860 from coca leaves a pure alkaloid "cocain" (which meant - the substance inside the coca) with the formula C16H20NO4. The cocaine boom began. Wilhelm Lossen (W.Lossen) clarified the formula of cocaine - C17H21NO4. Numerous works have appeared on the effects of cocaine on the body of animals and humans.
In 1879, the Russian scientist Vasily Konstantinovich Anrep (Basil von Anrep), while training at the University of Würzburg (Germany), discovered the local anesthetic effect of cocaine when injected under the skin and suggested using it for pain relief in surgery. Anrep's works were published in 1880 in the journal Archive für Physiologie and in the pharmacology textbook of Notnagel and Rossbach (H. Notnagel, M. Rossbach, 1880). However, Anrep did not suffer from the ambitions of a pioneer and his work went unnoticed by the general medical community.
The young Viennese ophthalmologist Karl Koller (Carl Koller, 1857 - 1944) was destined to become the founder of local anesthesia, the man who presented his discovery to the world and introduced it to the clinic. As an intern, Koller lived near Sigmund Freud (1856 - 1939), who attracted him to the idea of curing his friend and colleague Ernst von Fleisch of morphinism, using cocaine as an alternative. Freud, as a true enthusiastic researcher, decided to try cocaine on himself by drinking a 1% aqueous solution of cocaine. In addition to the feeling of lightness, fun, self-confidence, increased ability to work and sexual arousal, Freud noted that “the lips and palate were at first kind of swept, and then there was a feeling of warmth. He drank a glass of cold water, which seemed warm on his lips, but cold in his throat ... "
Z. Freud practically passed by the grandiose discovery. From the idea of curing Fleisch, nothing came of it, since he became addicted to cocaine, becoming a cocaine addict.
Karl Koller, who also took part in the treatment of poor Fleisch, accidentally touched his lips with his fingers soiled with cocaine powder, and found that his tongue and lips had become insensitive. Koller reacted instantly - immediately using cocaine for local anesthesia in ophthalmology. The clinical experiment practically solved the problem of anesthesia in ophthalmology, since the use of general anesthesia during these operations, due to the cumbersomeness of the equipment, was extremely difficult. By stating the method of local anesthesia with cocaine as a priority, on September 15, 1884 at the Congress of Ophthalmologists in Heidelberg, Koller actually ushered in the era of local anesthesia.
An avalanche of cocaine use as anesthetic in various fields of surgery soon followed: pain relief of the larynx mucosa- Jellinek, lower urinary tract mucosa- Frenkel, in major surgery Welfler, Chiari, Lustgatten.
In December 1884 in New York, young surgeons William Holstead and Richard Hall performed cocaine blockade of the sensory nerves of the face and hand. Halstead found that anesthesia of the peripheral nerve trunk gives anesthesia to the area of its innervation. Subsequently, he performed the first brachial plexus block by direct application of a cocaine solution to surgically isolated nerves in the neck. The patient was under mask anesthesia. Self-experimentation with cocaine ended sadly for Halstead and Hall, as both became cocaine addicts.
The Great Cocaine Epidemic began in the 80s - 90s of the 19th century.
Cocaine was considered a fashionable medicine that cured all diseases, and was freely sold in drinking establishments. The famous wines of Angelo Mariani, containing cocaine, and the famous Coca-Cola, invented in 1886 by a pharmacologist from Atlanta (Georgia, USA), John S. Pemberton, became famous.
Initially, Coca Cola was an alcoholic drink, but since children were addicted to it, the state government banned it. Pemberton substituted sugar syrup for wine in the recipe, adding caffeine to create a moderately tonic drink. Coca-Cola was originally composed of: "caramel for coloring, phosphoric acid, an extract of coca leaves from the South American Andes containing cocaine, an extract of the African nut Cola nitida, containing sugar and masking the bitterness of cocaine."
Along with the triumphant march of cocaine, the first reports began to appear about the dangers of not only cocaine psychoses and fatal overdoses, but also deaths under local anesthesia. A case of rectal cocaine is indicative, which led to the suicide of the famous surgeon, professor at the Imperial Military Medical Academy (until 1838, the St. Petersburg Medical and Surgical Academy, founded in 1798), Sergei Petrovich Kolomnin.
Sergey Petrovich Kolomnin (1842 - 1886) - an outstanding surgeon, author of many works on vascular and military field surgery, the first transfusion on the battlefield, in October 1886 diagnosed a tuberculous rectal ulcer in a young patient. A decision was made about surgical treatment. In order to provide anesthesia, a cocaine solution was injected into the rectum by means of an enema, in four doses. The total dose of cocaine was 24 grains (1.49 g, since 1 grain = 0.062 g). The scope of the operation was limited to curettage of the ulcer followed by cauterization. The patient died a few hours after the operation. An autopsy confirmed the version of cocaine poisoning. Later Kolomnin came to the conviction that the operation of the patient was not indicated, since the patient turned out to be not tuberculosis, but syphilis. Blaming himself for the death of the patient, unable to withstand the attacks of the press, Kolomnin shot himself.
