To the Editor:— I enjoyed three of the editorials in the December 2008 issue of Anesthesiology, because each one alluded to events in the history of anesthesia. In the first one I read, Orser and Saper argued that the quid pro quo for exiting the current “ether era” is tied to identifying the neural circuits and receptors responsible for the anesthetic state and designing new anesthetic drugs that are more focused in their action.1In the second, the effects of nitrous oxide and xenon on N -methyl-d-aspartate and α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors in the amygdala were compared. According to Hemmings and Mantz, the differences between the two inhaled agents “are no laughing matter”2—a very nice allusion—both to the early use of nitrous oxide as a laughing gas at public demonstrations and medical student frolics in the early 1800s and to the “failed” public demonstration of nitrous oxide for surgical anesthesia by Wells, contrasted with the successful administration of ether in this setting by Morton and the subsequent declaration by the surgeon Warren, “Gentlemen—this is no humbug.”3Now historically primed, I read the third editorial by Davidson et al. suggesting that spinal anesthesia be used in the control group for neurotoxicity studies of general anesthetics in neonates.4Immediately I recalled the early 1900s argument that general spinal anesthesia, or deliberate total spinal anesthesia, even for head and neck surgery, avoided some of the problems associated with the administration of general inhalational anesthesia, such as the mortality rate attributed to chloroform and the technical problems involved with inhaling ether.5If we look at 50-yr snapshots, we see anesthesia for frolics in the 1800s replaced by inhalational anesthesia for surgery in the 1850s, spinal anesthesia emerging in the 1900s, a preference for general anesthesia in the 1950s, and now spinal anesthesia as the “less neurotoxic” control group. We have clearly made improvements in both approaches to anesthesia. More importantly, we have become much more rigorous and demanding in what we consider safe anesthesia.
Wake Forest University School of Medicine, Winston-Salem, North Carolina. rroy@wfubmc.edu
