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Surgery with Music Series Post #14: Music with Dental Anesthesia

Music with Dental Anesthesia

Just yesterday we talked about the use of novocaine in dentistry. Today we’ll take a look at the other main anesthesia used in dentistry: Nitrous Oxide or “laughing gas.” My main concern would be not whether or not it’s effective because I’ve had it and I know that it does work. What you want to know is what the dangers or side-effects might be. Here is some good information that I found on a site called “Just Say N2O”

“N₂O, or Nitrous Oxide, also known as laughing gas, is a weak anaesthetic (painkilling) gas that was first synthesised in 1775 by Joseph Priestley. Of the three early anaesthetics discovered (chloroform, ether and nitrous oxide) it is the only one still in regular use. While insufficiently strong for surgery, it was ideal for the lesser pain of dentistry. Unfortunately, it became popular as a scientific demonstration for public edification (and entertainment). The public entertainment aspect reduced its respectability and although it was first used in dentistry in 1844, it was not until the 1860s that it became more commonly used. Many famous people are recorded as having tried nitrous oxide.

What Is Nitrous Used For?

Common uses of nitrous oxide include surgical, food service and recreational purposes. Many people have experienced nitrous as an anaesthetic for dental surgery. Nitrous oxide chargers are also used to make whipped cream. The dairy industry uses nitrous as a mixing and foaming agent as it is non-flammable, bacteriostatic (stops bacteria from growing) and leaves no taste or odour. Nitrous is sometimes used in auto racing to speed combustion. Nitrous is even used in diving to prepare divers for the nitrous-like effects of nitrogen narcosis. It is also a greenhouse gas emitted by fertilizer and implicated in global warming.

Is Nitrous Illegal?

Given its myriad uses, it is not illegal to sell or possess nitrous. However, in the State of California the possession of N2O with intent to inhale is a misdemeanor: this is probably true of most states. One internet merchant was sentenced to 15 months in prison for selling nitrous with devices intended to facilitate its inhalation. The following is taken from the CA penal code:

381b.  Any person who possesses nitrous oxide or any substance
containing nitrous oxide, with the intent to breathe, inhale, or
ingest for the purpose of causing a condition of intoxication,
elation, euphoria, dizziness, stupefaction, or dulling of the senses
or for the purpose of, in any manner, changing, distorting, or
disturbing the audio, visual, or mental processes, or who knowingly
and with the intent to do so is under the influence of nitrous oxide
or any material containing nitrous oxide is guilty of a misdemeanor.
This section shall not apply to any person who is under the
influence of nitrous oxide or any material containing nitrous oxide
pursuant to an administration for the purpose of medical, surgical,
or dental care by a person duly licensed to administer such an agent.

You should check your State’s Laws. When purchasing nitrous you implicitly agree to abide by the laws governing its use: the same as with gasoline, marker pens, white out, spray paint, ant poison, fabric softener, etc, etc, etc.

What Does Nitrous Do?

Physiological effects last a minute or two for a lungful of nitrous and then mainly dissipate. Some residual effects may last up to several minutes later. Unlike other drugs, the effects of nitrous very rapidly recede. As noted in 1845, “Those who inhale the Gas once, are always anxious to inhale it the second time.” When inhaled, nitrous produces a variety of physical effects including:

Disorientation (both spatial and time-based)
Fixated vision
Throbbing or pulsating auditory hallucinations
Similarly pulsating visual hallucinations
Increased pain threshold
Deeper mental connections
Lowered vocal pitch (opposite of helium)

What Are The Dangers?

The most common dangers from nitrous are due to its disorienting effects and the silliness that surrounds something called laughing gas. Tripping, falling or tipping over in a chair are very common. In one recorded case this caused death. The main cause of death from nitrous seems to be asphyxiation from a bag over the head. Frost bite from the very cold gas is also a concern, especially if dispensing when still disoriented.

Use common sense to avoid most problems.

Because nitrous permeates the lipid (fatty) membranes of your body, it can outgas into your gut or middle ear causing an ache. Cronic heavy usage has very unpleasant effects that could be permanent. Read more detailed dangers of nitrous use.

What Does Nitrous Feel Like?

After several deep breaths of air, I inhale nearly a lungful of nitrous and pull some air down on top and then hold my breath. Within seconds, a light tingling can be felt which seems to increase in frequency. The sensation is much as if waves were traveling up your body or as if you were twisting or spinning. Disorientation increases rapidly and the pulsing sounds/feelings increase, wrapping over one another. It is now, with eyes shut, that I enter a dreamlike state, where I am thinking out something and the external world has essentially ceased to exist. The urge to breathe takes over at some point and partial or whole breaths taken. Open eyes reveal some sort of tunnel vision, with regions of disorientation about the outside. Slowly the throbbing subsides. At other times I experience a sense of paranoia mixed with disorientation. I have a deep conviction while under the influence that all things are cycling together, that there is some deeper cyclical event occuring. It is as an experience of deja vu continually occuring. The feeling is profound and not altogether pleasant.

