Dr Satya Dev Gupta
Many persons don’t know about the anesthesia, anesthetist and anesthesiologist.They are in a notion that in an operation theater, a man with a magic bottle containing virtuous volatile liquid, or a gas enters the operation room and make the patients unconscious to ease out the surgical procedure painlessly. They are accustomed to an idea that this gentleman with a bottle makes the patient smell a dose to become unconscious. He has nothing to do with the operative procedure and his job is over once the patient goes into a deep sleep. As and when untoward happens, the simple oration is showered ” The patient overdosed”. This might used to happen often times centuries ago when surgery was primitive and limited. However, the world history of surgical interventions for an alternative treatment did exist. Before the advent of anestheticsin the 1840’s, surgical operations were conducted with little or no pain.
It is a pride for India that it has attained the position of “Cradle of Surgery ” as the father of Surgery, the great Sushuratha in 6th century BC used to do 8 types of the surgical interventions including Rhinoplasty i.e. the reconstruction of the nose, a sort of plastic surgery. It is well documented in Sushratha Sahimta that he used a concoction of cannabis hemp etc in wine or alcohol. In 527 AD Raja Bhoj’s time, surgical interventions used to be done with the concoction of herbs. “Samohini and Sanjeevni” the terms were coined for induction and recovery from the concoction effects. It is said that opium was brought in India by Arab traders and Sumerians and Babylonians knew about the euphoric effects of the opium. It is also documented that Egyptians used Mandrake fruit extract whilst China, Greek Japan used opium extract. The credit for the development of modern Anesthesia goes to the western world.
In the 19th century many efforts were made towards the performance of painless surgery but results were not published till the 1840s. The journey was not smooth sailing as it remained in the voyage of Columbus or Vasco da Gama. This path was zigzagged across all corners of the world.
REVOLUTION IN ANESTHEISA
Ultimately, a fateful day approached on 16th OCTOBER 1846. A dentist William T.G. Morton of Boston performed the first public demonstration of surgical etherization at Massachusetts General Hospital, Boston. Morton administered sulphuric ether to Edward Gilbert Abbott for an operation performed by Boston’s leading surgeon John Colin Warren Professor of anatomy and surgery at Harvard Medical School Boston. Reports of surgical and dental operations performed when patients were rendered insensible by the inhalation of ether appeared in newspapers, medical journals, and personal correspondence from Boston physicians. Ships carried the news to you of etherization to Europe and the rest of the world.
ADVANCEMENT IN ANESTHESIA AND SURGERY
With the advent of modern anesthesia, the surgery got the wings for further advancement like an eagle in the free skies gaining remarkable heights. This bump was only possible with advancement in the field of anesthesia. Once impossible anesthesia is now achieved with exquisite precision, attaining not just loss of consciousness but also muscle relaxation, pain relief, and of course stable cardiac, respiratory, and brain vitals.
The contribution of local anesthesiahas also been proved marvelous. This impetus made surgical procedures, services, and workouts cheapest and simplest. Now anesthesia has crossed the walls of the operation theatre. Critical Care, intensive care, emergency services, resuscitation, painless delivery for women(In 1853 British Queen Victoria gave the birth to Prince Leopold in first ever painless delivery by Sir John Snow)alleviate the labor horrors, pain clinics, and many other aspects where anesthesiologist has a big role.
THE BIRTH OF INTENSIVE CARE UNIT
The major advances came out in 1952 in Denmark when the outbreak of poliomyelitis engulfed the kids in that country and Copenhagen was an epicenter of one of the worst polio epidemics that the world ever saw. BjørnAageIbsen, an anesthesiologist had a radical idea. His idea was to blow air directly into the lungs to make them expand with a bellow (Ambu bag) and then allow the body do passively relax and exhale. He proposed the use of tracheostomy: an incision in the neck, through which a tube goes into the windpipe and delivers oxygen to the lungs. This type of breathing is called positive pressure ventilation. The mortality which was 87 percent dropped to 31 percent. This adventure gave birth to mechanical ventilation, Ventilators, a new concept of ANESTHESIA, and intensive services.
ROLE OF ANESTHESOLOGIST IN COVID EPIDEMICS
From December 2019, a respiratory disease caused by the novel coronavirus severe acute respiratory syndrome (SARS-CoV-2) was traced to Wuhan, China, and transmitted to more than 143 countries. On January 30, 2020, the WHO designated the novel coronavirus pneumonia outbreak as a global health emergency and named it coronavirus disease 2019 (COVID-19). As of March 15, 2020, a total of 81,048 confirmed COVID-19 cases had been reported in China. Starting on January 24, 2020, the traditional Chinese New Year’s Eve, more than 42,000 healthcare providers from all over China gathered in Wuhan to support the local healthcare system (data from the National Health Commission of China). Among them, more than 1000 were anesthesiologists(data from the Chinese Society of Anesthesiology [CSA]). In the battle against COVID-19, Chinese anesthesiologists explored new working models to improve patient outcomes and minimize the risk of contracting COVID-19.
COVID-19 IN INDIA AND THE STATE OF JAMMU & KASHMIR
Emphasizing the role of anesthesiologists in the management of critically sick COVID-19 patients, on the Chinese model comprehensive planning has to be considered, where chest disease specialists and internal medicine experts can render their services along with the anesthesiologists. In our state of the union territory of Jammu and Kashmir, the resident doctors of these branches are working in the major institutions on their toes and are real COVID-19 warriors. The Government of India has infused a lot of ventilators in the prime and peripheral hospitals. Due to a lack of oxygen and other paraphernalia, these machines are catching the dust. The Lt Governor and his subordinates have taken a serious note of this scenario. It may also be suggested by the author that in smaller peripheral hospitals neither Corona patient’s treatment nor normal operative procedures and other major work are being done due to lack of staff, equipment, and proper planning.
Henceforth it is desirable to establish a COVID-19 hospital at district level on war footage and engage the free workers to take the best service ever available. It is also mandatory to recruit the required staff. As mentioned above when Denmark in polio epidemics in 1952 and China in 2020 can defeat the pandemics by the anesthesiologists why can’t we do when much of the human resources could be made available.
Anesthesia specialists doctors can do the wonders as and when their services are utilized and they are on the forefront in the rest of the world and the country. It is a paradox that since 2006-8 doctors of this important specialty in the peripheral hospitals don’t have promotion avenues. It is so unfortunate that one after the other Government of Jammu and Kashmir came and passed. The file is still catching the dust for the last 14 years, reflects the commencement of the work culture. Hoping the Lt Governor takes an initiative to mar the COVID-19 in a big way.
(The author is Ex-Head of Intensive Care Unit & Department of Anesthesia Government Medical College Jammu.)
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