For the first time, the statistics of the study of lethal outcomes recorded 2 such cases with cocaine of the pharynx, 1 with cocaine of the larynx, and 3 with rectal administration of cocaine. The works of P. Reclus in France and Carl Ludwig Schleich (C.L. Schleich) in Germany on cocaine intoxication appeared, where it was suggested that intoxication was mainly associated with a high concentration of cocaine.
Scientific thought worked in the following directions:
- the search for drugs that, when added to cocaine, reduce the toxicity of the latter and, if possible, increase the duration of the anesthetic effect;
- development of new, less toxic local anesthetics;
- search for the possibility of percutaneous application of anesthetic along the nerve trunks.
The next two discoveries are associated with the name of the outstanding German surgeon - Heinrich Friedrich Wilhelm Braun, 1862 - 1934 - "the father of local anesthesia", the author of the famous book "Die Lokalanästhesie" (1905) and the term conduction anesthesia (German - Leitungsanästhesie, English . - conduction anesthesia).
In 1905, Brown, in order to prolong the anesthetic effect of cocaine through absorption, added adrenaline to the solution of the latter as an adjuvant, thereby realizing a "chemical turnstile".
Adrenaline was given to humanity in 1900 by John Abel and Jokichi Takamine.
History of anesthesia - Novocain
New anesthetic novocaine, which became the standard of local anesthetics, was first described by A. Einhorn in 1899 (Münch.Med.Wochenschr., 1899, 46, 1218), used in an experiment in 1904 and popularized by Brown in 1905.
Alfred Einhorn's discovery of novocaine marked the beginning of a new era in anesthesia. Until the 40s of the XX century, novocaine was the "gold standard" of local anesthesia, with which the effectiveness and toxicity of all local anesthetics were compared.
Despite the presence and widespread use of cocaine in practice, due to its toxicity, high cost and mental drug addiction, an intensive search for a new safe MA continued. However, prior to Einhorn's synthesis of novocaine, all attempts to synthesize a suitable local anesthetic failed. In everyday practice, there were analogues of cocaine ( allokaine, eikaine, tropacocaine, stovaine), which were less effective and inconvenient in practical use. In addition to the lack of inherent disadvantages of cocaine, the new local anesthetic drug had to meet four requirements: be water-soluble; non-toxic in amounts used in "big" surgery; sterilizable at high temperature and absolutely non-irritating to tissue.
Since 1892, the German chemist A. Einhorn, a student of Adolf von Bayer, searched for a new local anesthetic. After 13 years of work on the synthesis of various chemical compounds, A. Einhorn found a solution to the problem and created "Procaine hydrochloride", which in January 1906 began to be produced by the "Hoechst AG" company under the trade name "Novocaine" [lat .: novocain - new cocaine] ... The exact date of Einhorn's discovery of novocaine is unknown. He probably managed to synthesize procaine in 1904 without publishing any message. On November 27, 1904, the Höchst chemical plant (Frankfurt am Main) granted Einhorn a patent (DRP No 179627) for a chemical composition called Procaine.
In 1905, surgeons and dentists were introduced to novocaine. Previously, novocaine was tested in clinical practice by the German surgeon Heinrich Braun, who gained worldwide fame for his fundamental work with novocaine. Brown also tested novocaine, first on himself, then on his patients. Like Anrep, who first injected himself with cocaine subcutaneously, and Halstead, he injected into his forearm a variety of drugs recommended for local anesthesia. Professor D. Kulenkampff, Brown's son-in-law and successor, later mentioned this in a memorable address: "... multiple skin necrosis on Brown's forearm indicated how many drugs he rejected as inappropriate."
The "golden age of German medicine" was bearing fruit. The momentous year 1911 has come. Independently of each other, Georg Hirschel in Heidelberg and, soon after, Dietrich Kulenkampff in Zwickau were the first to perform blinded percutaneous brachial plexus block without prior isolation of the nerve trunks. Moreover, G. Hirschel became the "father" of axillary blockade - blockade of the brachial plexus by axillary (axillary) access (Fig. 1.2), and D. Kulen Kampf - the "father" of the supraclavicular (supraclavicular) brachial plexus blockade so much loved by the older generation of domestic anesthesiologists (Fig. . 1.3).
Figure 1.3. Kulenkampf plexus anesthesia 
Figure 1.2. Plexus axillaris anesthesia according to Hirschel Subsequently, many modifications of their original technique appeared, differing, for the most part, in the place of injection and the direction of the needle.
