Definitive control of the airway, a skill anesthesiologists now consider paramount, developed only after many harrowing and apneic episodes spurred the development of safer airway management techniques.
Joseph Clover, an Englishman, was the first person to recommend the now universal practice of thrusting the patient's jaw forward to overcome obstruction of the upper airway by the tongue.
Tracheal Intubation
The development of techniques and instruments for intubation ranks among the major advances in the history of anesthesiology.
An American surgeon, Joseph O'Dwyer, designed a series of metal laryngeal tubes, which he inserted blindly between the vocal cords of children having diphtheritic crises.
In 1895 in Berlin, Alfred Kirstein devised the first direct-vision laryngoscope.
Before the introduction of muscle relaxants in the 1940s, intubation of the trachea could be challenging. This challenge was made somewhat easier, however, with the advent of laryngoscope blades specifically designed to increase visualization of the vocal cords.
In 1926, Arthur Guedel began a series of experiments that led to the introduction of the cuffed tube.
In 1953, single-lumen tubes were supplanted by double-lumen endobronchial tubes.
Advanced Airway Devices. Conventional laryngoscopes proved inadequate for patients with difficult airways. Dr. A. I. J. “Archie” Brain first recognized the principle of the laryngeal mask airway in 1981.
Early Anesthesia Delivery Systems.John Snow created ether inhalers, and Joseph Clover was the first to administer chloroform in known concentrations through the “Clover bag.” Critical to increasing patient safety was the development of a machine capable of delivering calibrated amounts of gas and volatile anesthetics (also carbon dioxide absorption, vaporizers, and ventilators).
Two American surgeons, George W. Crile and Harvey Cushing, advocated systemic blood pressure monitoring during anesthesia. In 1902, Cushing applied the Riva Rocci cuff for blood pressure measurements to be recorded on an anesthesia record.
The widespread use of electrocardiography, pulse oximetry, blood gas analysis, capnography, and neuromuscular blockade monitoring have reduced patient morbidity and mortality and revolutionized anesthesia practice.
Breath-to-breath continuous monitoring and waveform display of carbon dioxide (infrared absorption) concentrations in the respired gases confirms endotracheal intubation (rules out accidental esophageal intubation).
Safety Standards. The introduction of safety features was coordinated by the American National Standards Institute Committee Z79, which was sponsored from 1956 until 1983 by the American Society of Anesthesiologists. Since 1983, representatives from industry, government, and health care professions have met as the Committee Z79 of the American Society for Testing and Materials. This organization establishes voluntary goals that may become accepted national standards for the safety of anesthesia equipment.