So how can music make a difference? Well, what I have found after 25 years as a therapist dealing with addictions, any substance that makes a person feel better or puts them in an altered state, is subject to abuse. I don’t think that nitrous oxide is not one of the top drugs to abuse, but it is true that dentists and anesthesiologists do sometimes become addicted because of easy access and a tendency to chemical addictions:

Abuse in the Medical and Dental Fields

There have also been cases of nitrous oxide abuse among healthcare professionals. Dentists and anesthesiologistsMedical doctors trained to use medications to sedate a surgery patient. with easy access to the drug seem to be at a higher risk than the general public of developing nitrous-related dependence problems. Dependence is the belief that a person needs to take a certain substance in order to function.

Substance abuse is also especially high among healthcare professionals who administer anesthesia in a hospital setting. According to the American Association of Nurse Anesthetists (AANA), about 15 percent of anesthesia providers are substance abusers. “Nurse anesthetists are dying … from accidental overdose or from suicide,” reported Carlos “Rusty” Ratliff in “Anesthetists in Recovery: Chemical Dependency in the Profession.” Like dentists, certified registered nurse anesthetists have large supplies of nitrous oxide readily available to them. Consequently, nitrous oxide is one of the drugs these professionals may end up abusing.

Dental Highs

In an article posted on the American Dental Association (ADA) Web site titled “Escaping Addiction: The Door to Freedom,” Dr. Thomas L. Haynes discusses the topic of addiction among dentists. “The access to large amounts of nitrous oxide,” noted Haynes, along with the stress and isolation of the profession, increases the risk of abuse. “Many a dentist has been found lifeless in the office,” he continued, “the N₂O mask still strapped to the face.”

“Chemical Dependence in Anesthesiologists,” a document developed by the ASA TaskForce on Chemical Dependence, addresses the problem of drug abuse among anesthesiologists. Although addicted medical doctors typically become hooked on opioidsA substance created in a laboratory to mimic the effects of naturally occurring opiates such as heroin and morphine. such as fentanyl, nitrous oxide was mentioned by the ASA as another potential drug of abuse. (An entry on fentanyl is available in this encyclopedia.)

The main use of music here is to decrease the amount of nitrous oxide needed for something like a root canal or an extraction. If you can use mainly your favorite calming music and no other anesthetic, that is ideal! Good luck!

By DrAlice|June 15, 2011|Anesthesia, Characteristics of music for surgery, Dangers and Side-effects of anesthesia, How music works, Music and Anesthesia|0 Comments

Surgery with Music Series Post #13: Music with Local Anesthesia

Local anesthesia involves injecting a numbing agent into a localized area. The area that will be affected by the surgery receives anesthesia to block pain sensation. Local anesthesia is only used during surgeries that are fairly minor and that only involve a small area of the body. In many cases, you will be able to remain awake and alert during the procedure. However, some surgeries require the use of sedation that will allow you to relax or even sleep through the surgery. (source: http://www.anesthesiaprogress.com/what-you-need-to-know-about-anesthesia.html)

Probably, local anesthesia is the easiest medical/dental situation in which to use the Surgical Serenity Headphones. The dentist particularly is a very unpopular place to go and not surprisingly. Who wants to be laid on their back, machines put into your mouth and a man leaning into your mouth and drilling on you with that loud, insistent, painful sound? (Not to be overly dramatic!)

On the other hand, dentistry was a leader, back in the 1950’s of what was called audio anesthesia. My dentist in SC actually gave me hadphones in 1958 or so that had 7 different channels on them with 7 different types of music and one with “white noise.” They were huge clunky things, but I remember liking them a lot! Our headphones are super-light and yet they cover the ears enough to greatly muffle the sound of the drill. Give them a try!

By DrAlice|June 14, 2011|Anesthesia, Common Fears in Surgery, Headphones for other medical procedures|0 Comments

Surgery with Music Series Post #12: Music with Regional Anesthesia

Regional anesthesia is used in many, many surgical procedures and medical procedures. The following description is taken from http://www.seanesthesiology.com/regional-anesthesia.html

and gives an excellent overview of various examples of regional anesthesia.