Georg Perthes, a surgeon from Tübingen, first described neurostimulation in 1912 in his work "Conduction Anesthesia with Electrical Response" (Fig. 1.4.)
Figure 1.4. Georg Perthes - 1912 He used a pure nickel injection cannula. As an electric wave, I used an induction apparatus with an iron candle to induce a nervous response to an electric current of any intensity from "0" to unpleasant sensations on the tongue.
Experiments on animals were carried out with this equipment, and then, with great success, it began to be used in the clinic for blockages of N.ischiadicus, N. femoralis, Plexus brachialis and other peripheral nerves. Perthes has shown the advantage of an electrical neural response in comparison with the classical technique of inducing paresthesias.
In the mid-50s, there was a proverb: "no paresthesia - no anesthesia." In the 60s, devices for transistor technology of "pocket size" were discovered, they produced pulses with a duration of 1 ms and an adjustable amplitude from 0.3 to 30 V. Modern devices give more differentiated electrical impulses: with a pulse duration (0.1 - 1 ms ) and the amplitude of the pulses when the contact current is set (0 - 5 A), and the current passing between the tip (tip) of the needle and the neutral electrodes on the skin can be measured. Many studies have been carried out that have led to the conclusion that the paresthesia method often leads to nerve damage, and for the last 30 years the use of neurostimulants for the safety of anesthesia has been considered the standard of regional anesthesia.
The First World War (1914 - 1918) proved the effectiveness of regional anesthesia and gave impetus to the further improvement of its technique, as well as the synthesis of new local anesthetics. Brief follow-up chronology of brachial plexus blocks:
- 1914 Buzy - described infraclavicular access for brachial plexus blockade.
- 1919 Mully - developed the method of interscalene access to the brachial plexus, eliminating the high probability of pneumothorax.
- 1946 Ansbro - catheterization of the perineural space of the brachial plexus supraclavicular access.
- 1958 Burnham - Axillary perivascular technique.
- 1958 Bonica - supracapular blockade.
- 1964 A. Winnie and Collins - Subclavian technique.
- 1970 A. Winnie - Interscalene approach.
- 1977 Selander - catheterization of the perivascular space by axillary access.
In parallel, intensive research was carried out on new low-toxic and more effective local anesthetics.
If cocaine can be called the “South American ancestor” of local anesthetics, revived to a new life in the heart of Old Europe (Germany, Austria), then the “purebred German” procaine (novocaine) was the prototype of aminoesterase local anesthetics, which later gave birth to a whole dynasty of esterocaines (in English ester caines), among which the most famous is tetracaine (Tetracain) - 1933 and 2 - chloroprocaine (Chloroprocain) - 1955. One of the first amidocaines - dibucaine (Dibucain), synthesized, again, in Germany in 1932, turned out to be quite toxic , in connection with which its use was limited.
Anesthesia History - LL30
Sweden, 1942 - Nils Lofgren (N. Lofgren) successfully synthesizes a promising local anesthetic from the aminoamide class, codenamed LL30 (since this was the 30th experiment conducted by Lofgren and his student Bengt Lundqvist).
1943 - Thorsten Gord and Leonard Goldberg report extremely low toxicity of LL30 compared to novocaine. The pharmaceutical company "Astra" received the rights to manufacture LL30.
1944 - the commercial name Xylocain is chosen for LL30 (lidocaine, lignocaine). 1946 - approbation of xylocaine in dentistry. 1947 - the use of xylocaine in surgical practice is officially allowed (priority for Torsten Gord).
1948 - the beginning of the commercial production of xylocaine and the registration of lidocaine in the United States. In the coming years, lidocaine takes over from novocaine and becomes the "gold standard" of local anesthetics. Lidocaine became the first in the so-called "Swedish family", or in the figurative expression of Geofrey Tucker - "Viking maidens", where the most famous - mepivacaine (Mepi va caine) 1956, prilocaine (Prilocain) 1960, bupivacaine (Bupivacain) 1963 and their "American cousin" - etidocaine (Etidocain) 1971, ropivacaine 1993 (Fig. 1.5. - 1.9.).
The end of the XX - beginning of the XXI century was marked by the arrival of a new wave of local anesthetics - ropivacain (1993), levobupivacain (Chirocain).
A significant contribution to the development of regional anesthesia was made by a French surgeon working in the USA, Gaston Labat
Technique and Clinical Application ”(1922), who founded the American Society for Regional Anesthesia in 1923. The strongest school of regional anesthesia in the United States is represented by the names: John Adriani, Daniel Moore, T. Murphy, A. Winnie, Prithvi Raj, Jord on Katz (Jordan Katz), Philip Bromage, Michael Mulroy, B. Covino, Donald Brindenbaugh.
