Moses Reyes Nursing 110 Anesthesia and Antiseptic Paper PDF

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Essay About Development of Anesthesia and Antiseptics...

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Running Head: ANESTHESIA AND ANTISEPTIC

The Significance of Anesthesia and Antiseptic

Moses Reyes

Binghamton University

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Anesthesia and Antiseptic 2 Abstract Modern day surgeries operate smoothly in large part due to the discovery and implementation of anesthesia and antiseptic technologies. The National Medical Association defines an anesthetic as, “An agent which is capable of deadening the sensibilities and so relieving pain and permitting otherwise distressing surgical operations to be performed without discomfort to the patient,” (Dumas 1932). William Morton first pioneered the discovery of anesthesia in 1846 when he successfully performed a painless dental procedure by using a gas administered through the mouth (Gawande 2013). The technology spread rapidly and provided patients with pain free surgeries however surgery remained an unreliable practice due to high mortality rates. High mortality rates resulted from unsanitary surgical conditions which often led to severe infection. In 1847, obstetrician, Ignaz Semmelweis, spearheaded the idea of improving surgical conditions through antiseptics or, “Substances applied to living tissue to either kill bacteria or inhibit their growth,” (Trotter 2014). Surgeons initially doubted the significance of antiseptics however a dramatic decrease in the mortality rate of surgery proved skeptics wrong in the decades to come. The introduction anesthesia and antiseptic made surgeries painless and clean, however, the Mo and implementation of both made surgeries successful and reliable. Moses ~ Be mindful of formatting – the title should be on the first page. The running head should be all caps. Be mindful of punctuation or run-on sentences. There are a few confusing sentences. Otherwise, very good!

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People in the early 19th century surgery regarded surgery as an extremely painful and risky ordeal. Amputations, the most commonly performed surgeries at the time, left patients in agony due to a lack of an agent to numb the pain. Surgeons often regarded amputations as a last resort procedure because of the astronomical mortality rates. The development of anesthesia introduced a technology which made surgery a far less painful procedure and the development of antiseptic introduced a technology which improved sanitary surgical conditions. Together anesthetics and antiseptics drastically improved surgical procedures by making them painless, clean, and reliable. Before the development of anesthesia, according to Azul Gawande, “The sounds of patients thrashing and screaming filled operating rooms,” (2012). The distress of the patients forced surgeons to value speed over precision and conduct timed operations. Timed operations in conjunction with frantic patients pressured surgeons to sacrifice precision for speed. Gawande, for example, described a procedure which, “Took an astonishing 25 seconds from incision to wound closure. [The surgeon] operated so fast that he once accidentally amputated an assistant’s finger along with a patient’s leg…The patient and assistant both died…resulting in the only known procedure with a 300% mortality,” (Gawande 2012). Patient mortality from surgery remained an unfortunately common reality through the 19th century, which triggered extreme wariness from surgeons to operate unless absolutely necessary. As a result surgeons desperately searched for means to improve the reliability of surgery. The development of anesthesia brought about a new technology that made surgery virtually painless. In 1842 Robert Collier demonstrated the first use of an anesthetic when he used alcohol to treat a patient with a broken hip, to which the patient reported no pain. In 1844

Anesthesia and Antiseptic 4 Horace Wells presented the second demonstration of an anesthetic as an exhibition of the effects of nitrous oxide gas. A participant in the exhibition injured his shin and failed to notice his injury until he looked at it. Finally in 1846 William Morton revolutionized surgery, when he performed the first pain free dental procedure at the Massachusetts General Hospital (Markel 2013). He administered his patient a gas that he called Letheon, which, “Rendered them insensible to pain,” (Dumas 1932). The incredible feat gained attention from surgeons around the world. Many viewed it as a sign of progress and hope for the future of surgery, yet many doubted the effectiveness of anesthetics or dismissed them as needless luxuries (Gawande 2012). This controversy made Morton a polarizing figure, however, according to Howard Markel, “Morton’s remarkable demonstration at the Massachusetts General Hospital that long ago October morning transmogrified his status from profitable dentist to internationally acclaimed healer,” (2013). Morton contributed further to his polarizing persona through his refusal to share the exact details about the composition of his newly found anesthetic, which he called Letheon. Morton insisted on exclusively patenting Letheon, which outraged many physicians and surgeons because of failure to spread new knowledge amongst a community dependent on progression (Markel 2013). Observers of Morton’s infamous operation soon identified the smell of the gas used in the procedure to be that of one resembling ether, an ingredient sometimes used in medical preparations. Immediately after the publication of this hypothesis, ether became commonly administered as an anesthetic by surgeons across Europe and within a few years by most regions of the world (Gawande 2012). The countless success stories of astonishment experienced by surgeons and patients alike after witnessing painless surgery for the first time quickly moved throughout the medical field. Despite Morton’s questionable ethical values, his

