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September 1998
Volume 62 |
Number 9
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| Pediatric Anesthesia
Celebrates Its 150th Birthday! |
This year marks the 150th anniversary of the inception of modern
pediatric anesthesia. Since 1848, the advances in this complex
and often delicate area of anesthesiology have grown tremendously.
The articles that follow explore some of these feats, including
a look at the research in children's pain responses, developments
in the field of pediatric cardiac anesthesia, the use of rectal
anesthesia for children and the accomplishments of pioneer M.
Digby Leigh, M.D. In fact, all of the accomplishments of the
last one and one-half centuries would not have been possible
without the dedication and tireless efforts of many anesthesiologists
who recognized the special needs of infants and children. Additional
articles on other pioneers such as Margo Deming, M.D., and Robert
M. Smith, M.D., will be included in future issues of the NEWSLETTER,
but it must be noted that there were countless others who also
gave of themselves selflessly in achieving the advances that
today's anesthesiologists - and their young patients - now enjoy.
Pediatric Anesthesia in the United States: Coming of Age
1840-1940:
Open-drop ether and later chloroform were the principal agents
used during the first 100 years. There were few references in
the medical literature of the time and little formal training
specific to pediatric anesthesia. The sentiments of the scientists
and philosophers of the day vacillated on the issue of whether
infants felt pain; regardless, they knew little about how to control
it. The introduction of cyclopropane in 1934 brought about the
first major change in the administration of pediatric anesthesia.
1940-1960:
Post-World War II, pediatric surgery surged, bringing with it
the demand for improvements in the anesthetic management of infants
and children. Research focused on sedatives to control fear and
psychological trauma, new forms of administration (oral, I.M.,
I.V., rectal) and new agents that would control pain and movement
without serious side effects. This led to the need for airway
management and ventilatory control and the adaptation of adult
devices. Ether was replaced by other safer, nonflammable agents.
1960-1980:
Teaching and communication came to the forefront, augmenting
the growing base of clinical research. Ways to control children's
(and parents') fears were explored, and more predictable medications
were developed. Rapid I.V. sedation and tracheal intubation became
firmly established practices. Safety was enhanced by the precordial
stethoscope, BP cuff (or arterial line), ECG, constant temperature
monitoring and fluid management. Greater control of blood volume
and pain management allowed for ever more complex, lifesaving
surgeries.
1980-present:
Though introduced in the 1970s, pulse oximetry became the national
standard of care, enhancing patient monitoring and greatly reducing
morbidity and mortality in children (and adult patients). Teaching
programs, pharmacological research and medical forums specific
to pediatric anesthesia have multiplied. Outpatient surgery and
patient/child-controlled analgesia are now commonplace, and organ
transplantation and surgery on the neonate (and more recently,
the fetus) are on the cutting edge.
Reference:
Smith RM. History of pediatric anesthesia in the United States.
Anesthesia History Association Newsletter. 1993; 11(2):1-6.
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