Worthy successors of the "founding fathers" of the European School of Regional Anesthesia are: JAWildsmith - United Kingdom, Hugo Adriaensen - Belgium, Gisela Meier, Hugo Van Aken, Joachim J. Nadstaweck, Ulrich Schwemmer, Norbert Roewer - Germany.
The domestic school of regional anesthesia is closely related to the names of V.F. Voino Yasenetsky, C.C. Yudin, P.A. Herzen, A.V. Vishnevsky. A special contribution to the development and popularization of regional anesthesia in our country belongs to the Kharkov school. Monographs by A.Yu. Pashchuk "Regional anesthesia" (1987) and MN Gileva "Conductive anesthesia" (1995) have become a bibliographic rarity. Of the latest works, the textbook by V.S.Fesenko "Blocking nerves" (2002) should be noted.
For a long time, the use of cocaine was considered one of the best methods of anesthesia ...
Anesthesia (Greek, without feeling) is the phenomenon of a decrease in the sensitivity of any area of the body or organ, up to its complete loss.
On October 16, doctors celebrate a wonderful holiday - the Day of the anesthesiologist. This date was not chosen by chance, exactly 162 years ago in Boston, American doctor William Morton performed the first public surgery using anesthesia. However, the history of anesthesiology is not so simple. Doctors used anesthesia long before Morton, and for a long time, the use of cocaine was considered one of the best methods of anesthesia ...
Modern medical historians believe that the first methods of anesthesia originated at the dawn of human development. Of course, then it was customary to act simply and rudely: for example, until the 18th century, the patient received general anesthesia in the form of a strong blow to the head with a truncheon; after he lost consciousness, the doctor could proceed to the operation.
Narcotic drugs have been used as local anesthesia for a long time. One of the earliest medical manuscripts (Egypt, around 1500 BC) recommends giving patients opium-based drugs as a pain reliever.
For a long time, opium was unknown in China and India, but the miraculous properties of marijuana were discovered there quite early. In the II century A.D. During operations, the famous Chinese doctor Hua Tuo gave patients as anesthesia a mixture of wine and hemp ground into powder he had invented as anesthesia.
Meanwhile, on the territory of America, not yet discovered by Columbus, local Indians actively used cocaine from the leaves of the coca plant as anesthesia. It is reliably known that the Incas in the highland Andes used coca for local anesthesia: a local healer chewed the leaves, and then dripped saliva saturated with juice onto the patient's wound to relieve his pain.
As humans learned to produce hard liquor, anesthesia became more readily available. Many armies began to take supplies of alcohol with them on the campaign to give it as pain reliever to wounded soldiers. It is no secret that this method of anesthesia is still used in critical situations (on hikes, during disasters), when it is not possible to use modern drugs.
On rare occasions, doctors have tried to use the power of suggestion as anesthesia, such as putting patients into hypnotic sleep. A modern follower of this practice was the notorious psychotherapist Anatoly Kashpirovsky, who in March 1988, during a special teleconference, organized anesthesia for a woman who had a tumor removed from her breast in another city without anesthesia. However, there were no successors to his work.
Who turned on the gas first?
Methods of anesthesia more familiar to modern humans were developed only in the middle of the 19th century. In the 1820s, the English surgeon Henry Hickman conducted experiments on animals, namely, he tried to amputate their limbs, using carbon dioxide as anesthesia.
However, nitrous oxide, also known as "laughing gas", discovered in 1799, proved to be much more suitable for anesthesia.
For a long time, people had no idea that it could be used for anesthesia. This property was first discovered by the American magician Gardner Colton, who, performing in a traveling circus, used "laughing gas" during his shows. On December 10, 1844, during one of the performances in the small town of Hartford, Colton summoned a volunteer to the stage to demonstrate the effect of an unusual gas. The man from the audience, breathing it in, laughed so hard that he fell and seriously injured his leg. However, Colton noticed that the volunteer did not feel pain at all - he was under the influence of anesthesia.
This unusual property of nitrous oxide was noticed not only by the magician himself, but also by his audience. Among them was local dentist Horace Wells, who quickly realized how magic gas could benefit his work. After the presentation, he approached Colton, asked him to once again demonstrate the properties of the gas, and then agreed to buy it. Having started using "laughing gas" in his practice, Wells appreciated its effectiveness, but did not patent his discovery, deciding that a new universal pain reliever should be available "like air."
In 1845, Horace Wells decided to showcase his discovery to the general public. In one of the Boston hospitals, he promised in the presence of spectators to pull out a patient's tooth, using nitrous oxide as anesthesia. The volunteer was a strong adult male who seemed to be able to withstand removal without anesthesia. However, when the operation began, the patient began to scream heart-rendingly. The medical students present in the hall began to mock Wells and shouting "Charlatan, charlatan!" left the hall. Subsequently, Wells found out that the patient during the operation did not feel pain, but screamed out of fear, but the situation could not be changed, his reputation had already been ruined. 
After giving up dental treatment, Wells earned a living as a traveling merchant for several years, then returned to experimenting in the field of anesthesia. However, they did not bring him to good, the former dentist became addicted to sniffing chloroform and once, in a state of severe intoxication, splashed sulfuric acid on the clothes of two street prostitutes. For this act he was arrested; sober up and realizing the horror of what he had done, Horace Wells committed suicide. Before cutting his veins, he breathed in chloroform for anesthesia.
A minute of glory and years of oblivion
Among those who attended Horace Wells' unsuccessful demonstration in 1845 was his former student and colleague William Morton. It was he who got the glory of the main inventor of anesthesia. After the failure of his teacher, Morton continued his experiments and found out that medical ether could be used for anesthesia.
On September 30, 1846, he performed an operation to remove a patient's tooth using ether as anesthesia. However, his later operation went down in history, on October 16, 1846, in the same Boston hospital where his teacher was ridiculed, William Morton publicly removed a tumor on the patient's neck, while he was under the influence of ether vapors. The operation was successful, the patient did not feel pain. 
William Morton was not an altruist, he wanted not only fame, but also money. For this reason, during the operation, he did not admit that he used ordinary medical ether for anesthesia, but began to assert that this was the gas "leteon" invented by him (from the word "Leta", the river of oblivion). Morton received a patent for his invention, but this did not help him. It quickly became clear that the main component of the "leteon" was ether, but it did not fall under the patent. On both sides of the ocean, doctors began to use medical ether for anesthesia, Morton tried to defend his rights in court, but he never received the money. But he got fame, it is he who is usually called the creator of anesthesia.
Anesthesia in Russia
The experience of using anesthesia in Russia also begins with ether. On February 7, 1847, F.I. Inozemtsev applied it. At the clinic of the Faculty of Surgery of Moscow University, he performs an operation for breast cancer.
A week later, on February 14, 1847, another great Russian surgeon, N.I. Pirogov, performed his first operation under ether anesthesia in the 2nd Military Land Hospital in St. Petersburg. In July 1847, Pirogov was the first to practice ether anesthesia in the field during the Caucasian War; he personally performed about 300 ether anesthesia in a year.
However, in fact, for the first time ether was used as anesthesia by the American surgeon Crawford Long. On March 30, 1842 (four years before Morton), he performed the same operation - removed a tumor from a patient's neck under general anesthesia. Later, he used ether many times in his practice, but did not invite viewers to these operations, and published a scientific article about his experiments only six years later - in 1848. As a result, he got neither money nor fame. But Dr. Crawford Long lived a long and happy life.
The use of chloroform in anesthesia began in 1847 and quickly gained popularity. In 1853, the English physician John Snow used chloroform as a general anesthetic during childbirth to Queen Victoria. However, it quickly became clear that due to the toxicity of this substance, patients often have complications, therefore, chloroform is no longer used for anesthesia.
Anesthesia from Dr. Freud
Both ether and chloroform were used for general anesthesia, but doctors dreamed of developing a drug that would work effectively as a local anesthetic. A breakthrough in this area occurred at the turn of the 1870s-1880s, and cocaine became the long-awaited miracle cure.
For the first time, cocaine from coca leaves was isolated by the German chemist Albert Niemann in 1859. However, for a long time, cocaine was of little interest to researchers. For the first time, the possibility of its use for local anesthesia was discovered by the Russian doctor Vasily Anrep, who, according to the scientific tradition of that time, conducted a number of experiments on himself and in 1879 published an article on the effect of cocaine on nerve endings. Unfortunately, then little attention was paid to her.
But a series of scientific articles about cocaine written by a young psychiatrist Sigmund Freud became a sensation. Freud first tried cocaine in 1884 and was amazed at its effect: the use of this substance cured him of depression, gave him confidence. In the same year, the young scientist writes an article "On Coca", where he strongly recommends the use of cocaine as a local anesthetic, as well as a medicine for asthma, indigestion, depression, neuroses. 
Freud's research in this area was actively supported by pharmaceutical firms, which anticipated huge profits. The future father of psychoanalysis has published as many as 8 articles on the properties of cocaine, but in recent works on this topic, he wrote about this substance less enthusiastically. This is not surprising, because Freud's close friend Ernst von Fleischl died of cocaine abuse.
Although the anesthetic effect of cocaine was already known from the works of Anrep and Freud, the ophthalmologist Karl Koller received the fame of the discoverer of local anesthesia. This young doctor, like Sigmund Freud, worked at the Vienna General Hospital and lived on the same floor with him. When Freud told him about his experiments with cocaine, Koller decided to test whether the substance could be used as a local anesthetic in eye surgery. Experiments have shown its effectiveness, and in 1884 Koller reported on the results of the research at a meeting of the Vienna Physicians' Society.