What is Regional Anesthesia?
Regional anesthesia is used when only one area of the body, like an arm or a leg, needs to be anesthetized in order to perform an operation. There are several types of regional anesthesia.

What are the different types of regional anesthesia?
• Spinal Anesthesia – Spinal anesthesia involves injecting a local anesthetic into the fluid
surrounding spinal nerves. Once injected, the medicine mixes with spinal fluid in the
lower back and numbs the nerves it contacts, effectively blocking sensation and pain.

Spinal anesthesia takes effect rapidly and is safe and effective for any surgery occurring
below the ribcage. It is especially effective for surgery on the lower abdomen and legs.

• Epidural Anesthesia – Epidural anesthesia involves the placement of a catheter into
a small space within the vertebral column just before the spinal fluid. Depending on the
nerves targeted, the epidural can be placed in various regions of the back from the neck
to the tailbone. Epidural medications can be given through this catheter to provide
numbness for the surgery, and also can be used to provide pain relief
in the post-operative period.

• Nerve Blocks – Your anesthesiologist can use a variety of nerve blocks to ensure
comfort throughout a surgical procedure. Often a group of nerves, called a plexus
or ganglion, that causes pain to a specific organ or body region can be blocked
with local anesthetics. Below are some of the most common nerve blocks and what
body parts they are associated with.
o Trigeminal nerve blocks (face)
o Ophthalmic nerve block (eyelids and scalp)
o Supraorbital nerve block (forehead)
o Maxillary nerve block (upper jaw)
o Sphenopalatine nerve block (nose and palate)
o Cervical epidural, thoracic epidural, and lumbar epidural block (neck and back)
o Cervical plexus block and cervical para-vertebral block (shoulder and upper neck)
o Brachial plexus block, elbow block, and wrist block (shoulder/arm/hand,
elbow, and wrist)
o Subarachnoid block and celiac plexus block (abdomen and pelvis)
• Intravenous Regional Anesthesia – Intravenous regional anesthesia is the process
of placing an IV catheter into a vein in your lower leg or arm so that the local anesthetic
can be administered. An important part of intravenous regional anesthesia is placing
a tourniquet above the area to ensure the medicine stays in the arm or leg that is being
anesthetized. Feeling will return to the area once the tourniquet is removed.

What are the most common procedures used with regional anesthesia?
Regional anesthesia can be used for many procedures, but the most common are orthopedic and obstetric procedures.

Are there side effects associated with regional anesthesia?
Patient safety is extremely important. Although anesthesia can carry some risks, major side effects or complications are uncommon. You can be assured that our physicians are extremely qualified to handle your anesthesia care. Southeast Anesthesiology Consultants regularly exceeds the national standards of care and safety. The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesiologist about any risks that may be associated with your anesthesia.

What are some of the side effects of regional anesthesia?
Although uncommon, potential risks include:
• Swelling
• Infection at the injection site
• Systemic toxicity (rare)
• Heart or lung problems (rare)

How can music make a difference? As with so many medical/surgical situations, one of the main things music through headphones will do is simply distract you. But with headphones, they will also create a sonic cocoon around you that keeps other hospital and clinic sounds away from your ears. The fact that our headphones are programmed with music chosen specifically for surgery makes them ideal to calm you and regulate your heart-rate and breathing with musical entrainment! Post any questions you might have here as a comment!

By DrAlice|June 13, 2011|Anesthesia, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Headphones for other medical procedures, Music and Anesthesia, Music in the hospital|0 Comments

Surgery with Music Series Post #11: Music with General Anesthesia

According to a recent article in Scientific American, people who are being “put to sleep” with general anesthesia are really being put into a temporary a (usually) reversible coma! I think for the average surgical patient, this sounds a little scarier. Again, if you can reduce the amount of anesthesia that you need by having slow, steady music played for you through headphones, why not do it?

Patients undergoing significant operations, such as major cardiac or transplant surgery, typically require general anesthesia. But putting patients to “sleep” might not be the best way to describe the process, argued the authors of a new review paper, published in the December 30 issue of the New England Journal of Medicine.

What anesthesiologists are really doing is closer to putting patients—close to 60,000 each day in the U.S.—into a drug-induced coma. “It’s a reversible coma, but it’s nevertheless a coma,” says Emery Brown, a professor of anesthesiology at Harvard Medical School and coauthor of the paper.

General anesthesia before major surgery dips brain activity (as measured by electroencephalogram, or EEG) down to levels akin to brain-stem death. For the most part, Brown has found that anesthesiologists talk about the process in colloquial terms, telling patients they will be “asleep,” rather than “unconscious”—likely in an effort to not make a medical ordeal any scarier than it already needs to be.

That approach is doing both patients and scientists a disservice, he argues.

“It would be nice if your anesthesiologist could explain where drugs are going to be working,” Brown says. Many clinicians, however, might be hard pressed to offer detailed neurological explanations for how each compound they administer is working on the nervous system. They are more likely to think of it in terms of

“we turn the knob and they go to sleep,” says Michael Alkire, an associate professor of anesthesiology at the University of California, Irvine, who was not involved in the new paper.

Inducing a coma-like state does require careful monitoring, breathing and temperature support as well as a delicate balance of “hypnotic agents, inhalational agents, opioids, muscle relaxants, sedatives and cardiovascular drugs,” Brown and his colleagues noted in their paper.

The mechanisms behind this concoction, carefully devised though it might be, are not always well comprehended. Long thought of as a “black box,” anesthesia now “can be explained and understood—it’s not a mystery,” Brown says. And researchers can further help to clear the field’s fog by expanding the field of anesthesiology to collaborations with experts in other fields, such as sleep and coma research.

Although anesthesiology and research on sleep and coma generally carry on independently of one another, “there’s a way to think about them all in the same framework,” Brown explains. And that common frame should be neuroscience, he says.

Alkire agrees that the coma model “is more appropriate,” and that “shifting toward that view is going to be helpful” in moving the field forward. And bringing the disparate fields, including researchers from sleep and coma work, together makes sense because “it’s all the same fundamental neuroanatomy.”

A push for more detailed neuroscience in the field might also help drive research toward new, more effective methods. Diethyl ether was a revolutionary tool in the 19th century that could knock people out before surgery, but it had some unpleasant side effects. “Now we need nuance” and more targeted tools like those cropping up in other areas of medicine, such as cancer treatment and screening, Brown notes.
Anesthesia, Alkire says, “is still kind of on the level of ‘we have a big hammer, and we hit you on the head, and you get knocked out.'” He and his colleagues have been working to find more “regional brain anesthesia that would change the state of consciousness,” he explains. “I think we have a ways to go” he says but notes that they have had some promising leads by zeroing in on the thalamus in animal studies. But even if clinicians might not yet have more delicate tools to dip patients into surgery-ready unconsciousness, Alkire notes, “understanding how it works puts you in a position to do better anesthetics eventually—if not with the agents you have right now.”

And taking a deeper look at how drugs are working during anesthesia might also yield helpful models for different neurological disorders, Brown says, noting the similarities between EEGs in patients under general anesthesia and those in comas.

On the more mundane front, advances in anesthesiology might also help with treatments for insomnia—but not in the ways one might think.

Traditional treatments often work on the same mechanisms as the drugs given to anesthetize patients before surgery, thus helping people conk out, but not necessarily replicating normal sleep patterns. By taking a closer look at the mechanisms at work during general anesthesia—and how some of the more widely prescribed sleeping meds behave in the brain—”we can ask ‘is that the way we want to

[treat insomnia]?'” Brown explains.

And those advances in turn could feed back into the field of anesthesiology, helping to reduce side effects of general anesthesia, such as postoperative cognitive decline. Better understanding of the coma-like state of general anesthesia could also shed light on patients who are in a more permanent vegetative state, who upon waking go through very similar stages as those coming up from general anesthesia—albeit much more slowly. The key, says Brown, is “taking time to understand these mechanisms” and applying them to fine tune the proverbial hammer—a challenge that he and his colleagues hope to announce progress on in the coming months. (here ends the article from Scientific American.)

There is ample evidence that music before surgery calms and relaxes the patient, necessitating less anxiety medication and music after surgery, into the recovery room and on into the patient’s room, decreases the amount of pain medication the patient requires. If you are a loved are having surgery please visit www.surgicalheadphones.com.

By DrAlice|June 12, 2011|Anesthesia, Dangers and Side-effects of anesthesia, Headphones for other medical procedures, Music and Anesthesia, Music in the hospitals|0 Comments

Surgery with Music Series Post #10: How does music affect other medication requirements

This is such a simple concept, and yet, very few hospitals or sugery centers implement therapeutic music. There are many, many studies that document that music pre- and post-surgery can decrease the use of anxiety medications before and pain medication afterwards. Studies have been conducted on major hospitals and universities all over the world. As recently as April 1, 2011 I presented a Grand Rounds at Cleveland Clinic Florida that went over the top studies for music before, during and after surgery. To see highlights of this, click HERE.

How does it work? Before surgery, when you put on the headphones, the music enters your brain through the 8th cranial nerve. Within moments, you close your eyes and your heartrate and breathing begin to slow down and become steady. You begin to relax, naturally, and the need for I.V. anxiety medication greatly reduces. After surgery, the headphones are again used as you move into the recovery area and your body stays relaxed as you come out from under the anesthesia.