Anesthesia and Antiseptic 5 introduction of anesthesia to the medical world cemented his legacy in the medical field as anesthesia finally provided patients with a pain free surgeries, which brought a greater level of trust to surgeries. While anesthesia advanced the capabilities of surgery, reliability issues still remained. According to J.S. Springge, “The discovery of successful general anesthesia in1846 spread throughout the world rapidly. However, it was soon recognized that general anesthesia was dangerous, with deaths reported from England, America and Australia,” (2012). An estimated 40-50% surgical mortality rate prior to the discovery of anesthesia only increased in the years following the discovery. The mortality rate increased after anesthesia because of the lengthier procedures and increased risk of infection. The new ability for surgeons to operate without discomfort from patients shifted value back to precision from speed. The discovery of anesthesia also broadened the scope of complications that doctors could treat through surgery. Naively, surgeons experimented with more complex and unproven operations. According to Gawande, “The mortality associated with ovariotomy and other types of major abdominal surgery, repair of open fractures, and limb amputation commonly remained at 50% or higher owing to infection” (2012). These complications demonstrated a common link: sepsis, or infection by microorganisms. Medical professionals failed to recognize that link, leading many to realize that despite the advance that anesthesia brought to the medical community, surgeons still remained unsure of how to make surgery a safe and reliable procedure The development of antiseptic in surgery brought about new technology, which dramatically improved post-surgery survival rates,. Michael C. Trotter defines antisepsis as, “The practice of destroying or inhibiting growth of microorganisms with the goal of infection prevention,” (2014). In 1847, Hungarian obstetrician Ignaz Semmelweis proposed the idea of

Anesthesia and Antiseptic 6 antiseptic hand washing as a means to control infection resulting from surgery. Semmelweis based his argument on his research on puerperal fever. From his research Semmelweis found a 90% decrease in deaths from puerperal fever after autopsy performed by professionals with washed hands. His undeniable results led to the initiation of a policy requiring hand washing with calcium hypochlorite between autopsies and obstetrical patient evaluations (Trotter 2014). Unable to gain publishing until 1861 Semmelweis’ ideas remained largely unaccepted and unpracticed in a field in desperate need for improvement. Though it remained unknown at the time, scientist Louis Pasteur expanded on Ignaz Semmelweis’ work between 1860 and 1864 to develop germ theory, or a theory concerned with understanding infectious diseases (Whinder 2012). Pasteur, According to Michael C. Trotter, Believed that bromine could be safely used on patients with hospital gangrene, he developed a protocol of surgical debridement (i.e., the removal of dead or damaged tissues) followed by subcutaneous injection of bromine solution and topical application. He carefully compiled data and analyzed his results and found an overall 2.6 percent with bromine-based therapy compared to 45.6 percent mortality rate without it (2014). His contemporaries challenged his findings because of the lack of research on germ theory and, however his contributions towards the importance of antiseptic in surgery remain significant.

Joseph Lister built upon the findings of Semmelweis and Pasteur and further challenged common unsanitary surgical conditions and pushed for use of antiseptics in surgery. According to Gawande, “In the eighteen-sixties, the Edinburgh surgeon Joseph Lister read a paper by Louis Pasteur laying out his evidence that spoiling and fermentation were the consequence of microorganisms,” (2013). Lister hypothesized that a similar process accounted for wound sepsis and argued that heat application and exposure to certain chemicals eliminated the germs responsible for sepsis. In the following years Lister determined ways to use carbolic for cleaning