Almost immediately Kohler's discovery began to be applied in literally all areas of medicine. Cocaine was used not only by doctors, but by everyone, it was sold freely in all pharmacies and was almost as popular as aspirin today. Grocery stores sold wine with cocaine and a carbonated drink called Coca Cola, which until 1903 contained cocaine.
The cocaine boom of the 1880s and 1890s cost the lives of many ordinary people, so at the beginning of the 20th century this substance was gradually banned. The only area where the use of cocaine has long been tolerated has been local anesthesia. Karl Koller, to whom cocaine brought fame, was later ashamed of his discovery and did not even mention it in his autobiography. Until the end of his life, colleagues behind his back called him Coca Koller, hinting at his role in the introduction of cocaine in medical practice.
In the XX century in anesthesiology, cocaine was replaced by safer drugs: procaine, novocaine, lidocaine. So anesthesiology has finally become not only effective, but also safe.
The history of pain relief is inextricably linked to the history of surgery. The elimination of pain during the operation dictated the need to undertake a search for methods to resolve this issue.
The surgeons of the ancient world tried to find methods for adequate pain relief. It is known that for these purposes, compression of the vessels in the neck and bloodletting were used. However, the main direction of searches and the main method of pain relief for thousands of years has been the introduction of various intoxicating substances. In the ancient Egyptian papyrus of Ebers, which dates back to the 2nd millennium BC, there is the first mention of the use of pain-relieving substances before surgery. For a long time, surgeons used various infusions, extracts of opium, belladonna, Indian hemp, mandrake, and alcoholic beverages. Probably, Hippocrates was the first to use inhalation anesthesia. There is evidence that he inhaled cannabis vapors for the purpose of pain relief. The first attempts to use local anesthesia also date back to ancient times. In Egypt, a Memphis stone (a type of marble) with vinegar was rubbed into the skin. As a result, carbon dioxide was released, and local cooling occurred. For the same purpose, local cooling with ice, cold water, compression and constriction of the limb were used. Of course, these methods could not provide good pain relief, but for lack of better, they have been used for millennia.
In the Middle Ages, sleep sponges were used for pain relief; it was a kind of inhalation anesthesia. The sponge was impregnated with a mixture of opium, henbane, mulberry juice, lettuce, hemlock, mandrake, ivy. After that, it was dried. During the operation, the sponge was moistened and the patient inhaled vapors. There are other known methods of using "sleeping sponges": they were burned, and the patients inhaled the smoke, sometimes they chewed it.
In Russia, surgeons also used "ball", "afian", "medicinal glue". "Rezalnikov" of that time could not be imagined without "seduction" means. All these drugs were of the same origin (opium, hemp, mandrake). In the 16-18 centuries, Russian healers widely used euthanasia for the duration of the operation. Rectal anesthesia also appeared at that time; opium was injected into the rectum, and tobacco enemas were performed. Hernias were repaired under such anesthesia.
Although it is believed that anesthesiology was born in the 19th century, many discoveries were made long before that and served as the basis for the development of modern methods of pain relief. Interestingly, the broadcast was discovered long before the 19th century. In 1275, Lulius discovered "sweet vitriol" - ethyl ether. However, its analgesic effect was studied by Paracelsus three and a half centuries later. In 1546, ether was synthesized in Germany by Cordus. However, it began to be used for anesthesia three centuries later. It should be remembered that the first tracheal intubation, however, in the experiment, was performed by A. Vesalius.
All the methods of anesthesia used until the middle of the 19th century did not give the desired effect, and operations often turned into torture or ended in the death of the patient. The example given by S.S.Yudin, described back in 1636 by Daniel Becker, allows us to present the surgery of that time.
“A German peasant accidentally swallowed a knife and the doctors of the University of Königsberg, convinced that the patient's strength allowed the operation, decided to do it, having previously given the victim“ Spanish pain reliever ”. With a large crowd of doctors, students and members of the medical college, a gastrostomy operation was started. After praying to God, the patient was tied to a board; the dean marked with charcoal the place of the incision four transverse fingers long, two fingers below the ribs and a palm-width apart to the left of the navel. After that, the surgeon Daniel Schwabe opened the abdominal wall with a lithotomy. Half an hour passed, fainting occurred, and the patient was again untied and tied to the board. Attempts to pull out the stomach with forceps failed; finally they hooked it with a sharp hook, passed a ligature through the wall and opened it at the direction of the dean. The knife was pulled out "with applause from those present." In London, in one of the hospitals, a bell still hangs in the operating room, which was rung so that the screams of the sick were not heard.