The recovery room is known for it’s busy-ness and (often) lack of peace and quiet. In today’s crowded hospitals, nurses are trying to take care of many patients at the same time and those without music are often moaning and crying out. Those with the headphones are not only staying relaxed, but the headphones help block out other patients cries and sounds of pain and discomfort.

Some hospitals have tried having CD players at bedside, but that doesn’t work nearly as well as the pre=programmed headphones. A recent patient wrote this to me:

I kept expecting to be nervous as the date of surgery rolled around but couldn’t seem to summon up any anxiety
My blood pressure has dropped to normal limits
I “knew ” I wouldn’t be able to sleep prior to surgery but guess what I slept well
I was calm and relaxed before surgery
The dentist and staff tucked me in, made sure I had my music (I had my i POD set to repeat ) and away we went.
Post -op I was still relaxed – had a sleep and had little pain- I had a bunch of work done – I did take an Advil at bedtime just for “insurance” but really didn’t need it.
My mouth is healing beautifull

Thank you for the wonderful music.

Blessings, Anne

If you have any questions at all, please don’t hesitate to leave them as comments on this blog and I will get right back to you!

By DrAlice|June 11, 2011|Anesthesia, Characteristics of music for surgery, Common Fears in Surgery, Headphones for other medical procedures, How music works, Music in the hospitals, Surgery Music, Surgical Headphones reviews|0 Comments

Surgery with Music Series: Post #9 “How much does music affect the anesthesia requirement of a patient?”

We’ve established that anesthesia is a modern wonder, of sorts. Nevertheless, we also established that it carries with it certain risks and dangers, the worst of which would be an untimely death. Anesthesia MUST be administered by a medical specialist, an anesthesiologist who has gone beyond the MD degree to specialize in anesthesia.

Besides finding the very best anesthesiologist your hospital offers, what else can you do? You already know that I’m going to recommend using slow, steady, purely instrumental music that has the tempo of the resting healthy heartbeat. And not from a nearby boombox or ipod on speakers or even an iPod with earbuds. My recommendation is to use cordless/wireless headphones that are already pre-programmed with the ideal music for surgery under general anesthesia.

Why? Because we know that even when the hearing has shut down from the effects of the general anesthesia, the body still responds to the vibrations coming through the headphones into the body. When this happends, the process called entrainment is triggered and the heartrate and breathing synchronize with the music, keeping the body relaxed and in need of less anesthesia. Just imagine how nervous your would be if you knew your body had a serious problem and you were going to be put to sleep and operated on? Your body would be very tense and it would like require more anesthesia to put you to sleep that if you’ve been listening to slow, steady music for 45 mins or so before you’re taken into surgery? At this moment, a scientific study is being done with our headphones at a large hospital here in Lousiville, KY to measure the exact effects and benefits of these headphones. Tomorrow we’ll look into the benefits of these headphones with regional anesthesia!

By DrAlice|June 10, 2011|Anesthesia, Characteristics of music for surgery, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Music and Anesthesia, Music in the hospital, Music in the hospitals|0 Comments

Surgery with Music Series, Post 8: A Brief History of Anesthesia (Pt. 2)

Even though we are doing a brief history of anesthesia, there is enough to divide into two parts! Tonight we look at part two, beginning with Dr. Colton:

Davy was a remarkable if somewhat erratic chemist who was not only responsible for

the above discovery but many others such as the Davy miners’ lamp and many of the properties of the Alkali Earth metals. He died May 29th, 1829 at the age of 51 from a

myocardial Infarction following a prolonged illness considered to be brought on by the inhalation of many gases over his lifetime.

Despite Davy’s work it wasn’t until 45 years later in 1844 when nitrous oxide was used as an anaesthetic by Gardner Colton and Horace Wells. Colton was a travelling At the age of 21, Davy, a keen chemist was employed as a superintendent of the medical pneumatic institution of Bristol to investigate the properties of various gases and their application to medicine. A quote in the diary of an observer at the time states,

‘He breathed 16 quarts of the gasover a period of 7 minutes and became completely

Colton administered nitrous oxide to Wells and Wells’ partner John Riggs extracted his wisdom tooth whilst under the effect of the gas.

intoxicated.’ scientist who gave public demonstrations of his discoveries. Wells, a practicing Connecticut dentist, was at one such demonstration when he witnessed Colton administer Nitrous oxide to a man who then bashed his shin against a stone bench and displayed no sign of pain. Excited by this observation Wells invited Colton to his dental practice the next day. No pain was experienced during the extraction and Wells and Riggs pioneered the use of Nitrous oxide as a dental anaesthetic and went on to anaesthetise many more patients for wisdom tooth extraction. During his career Wells was to influence the life of one of the most important names in anaesthetic history, William Morton. Unfortunately the rest of Wells’ career was not so illustrious and in 1848 he committed suicide after being arrested for dousing a prostitute in sulphuric acid.

