Issue 97 / January - February 2014
The Blessing of Anesthesia in Medical Practices
Before anasthesia, even routine surgeries were painful and dangerous. Its advent has allowed for amazing advances in public health and patient safety.
Humanity has faced various kinds of health problems throughout history, and will be facing them until the end of time. Even someone who has not yet suffered from an illness, will almost certainly suffer from one in the future. Let's take a moment to reflect on all the people who are currently undergoing treatment at hospitals in the hopes of curing an illness.
From time to time we visit close friends and relatives who have undergone such operations. We wish them health and talk with them a little. We ask them how the operation felt, how many stitches they have. They usually say, "They injected me with something and I don't remember the rest." Then they may show us their gall bladder, wrapped in gauze, or their kidney stone, which was removed. Have you ever pondered how it is possible not to feel any pain during these kinds of operations, or how it is possible not to remember anything?
Surgical practices have advanced so much in present times. Heart, liver, and kidney transplants are now commonplace, as are finger and arm reattachments. Anesthesia, which makes all of these operations possible and painless, is a great blessing. Even the small and simple surgeries performed just 150 years ago were very difficult for surgeons ÔÇô not to mention very painful for patients.
In his famous book on physiology and treatment, The Canon of Medicine the renowned 10th and 11th century scholar, Avicenna (Ibn-i Sina) (980-1037), defines anesthesia as, "a numbing and a cooling remedy." He gives pathophysiological commentary on the influences of anesthetics and analgesics, and summarized painkilling methods as following:
1. A mixture prepared from linseed and dill should be applied to the area of pain.
2. Decreasing the sensitivity of the area of pain by increasing the moisture of the area, or providing narcotics for sleep.
3. Providing cooling and analgesic and anesthetic medicine.
Biruni, another Islamic scholar from the 11th century, documented his work with analgesic and anesthetic medicine. One of his writings recommends boiling the root tubers of henbane, Mandragora, horned poppy (Glaucium flavum), and Iris, together with the attar of roses and vinegar.
In his pharmacological works of the 12th and 13th centuries, Samarqandi recorded the analgesic, sedative (calming), anesthetic, and hypnotic effects of opium, mandragora, henbane, lettuce, beaver testicles, aloe vera, and coriander.
During the end of the 17th century, in Italy, anasthesia was performed by preventing the patients from breathing until they lost consciousness, and then immediately performing surgery on the patient who had fainted. This was called the asphyxia technique. The surgeries performed were relatively easy, such as the cutting of an arm or leg. The surgeon who was fast was considered the best, because patients could wake up during the surgery ÔÇô that is, if they survived the procedure.
Another interesting anesthetic technique was making the patient lose consciousness by hitting them on the head. The hitting had to be done, "Hard enough to break the shell of an almond but gentle enough not to destroy its seed." However, a bitter truth is that many patients were killed during this process.
Many have suffered the consequences of the absence of anesthesia in the past. Dr. Warren, a professor at Boston's Massachusetts General Hospital in 1846, had placed his operating room on the very top floor of the hospital in order to avoid disturbing others with the screams of the suffering patients. One day, while examining one of patient's tongues with pliers and a scalpel, he pulled the tongue of the patient without warning, and cut off his tongue with the scalpel. Afterwards, without hesitation, he cauterized his patient's tongue with a hot iron. Dr. Warren observed the screaming, moaning, and suffering of the patients with no sign of emotion. He did not seem disturbed, and this was the exact attitude he needed in order to perform his duty. However, years later when enough advancement was done in the area of anesthesia, he couldn't hold back his tears during the first operation that was performed with anesthesia.
Surgeries performed without anesthesia were hard on surgeon and patient alike. During his studies, the English gynecologist, Doctor James Young Simpson, fainted while cutting off a breast and considered quitting being a surgeon. Prof. Dr. Robert Liston was a famous surgeon at London University College. Dr. Liston had a reputation for being rude, arrogant, and strong. But he had no choice: he was forced to cut off a leg in 28 seconds, as anesthesia was not yet developed.
As can be seen from these examples, the absence of anesthesia, and the incredible suffering of the patients, pushed surgeons to be incredibly fast and emotionally insensitive. This period of time defined surgeons as strict, insensitive, and despotic. This went on until 1846, when William Thomas Morton performed the first surgery with anesthesia.
Since then, anesthesia has made surgeries much easier for all involved. Today, the definition of general anesthesia is total or partial loss of sensation in a human or animal body before surgical intervention.
Usually, anesthesia is performed by injecting medicine into the blood, or by making a patient breath an anesthetic gas. First, the patient loses consciousness, and then, with the help of muscle relaxants, the patient is put in a state of paralysis. Artificial respiration is performed until the end of the operation with the help of breathing machines called ventilators. For this purpose, an endotracheal tube is inserted in the windpipe of the patient and they are hooked to an anesthesia machine. This feeds oxygen, air, and the anesthetic gas to the patient. The anesthesia doctor controls the patient's breathing, blood pressure, and heart rhythm, as well as other various, vital parameters, and the fluids that will be fed to the patient throughout the surgery. By doing this, the continuity of the anesthesia is made possible. When the surgery is over, the anesthetic drugs are no longer fed to the patient. When the muscle relaxants lose their effect and breathing returns to normal, the endotracheal tube is taken out and the patient is taken to another room to wake up. This is where the patient opens their eyes; it's almost like a re-birth.
The chemicals in cannabis, opium, and coca were the essence of the first drugs used for general anesthesia; they are still being used, partially, in modern times. These chemicals, and some synthetic chemicals like them, are used for anesthesia and can be used after surgery in order to soothe pain. Most of our contemporary drugs are mostly synthetic, and they require many years of difficult education to be properly handled. It takes four years of additional education, after medical school, for a surgeon to become proficient with anesthetics.
Medical research done in the last two centuries about the dosage and quantity of these chemicals has advanced the practice of anesthesia incredibly. All this research provides a very good answer to why drugs have been created. While surgeons use the chemicals extracted from cannabis, opium, and coca, and from the synthetic chemicals like them, as a service to humanity, it is really hard to understand why some ill intentioned people use them for the detriment of human health.