American William Morton is considered the father of anesthesia. It is on his monument in Boston that "BEFORE HIM surgery was agony at all times." However, to date, the debate continues over who discovered anesthesia - Wells or Morton, Hickman or Long. For the sake of fairness, it should be noted that the discovery of anesthesia is due to the work of many scientists and was prepared in the late 18th and early 19th centuries. The development of the capitalist formation led to the rapid development of science and a number of great scientific discoveries. Significant discoveries that laid the foundation for the development of anesthesia were made in the 18th century. Priestley and Schele discovered oxygen in 1771. A year later Priestley discovered nitrous oxide, and in 1779 Ingen-Howes discovered ethylene. These discoveries gave a significant impetus to the development of pain relief.
Nitrous oxide initially attracted the attention of researchers as a gas that has a laughing and intoxicating effect. Watts even designed a nitrous oxide inhaler in 1795. In 1798, Gamphrey Davy established its analgesic effect and introduced it into medical practice. He also designed a gas machine for "laughing gas". It has long been used as a means of entertainment at musical evenings. The English surgeon Henry Hill Hickman continued his study of the analgesic effect of nitrous oxide. He injected the animals with nitrous oxide into the lungs, made them completely insensible, and under this anesthesia performed incisions, amputation of ears and limbs. Hickman's merit also lies in the fact that he formulated the idea of anesthesia as a defense against surgical aggression. He believed that the task of anesthesia is not only to eliminate pain, but also to correct other negative effects of the operation on the body. Hickman actively promoted anesthesia, but his contemporaries did not understand him. At the age of 30, in a state of mental depression, he died.
In parallel, studies of other substances were carried out. In 1818, in England, Faraday published materials on the analgesic effect of ether. In 1841 the chemist C. Jackson tested this on himself.
If we adhere to the historical truth, then the first anesthesia was not performed by V. Morton. On May 30, 1842, Long applied anesthesia to remove the head tumor, but he could not appreciate his discovery and published his material only ten years later. There is evidence that Pope removed the tooth under ether anesthesia several months earlier. The first operation using nitrous oxide was carried out at the suggestion of Horace Wells. Dentist Riggs, under nitrous oxide anesthesia given by Colton, pulled out a healthy tooth on December 11, 1844. Wells performed 15 anesthesia on tooth extraction. However, his further fate turned out to be tragic. During the official demonstration of anesthesia by Wells in front of surgeons in Boston, the patient almost died. Anesthesia with nitrous oxide was discredited for many years, and H. Wells committed suicide. Only a few years later, Wells's merit was recognized by the French Academy of Sciences.
The official date of birth of anesthesiology is October 16, 1846. It was on this day that surgeon John Warren, under ether anesthesia given by W. Morton, removed a vascular tumor of the submandibular region at the Boston hospital. This was the first demonstration of anesthesia. But V. Morton made the first anesthesia a little earlier. At the suggestion of chemist C. Jackson, on August 1, 1846, under ether anesthesia (ether was inhaled from a handkerchief), he removed a tooth. After the first demonstration of ether anesthesia, Ch. Jackson reported his discovery to the Paris Academy. In January 1847, the French surgeons Malgues and Velpeaux, using ether for anesthesia, confirmed the positive results of its use. After that, ether anesthesia was widely used.
Our compatriots, too, did not stay away from such a fateful discovery for surgery as anesthesia. Ya. A. Chistovich published in 1844 in the newspaper "Russian Invalid" an article "On amputation of the thigh by means of sulfuric ether". True, she turned out to be an invaluable and forgotten medical community. However, for the sake of justice, Ya. A. Chistovich should be put on a par with the names of the discoverers of anesthesia W. Morton, H. Wells.
It is officially believed that F.I. Inozemtsev was the first to apply anesthesia in Russia in February 1847. However, somewhat earlier, in December 1846, N.I. Pirogov in St. Petersburg performed amputation of the mammary gland under ether anesthesia. At the same time, VB Zagorskiy believed that “the first in Russia to use ether for anesthesia during operations was L. Lyakhovich (a native of Belarus)”.
Chloroform was the third substance used in the early development of anesthesia. It was opened in 1831 independently by Suberan (England), Liebig (Germany), Gasrie (USA). The possibility of using it as an anesthetic was discovered in 1847 in France by Flurance. Priority for the use of chloroform anesthesia was given to James Simpson, who reported its use on November 10, 1847. An interesting fact is that N.I. Pirogov used chloroform for anesthesia twenty days after D. Simpson's message. However, the first to use chloroform anesthesia were Sedillo in Strasbourg and Bell in London.