Anesthesia and Antiseptic 7 hands and wounds and therefore eliminating any opportunity for germs to enter the body during surgical operation. Throughout the 19th century poor sanitary conditions existed in surgical operating rooms. According to Gawande, “The operating surgeon was usually garbed in a black…coat, kept hanging in the closet for the occasion and showing numerous evidences of previous operations in the way of dried blood, wound secretions, etc.,” and “For decades hand washing and skin cleansing remained routinely perfunctory,”(2012). Lister hypothesized that an antiseptic shield between the operating wound and the outside environment would protect the patient against infection. Despite Lister’s reasonable logic, he faced much skepticism and criticism from surgeons mainly because of a slow acceptance of germ theory and a lack of attention to hygienic detail during surgery. Several other advances in the practice of antisepsis occurred by the late 19th century, which eventually proved its effectiveness in surgery and made way for standardization of antiseptic practices by the start of the 20th century. In 1876 surgeon Lewis A. Stimson performed the first successful antiseptic surgery in the United States, using Joseph Lister’s method (Trotter 2014), in 1886 Ernst von Bergmann became the first surgeon heat sterilize his surgical instruments before operation, and in 1889 surgeon William S. Halsted requested the use of rubber gloves for surgery, which nearly eliminated the infection rate for hernia operations at his facility (Trotter 2014). By the late 19th century antiseptics gave surgeons the technology they needed to make surgeries safer and the widespread acceptance and practice of antiseptics finally made surgeries more reliable procedures. By the start of the 20th century, guidelines of the proper procedures of surgery became codified, specialization of the medical field took place, and training programs became established to normalize the use of surgery as a reliable tool to cure people. Popularized use of

Anesthesia and Antiseptic 8 antiseptic methods such as rubber gloves, clean white garb, and sterilized instruments became standard practice. Safety procedures regarding anesthesia also became codified to ensure proper use. For example, the French Society for Anesthesia and Critical Care (SFAR) implemented guidelines for proper administration of anesthesia such evaluating, Risks associated with managing each patient’s medications (including those taken chronically), high-risk medications, never events, and computerizing prescription systems and their interfaces must be given special attention together with human and organizational factors including interruptions of personnel during tasks (SFAR 2017). The French Society for Anesthesia and Critical Care also implemented checking measures for the prevention of medication errors in anesthesia (SFAR 2017). Furthermore, professional organizations such as the American College of Surgeons, American Society of Anesthesiologists, and other national organizations arose due to specialization in the medical field (Gawande 2012). These organizations advocated for communication of new information and in the field of anesthesiology in particular, contributed to the spread of new forms of anesthesia that proved to be more useful and reliable. These developments encouraged trust in doctors, surgeons, and the procedures that they performed. Anesthetics and antiseptics drastically improved surgical procedures. The introduction of anesthesia and antiseptic made surgeries painless and clean, however, the development and use of both made surgeries successful. With all the advancements in medical procedures stemming from the increased reliability of surgery due to anesthesia and antiseptics, one possible future field that medicine will venture into is nanotechnology having the ability to perform complex procedures with the help of robots.

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References Dumas, A. 1932. The History of Anesthesia. Journal of the National Medical Association. 24(1), 6-9 French Society for Clinical Pharmacy. Risk Management Analysis Committee of the French Society for Anesthesia and Critical Care. 2017. Preventing Medication Errors in Anesthesia and Critical Care (Abbreviated Version). Anaesthesia Critical Care & Pain

Medication, 36(4), 253-258

Gawande, A. 2012. Two Hundred Years of Surgery. New England Journal of Medicine, 366(17), 16-17. Gawande, A. 2013. Slow Ideas Some Innovations Spread Fast. How do you Speed the Ones that Don’t? The New Yorker. Retrieved from https://www.newyorker.com/magazine/ 2013/07/29/slow-ideas Markel, H. 2013. The Painful Story Behind Modern Anesthesia. PBS Newshour. Retrieved from http://www.pbs.org/newshour/rundown/the-painful-story-behind-modernanesthesia/ Randolph, F. 2009. Surgery in the 1700’s. Gale, Cengage Learning. (pp. 139-144) Sprigge, J.S. 2012. History of Anesthesia VI: Proceedings of the 7th International Symposium on the History of Anesthesia. British Journal of Anaesthesia. 109(3), 471-472 Trotter, M.C. 2014. Antiseptics. Discoveries in Modern Science: Exploration, Invention, Technology. (pp. 19-21).

Anesthesia and Antiseptic 10 Whinder, W. 2012. Germ Theory: Medical Pioneers in Infectious Diseases, Robert P. Gaynes. The Lancet. 12(4), 279....