William Thomas Green Morton was born in 1819 in Massachusetts. From a young age he aspired to study medicine but unfortunately lacked the capital to do so and so chose the less expensive option of dentistry.

He trained predominantly under the guidance of Horace Wells and together they started a dental practice that eventually turned out to be a financial failure. At this point in his life he separated from Wells and began studies at Boston medical school under the guidance of prestigious surgeon Charles Jackson. Here he began investigations into the properties of Ether. Unfortunately Morton’s constitution was never strong and he suffered frequently with anxiety and stress. Early on in his studies of ether he was thwarted by a nervous breakdown and had to return to hisfamily home for a period of respite. After this set back he returned to his studies and was briefly reunited with Horace Wells when Wells gave an unsuccessful demonstration of the properties of Nitrous oxide as an anaesthetic for wisdom tooth extraction. The demonstration was a farce with the patient crying out and thrashing around and subsequently Well’s work was rubbished. At this point Morton’s’ life began to flourish as he opened his own dental practice which was a financial success and even allowed him to open a factory which specialised in making false teeth. With his continuing dental practice his interest in anaesthesia was again stimulated. The problem that he and his patients faced were that to fit the dentures the roots of the old teeth had to be removed at considerable pain to the individual undergoing the experience. He decided to return his interest back to ether which he had studied before. His experiments, which almost certainly did not have the approval of the ethics committee, ranged from testing the effects of ether on his goldfish, his pet terrier and himself. Excited by his results from anaesthetising goldfish he was given a prime opportunity to test his research. On the 30th of September 1846 a patient named Ethan Frost came to his surgery for a painful wisdom tooth extraction and agreed to have it extracted under the influence of Ether. Morton held a handkerchief over the patients’ mouth and dripped ether onto it (without accurate end tidal measurements!). The results of the experiment were published the next day in the Boston daily evening Transcript Morton’s Article caught the eye of an up and coming young surgeon, Henry Jacob Bigelow. On the 16th of October 1846 Morton gave the first ever public demonstration of anaesthesia using sulphuric ether and Morton’s Inhaler in the Ether dome at Boston whilst Bigelow removed a tumour from the jaw of his patient, Gilbert Abbot.

Boston Daily Evening Transcript,

October 1st 1846

The Ether Dome, Boston, Massachusetts

As with most historical names in anaesthesia Morton’s tale is not a happy one. Because he was not a physician he did not receive full credit or financial reward for his discovery and spent the rest of his life in legal battles. He died in 1868 at the age of 49, a pauper. Bigelow kindly had inscribed on Morton’s headstone:

Before whom, In all time, Surgery was Agony By whom, pain in surgery was averted Since whom, science has control over pain’

His family were bakers by trade but sacrificed much of their earnings to allow the youngest and cleverest son, James, to go to University and be educated. Simpson went to Edinburgh University at the age of 14 where he studied Greek, Latin and Maths for his first year before applying for Medicine in his second year. He was accepted with the handsome bursary of ten pounds per year. At Medical schoolSimpson was a feisty individual with a keen intellect and was never one to just sit back and accept the standard teachings of his seniors always keen to challenge accepted practice. He graduated from University with his LRCSEd and then for a One of the most notable names in anaesthetic history and possibly one of the most eminent physicians in the history of medicine was James Young Simpson. Simpson was born in Bathgate in 1811

University. Shortly into this role Simpson heard of a discovery in London from his next door neighbour which was to change the course of his life. Robert Liston had performed a leg amputation in December 1846 with the patient anaesthetised with ether (shortly after Morton’s’ discovery). Excited by this he travelled to London to find out more and when he returned to Edinburgh his mind was filled with great ideas of applying the use of ether to the relief of pain in Labour . This was revolutionary and in many circles, unpopular. Simpson faced opposition from many angles. On the one side of the coin his professional colleagues opposed the idea saying that it would pose great risk to the mother and would certainly harm the child. On the other side many members of the public and clergymen opposed the idea on religious grounds. Simpson fought these ideas using his intellect to oppose them. Professionally he opposed his colleagues by using the ether in his practice and collecting data from 800 other maternity patients who had had ether for both natural and instrumental deliveries and demonstrated clearly that it did have a place in obstetric analgesia. On the religious front he produced a leaflet with an equally valid counter argument to some of the religious objections. He used direct quotes from the bible to emphasise his points including:

short period worked in a few general practices before embarking upon and completinghis MD thesis. After this he began work for an eminent Pathologist of the time. From this point Simpson’s’ keen intellect and voracity for his work lead him into the field of obstetrics and gynaecology where he challenged practices and produced a veritable cornucopia of publications, presentations and teachings on the subject. His esteem rose and in 1840 he was voted the Chair of Midwifery at Edinburgh

