The evolution of ether - Today’s anesthesiology

Today the discipline of anesthesiology has expanded far beyond the operating room, as reflected in this year’s change of the MGH department’s name to Anesthesia and Critical Care. In the core area of general anesthesia, better drugs, improved monitoring and specialized training have been responsible for great improvements in patient safety and comfort during and after surgery.

“Your anesthesiologist is probably the doctor you know least,” says Warren Zapol, MD, chief of Anesthesia and Critical Care. “But while you are in the operating room, he or she is responsible for keeping you safe during surgery.”

Depending on the requirements of the particular operation, the anesthesiologist may need to paralyze the body with muscle relaxants, help maintain circulation and oxygenation of blood while the heart or lungs are stopped, determine the need to replenish blood components, or chill the brain or spinal cord to avoid nerve damage.

Ether has long been supplanted by newer and safer agents that allow more precise control of consciousness and result in fewer side effects like nausea. Anesthetic drugs that quickly disappear from the bloodstream allow many patients to go home within hours of certain surgical procedures.

A nationwide movement to improve anesthesia patient safety has been led by several MGH staff members — including Richard Kitz, MD, former chief of Anesthesia, and Jeffrey Cooper, PhD, director of Anesthesia Technology and Biomedical Engineering. Safer drugs and ever-improving equipment to monitor patient vital signs and control the flow of medication have recently been joined by a specialized training tool: an anesthesia simulator that allows anesthesiologists to experience handling major crises in a computer-controlled environment.

The anesthesiologist’s expertise in keeping patients alive during surgery logically spilled over into helping patients through the critical post-surgical period as well. Intensive care units at the MGH and elsewhere were established, and many are directed, by anesthesiologists. During the 1950s, the use of mechanical ventilators to avoid lung complications in patients recovering from major surgery was pioneered by Henning Pontoppidan, MD, an MGH anesthesiologist.

Several techniques to relieve pain are offered through the hospital’s Pain Center, a collaborative program involving anesthesiologists, neurologists and other specialists. Many patients use patient-controlled analgesia to self-administer pain-killing drugs through special intravenous pumps. The technique, which even children can use safely, allows for steady relief with less grogginess. Pain control also is key in helping patients resume activity after injury or surgery and, it now appears, in preventing nerve damage that can lead to chronic, ever-increasing pain.

Specialized research by members of the MGH Anesthesia and Critical Care Department is leading to ways to reduce the amount of blood lost during surgery, and probing the molecular basis of pain itself. Zapol and several colleagues have pioneered the use of the gas nitric oxide to improve lung function in several life-threatening conditions of infants and adults.

“The changes we see in hospital care today — more outpatient care, more serious illness in those patients who are hospitalized — means that the need for the specialized care delivered by anesthesiologists is actually increasing,” Zapol says. “In collaboration with our colleagues in surgery, medicine, nursing, and other disciplines, we’ll continue advancing ways to keep patients as safe, healthy and comfortable as possible.”