In the second half of the 19th century, after the first attempts to use various types of anesthesia, anesthesiology began to develop rapidly. N.I. Pirogov made an invaluable contribution. He actively introduced ether and chloroform anesthesia. NI Pirogov, on the basis of experimental studies, published the world's first monograph on anesthesia. He also studied the negative properties of anesthesia, some complications, believed that for the successful use of anesthesia, it is necessary to know its clinical picture. NI Pirogov created a special apparatus for "etherization" (for ether anesthesia).
He was the first in the world who applied anesthesia in a military field. The merit of Pirogov in anesthesiology is that he was at the forefront of the development of endotracheal, intravenous, rectal anesthesia, and spinal anesthesia. In 1847, he applied the introduction of ether into the spinal canal.
The following decades were marked by the improvement of methods of conducting anesthesia. In 1868, Andrews began using nitrous oxide mixed with oxygen. This immediately led to the widespread use of this type of anesthesia.
Chloroform anesthesia was initially widely used, but high toxicity was quickly identified. A large number of complications after this type of anesthesia prompted surgeons to abandon it in favor of ether.
Simultaneously with the discovery of anesthesia, a separate specialty, anesthesiology, began to emerge. The first professional anesthetist is John Snow (1847), a Yorkshire doctor who practiced in London. It was he who first described the stages of ether anesthesia. An interesting fact from his biography. For a long time, the use of pain relief during childbirth was restrained by religious dogmas. Church fundamentalists believed that this was contrary to the will of God. In 1857, D. Snow administered chloroform anesthesia to Queen Victoria at the birth of Prince Leopold. After that, labor pain relief was accepted by all without question.
In the middle of the 19th century, the foundations of local anesthesia were laid. It has already been mentioned above that the first attempts at local anesthesia by cooling, pulling the limb, using the "Memphis" stone were made in Ancient Egypt. In later times, many surgeons used such anesthesia. Ambroise Paré even created special devices with pelots for compression of the sciatic nerve. The chief surgeon of Napoleon's army, Laray, performed amputations, seeking anesthesia with refrigeration. The discovery of anesthesia did not lead to the termination of work on the development of methods of local anesthesia. A fateful event for local anesthesia was the invention of hollow needles and syringes in 1853. This made it possible to inject various drugs into tissues. The first drug used for local anesthesia was morphine, which was administered in close proximity to the nerve trunks. Attempts have been made to use other drugs - chloroform, sopony glycoside. However, this was quickly abandoned, since the administration of the named substances caused irritation and severe pain at the injection site.
Substantial success was achieved after the Russian scientist professor of the Medical and Surgical Academy V.K. Anrep in 1880 discovered the local analgesic effect of cocaine. First, it began to be used for pain relief during ophthalmic operations, then in otolaryngology. And only after making sure of the effectiveness of pain relief in these areas of medicine, surgeons began to use it in their practice. A.I. Lukashevich, M. Oberst, A. Beer, G. Brown and others made a great contribution to the development of local anesthesia. A.I. Lukashevich, M. Oberst developed the first methods of conduction anesthesia in the 90s. In 1898 Beer proposed spinal anesthesia. Infiltration anesthesia was proposed in 1889 by Reclus. The use of cocaine local anesthesia was a significant step forward, but the widespread use of these methods quickly led to frustration. It turned out that cocaine has a pronounced toxic effect. This circumstance prompted a search for other local anesthetics. The year 1905 became historical, when Eichhorn synthesized novocaine, which is still used today.
Since the second half of the 19th and the entire 20th century, anesthesiology has developed rapidly. Many methods of general and local anesthesia have been proposed. Some of them did not meet expectations and were forgotten, others are still being applied. The most important discoveries that have defined the face of modern anesthesiology should be noted.
1851-1857 - K. Bernard and E. Pelican conduct research on curare in an experiment.
1863 Mr. Green proposed the use of morphine for premedication.
1869 Tredelenberg performs the first endotracheal anesthesia in the clinic.
1904 - N.P. Kravko and S.P. Fedorov proposed non-inhalation intravenous anesthesia with hedonal.
1909 - they also offer combined anesthesia.
1910 Lilienthal performs the first tracheal intubation with a laryngoscope.
1914 Krail proposed the use of local anesthesia in combination with anesthesia.
1922 - A.V. Vishnevsky developed the method of tight creeping infiltration.
1937 - Guadel proposes a classification of the stages of anesthesia.
1942 - Griffith and Johnson perform combined anesthesia with curare.
1950 Bigolow offers artificial hypothermia and Enderby offers artificial hypotonia.
1957 - Highward-Butt introduces ataralgesia into clinical practice.
1959 - Gray offers multi-component anesthesia and De Ka
Stroke neuroleptanalgesia.
Russian surgeons A.N.Bakulev, A.A.Vishnevsky, E.N. Meshalkin, B.V. Petrovsky, A.M. Amosov and others have also made a significant contribution to the development of anesthesiology. modern anesthesia equipment was created.
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