For everything God created is good, and nothing is to be rejected if it is received with thanksgiving,a

nd Anyone, then, who knows the good he ought to do and doesn’t do it, sins.

Simpson found however that ether took too long to work and was not efficient in terms of the volume that had to be used during the course of labour. For this reason he

searched for another agent. It wasn’t until a pharmaceutical colleague suggested

Chloroform that his mind focused on this. In November of the year after the discovery

of ether, Simpson and two colleagues inhaled Chloroform over his dining room table

and needless to say all fell unconscious and slipped under the table. Simpson’s first

thought on recovering (other than my head hurts) was how much more potent

chloroform was than ether.

A few days later Simpson had progressed from his clinical trial to patient testing and

by the end of the month had anaesthetised several patients with Chloroform. Simpson had first used chloroform on a patient by November 8th 1847. 2 months later on

January 28th 1848, chloroform had claimed its first victim, a 15 year old girl called

Hannah Greener. Investigation into this occurred but it was unclear whether the death was due to respiratory depression or some unknown effect on the heart. It wasn’t until

were:

60 years later that Levy used animal experiments to prove that deaths from chloroform

resulting in cardiac fibrillation’

Despite this discovery the popularity of chloroform rose well into the twentieth 30, 000 mourners lined the streets of Edinburgh as a mark of respect. His memory lives on with the dining room where he first used chloroform on himself being preserved to this day. Also there stands a statue in Princess place, Edinburgh, as well as a memorial plaque in Westminster cathedral. There is also an annual James YoungSimpson gold medal awarded by the Royal college of Surgeons of Edinburgh and the winner gives the annual Simpson memorial Lecture

By DrAlice|June 9, 2011|Anesthesia, Music and Anesthesia|0 Comments

Surgery with Music Series, Post 7: A Brief History of Anesthesia (pt.1)

From Out of the Primordial Soup:

A Brief History of Anaesthesia by Robert Hirst MB ChB
Department of Anaesthesia Sheffield Teaching Hospitals

Anaesthesia has been around in one form or another since around the 12th century and in some sense hundreds to thousands of years B.C. In the last 150 years however a revolution of anaesthesia has occurred with exponential growth in knowledge and substances available for use in anaesthesia making it one of the most advanced specialities in modern medicine. The following essay considers the core roots of our speciality and looks briefly ahead to see what the future may hold.

Primitive Anaesthesia

Medieval anaesthesia was primitive and barbaric when compared to the standards employed today. The most common before the 15th century was probably the use of liberal quantities of alcohol plus or minus opium and a wooden stick to bite down upon. However some of the substances used in this period still hold strong today suchas opium and some are even being ‘rediscovered’ such as Cannabis in chronic pain.Arabic alchemist were perhaps some of the most advanced in their beliefs on anaesthesia in the 12th and 13th centuries employing techniques such as the soporific sponge which was a sponge steeped in hashish, opium and other herbal aromatics. When required for surgery it would be moistened and held over the face inducing a state of unconsciousness. Writings about this practice can be found in Sir Richard Burton’s translation of The Arabian nights (1).

(2) Formal reference to the use of an anaesthetic agent for surgical intervention occurs around 1540 when dioscorides refers in his pharmacopoeia to: ‘Sleeping potions made from opium and mandragora root which may be used as surgical anaesthetics for such people whom be cut or cauteried’ (3) Mandragora continued to be a popular choice of anaesthetic upto the middle ages and was a mythical and respected plant. It was felt that the mandrake plant whose roots resembled a human form would kill the person who picked it if the screams of the root were heard. For this reason the plant was uprooted in novel ways such as tying the loosened plant to the collar of a dog and allowing the dog to uproot the plant, a practice that would be frowned upon by the RSPCA no doubt.

(4) Mandrake was usually combined with a blend of opium and hemlock and either rendered the patient unconscious or dead, as hemlock shows zero order kinetics and is a toxic piperidine alkaloid.

3 One of the commonest anaesthetic potions used was the ‘Dwale Potion’ from the medieval word dwale meaning confused or dazed. This comprised the gall from a castrated boar, lettuce, hemlock, henbane opium, mandrake and bryony.

