Anaesthesia Quotes

“We live in a world where we consider pain to be, largely, an avoidable experience. Worldwide, the over-the-counter analgesic market was worth over US$30 billion in 2007. For many of us, even a mild headache or sprain has us reaching for the paracetamol (acetaminophen) or the ibuprofen.
Yet, a little over a century and a half ago, things were very different. For most people, especially poor people, pain was more or less a daily experience. There were no readily available analgesics, which meant that pain of all kinds simply had to be endured. Poor nutrition, poor sanitation, overcrowding, and unsafe working conditions created an environment in which problems like rickets, abscesses, and toothache flourished. In the absence of pain relief, childbirth was a dreaded experience for many women.
Occasionally, a person would be suffering so dreadfully from pain that he or she would submit to surgery, without any form of anaesthetic. A limb crushed by the wheel of a cart would, in the absence of antibiotics, quickly turn gangrenous and cause the death of its owner – if not swiftly amputated.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction

“Published sources frequently show that people, including doctors, are generally very poor at judging risk and comparing the magnitude of different risks together, and often make emotional rather than purely statistical judgements of risk.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction

“The treatments for chronic pain come from several disciplines. Traditional analgesics may have only a marginal effect, but many other drugs have been found to be useful, including the anticonvulsants carbamazepine and gabapentin, the antidepressant amitriptyline, the hormone calcitonin, and the fiery extract of chilli pepper, capsaicin. Other interventions include nerve blocks, and even implantable devices such as spinal cord stimulators. These are supported by psychological treatments such as cognitive behavioural therapy.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction

“Other cells besides neurons use action potentials as the basis of cellular signalling. For example, the synchronized contraction of heart muscle is performed using action potentials, and action potentials are transmitted from nerves to skeletal muscle at the neuromuscular junction to initiate movement.
Local anaesthetic drugs are therefore toxic to the heart and brain. In the heart, local anaesthetic drugs interfere with normal contraction, eventually stopping the heart. In the brain, toxicity causes seizures and coma. To avoid toxicity, the total dose is carefully limited and extra care is taken to avoid accidental intravenous injection.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction

“The most useful way to estimate the body’s physiological reserve is to assess the patient’s tolerance for exercise. Exercise is a good model of the surgical stress response. The greater the patient’s tolerance for exercise, the better the perioperative outcome is likely to be, though marathon-running is not required. For most patients, the ability to sustain a little light exercise, such as playing a round of golf, or carrying a heavy shopping bag up a flight of stairs, is all that is required.
When I am in doubt about my patient’s exercise tolerance, I ask them to accompany me on a short walk up the hospital stairs, which usually clarifies the matter one way or the other. It is possible to put patients on a treadmill and measure their exercise tolerance formally (so-called CPX, cardiopulmonary exercise testing), but this is time-consuming, and is therefore reserved for especially difficult cases.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction

“In 1799, the British chemist Humphry Davy was experimenting with different gases, or ‘airs’, at the Pneumatic Institution for Inhalation Gas Therapy in Bristol, searching for treatments for tuberculosis and other respiratory ailments. In what seems to have been a time-honoured tradition, Davy experimented on himself, by inhaling his new discoveries to judge their effects. Having synthesized some nitrous oxide, he inhaled a few breaths and found it produced a sensation of euphoria. He later found that nitrous oxide had analgesic properties which temporarily relieved dental pain and headache.
Davy recorded in his notebook that nitrous oxide might prove useful in surgery, but thereafter became more interested in its recreational effects, and gave it its common name, ‘laughing gas’. No-one seems to have paid any attention to the idea that nitrous oxide might permit painless surgery.
Davy and his co-workers at the Pneumatic Institution invited distinguished visitors to inhale nitrous oxide to experience its pleasurable effects. These demonstrations were soon repeated by students of medicine and chemistry, and then eventually by carnival showmen in both Britain and America. It was to be almost half a century before nitrous oxide was to take its place as a general anaesthetic.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction

“The state of the medical art in the early 19th century was extremely primitive. Medical practice was still largely based on the classical works of Galen and Hippocrates, and harmful practices such as bloodletting were widespread. Nothing was understood about sterility. A surgeon might not trouble to remove his street clothes, or perhaps dress like a butcher, wearing overalls and a leather apron. The patient would require to be restrained by muscular assistants. The best surgeons were the quickest, and could often perform an amputation in less than a minute. Robert Liston of Edinburgh would perform amputations in front of rows of medical students, and begin with the command ‘Gentlemen, time me!’ and would clasp the bloody knife between his teeth when he needed to use both hands.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction