When I was seven years old, my big brother broke my arm (he fell on it). At the hospital, someone stuck a mask over my face. I saw a spinning pattern of black and white stripes and heard, above a loud buzz in my head, doctors and nurses talking about fishing…then I woke up to find my arm splinted and bandaged.
I had just had my first experience with an anesthetic, and while I didn’t like it much–I was sick as a dog afterward–I’m sure it beat having my arm set without any anesthetic at all.
An anesthetic is any substance or procedure that makes someone insensitive to pain. Anesthetics are vital to the modern practice of surgery; until they existed, operations had to be completed in minutes because of the pain and shock suffered by the patient. Over the centuries, physicians tried everything from alcohol to hashish to cocaine, none of which were particularly successful.
Then, in 1842, Dr. Crawford W. Long, a Georgia physician, started using diethyl ether to anesthetize patients for surgery. He failed to publicize his results; but shortly thereafter William Morton, a dentist, gave ether to a patient in Boston so Dr. John C. Warren could remove a tumor from the patient’s jaw, and news of that procedure spread like wildfire. Within two years, general anesthesia was being widely used throughout the U.S. and Europe.
“General” anesthetics act primarily on the brain, rendering people both insensible to pain and unconscious. “Local” anesthetics affects only part of the body; the patient remains conscious.
Ether, a volatile gas probably first discovered in the 13th century, is no longer widely used because it’s extremely flammable in air, it has a tendency to oxidize into an explosive compound, and patients anesthetized with it tend to have vivid nightmares, often of being held down and gradually drowning.
Chloroform, which exceeded ether in popularity in the latter part of the 19th century, has also fallen by the wayside: it tends to decompose into a highly poisonous compound in the presence of light and in one out of 3,000 cases it stops the heart.
Nitrous oxide, a.k.a. laughing gas, discovered in 1799, was first used as a dental anesthetic in 1844 by American Horace Wells. It’s still used today, usually in combination with newer anesthetic.
The second time I had an anesthetic, when I had my tonsils out, they put me under with a shot of thipentone, also known as sodium pentothal (or, in popular fiction, “truth serum”). Barbituates like thiopentone are often given to surgical patients first: it knocks them out in a hurry. Other drugs follow, such as a narcotic painkiller, to help ensure the patient remains unconscious and to lessen discomfort on awakening; an additional inhalent anesthetic, because barbituates are short-acting, and a muscle-paralyzing drug. Getting just the right balance of these various drugs, monitoring the patient’s vital signs and maintaining the patient’s breathing are duties of the anesthetist, a highly trained specialist.
General anesthetics apparently interfere with the transmission of nerve impulses in the brain, although the details are still sketchy. Local anesthetics, such as the needle in the jaw I recently received from my ever-cheerful dentist, interfere with the transmission of nerve impulses only in the region where the anesthetic is applied. There are four major types: infiltration anesthetics (such as novocaine, a synthetic relative of cocaine), injected into the area which is about to be operated on; nerve-block anesthetics, injected near specific nerves that lead to the area about to be operated on, preventing pain signals from reaching the brain; spinal anesthetics, injected into the cerebrospinal fluid to paralyze and numb the entire lower half of the body; and epidural and caudal anesthetics, injected into the vertebral canal (but not into the spine itself), often used for labor and delivery.
Anasthesia can be produced without chemicals in some people. Hypnosis, for example, can be helpful for minor procedures and to calm people before surgery; acupuncture works in some cases, as well. If only a mild local anesthetic is required, simply numbing the skin with cold can be useful.
When it comes to major surgery, though, I vote for the real thing. Although there is a slight chance in every use of an anesthetic of death or other complications, without anesthesia, many of the life-saving medical procedures we take for granted today would be impossible.
Besides, without anesthetics, I never would have found out my doctors fished.