(5) When the walls of the opium poppy are incised a latex like substance is secreted, from which many of the useful products are derived including opium and the isoquinoline alkaloid derivates morphine, codeine, noscapine, papaverine and thebaine. The Sumerians were the first to cultivate the poppy as far back as 3200 B.C. There is a feeling among some medical historians that the poppy itself is integrated into human culture and that this is one of the reasons that eradication of the illegal opium trade is so difficult. The first writings of opium overdose appear around 1037 A.D when the Islamic physician Avicenna died of an accidental overdose. A famous quote, which still holds true today, was in the 17th century when Thomas Syndenham wrote:

‘ There is no other pain killer that is so universal and efficacious as morphine’ (6) As you can see from the above techniques the balance between life and death was even more tenuous during anaesthesia than it is today. So when did things start to change? Certainly the longest standing substance used in anaesthesia throughout history and into modern day are extracts from the opium poppy, papaver somniferum meaning the poppy of sleep.

4 Evolution

From these primitive beginnings little changed in anaesthesia until the end of the 18th century. During this time a rapid evolution occurred in the practice of anaesthesia largely due to certain key individuals who shaped the foundations of our speciality as it stands today. The discovery of ‘dephlogisated nitrous air’ or nitrous oxide as we now know it, by Joseph Priestly was the catalyst for this evolution. The discovery occurred at the end of the 18th century but the relevance of the discovery was not stumbled across until a couple of years later in the early 19th century when a chemist, Humphrey Davy, conducted some ‘physiological’ experiments with the gas.

(8) Davy was a remarkable if somewhat erratic chemist who was not only responsible for the above discovery but many others such as the Davy miners’ lamp and many of the properties of the Alkali Earth metals. He died May 29th, 1829 at the age of 51 from a myocardial Infarction following a prolonged illness considered to be brought on by the inhalation of many gases over his lifetime. Despite Davy’s work it wasn’t until 45 years later in 1844 when nitrous oxide was used as an anaesthetic by Gardner Colton and Horace Wells. Colton was a travellingAt the age of 21, Davy a keen chemist was employed as a superintendent of the medical pneumatic institution of Bristol to investigate the properties of various gases and their application to medicine. A quote in the diary of an observer at the time states, ‘He breathed 16 quarts of the gas over a period of 7 minutes and became completely Humphrey Davy intoxicated.’ (7)

to be continued tomorrow!

By DrAlice|June 7, 2011|Anesthesia, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Music and Anesthesia|0 Comments

Music with Surgery Series: Post #5 “Side-effects of Anesthesia”

By DrAlice|June 6, 2011|Anesthesia, Dangers and Side-effects of anesthesia, Music and Anesthesia|0 Comments

Surgery with Music Series: Post #4 “Side-effects of surgery”

No one wants to have surgery, but sometimes it really is necessary if you want to continue with your life. Surgical procedures have dramtically improved over the last 50-60 years and most surgeries are completed with no problems whatsoever. Unfortunately, even when the surgery is completely successful, recovery from surgery can be difficult and stressful.

Of course there is no such thing as a “typical surgery.” Surgery includes everything from a Cesarean section for deliver a baby to heart bypass surgery, to joint replacements. No matter what the surgery, certain after-effects can be expected: nausea, pain, grogginess, sleepiness, tiredness, weakness, dizzyness, difficulty walking, stand, sitting, sleeping and many more. Luckily these things don’t last forever, but often there is a correlation with how long these side-effects last and how much anesthesia the patient had. It’s hard to separate the side-effects of surgery from the side-effects of anesthesia, but we do know that the less anesthesia you can get by with, the faster you’ll recover and also have the least number of side-effects.

One of the best ways to reduce the likely amount of anesthesia you’ll need is to use music through headphones for 30-60 minutes before your surgery begins. This allows your body to slow down and relax and when you begin the procedure already relaxed, less anesthesia will be required to put you under. It’s important that the music be very steady, purely instrumental music with the tempo of the healthy resting heartbeat. This way, your own heartbeat and breathing can synchronize or entrain with the music you’re hearing through headphones.

If you continue to wear the headphones into the recovery area, research shows that there can be a greatly reduced amount of pain medication needed…another way to keep you from experiencing nearly as many of the side-effects. If you or a friend has surgery scheduled, please consider using music with your surgery!

By DrAlice|June 5, 2011|Anesthesia, Characteristics of music for surgery, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Headphones for other medical procedures, Music and Anesthesia, Music in the hospital, Surgery Music|0 Comments

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