The idea of a printed scientific journal is on life support, after thriving for nearly 400 years. Henry Oldenburg (Secretary of the Royal Society in London) started the idea in 1641 (image).

75 years ago an anesthesiologist could hold a tight fitting mask for several hours (either hand). William Hamilton thought this skill was lost after tracheal intubations became popular in the 1940s (see text from his 1970 lecture). Did the LMA (1983) accelerate the problem?

Dagmar Nelson, CRNA was sued for illegally practicing medicine (1934). Her defense was that the surgeon directed the anesthetic and ordered her to deliver it. Arthur Guedel testified: 'surgeons cannot direct an anesthetic because they cannot look at the patient's eyes'. (Image)

This (30 min) 'introduction to ketamine' video was created by John Pender (1970). It cautions that expertise in airway management is necessary to use the drug. Now it can be purchased online and there is unsupervised use of ketamine. Deaths have occurred. dp.la/item/44db00160…

William Halstead (1852-1922) performed the first peripheral nerve block in 1884. He then started blocking his own nerves and became addicted to cocaine. He was 32 y/o when he wrote these nonsensical words describing regional anesthesia with cocaine (NY Med Journal - 1885).

There are 3 dangerous spaces in the vertebral canal into which a full epidural dose can be catastrophic: subarachnoid, intravenous, and subdural. Covino discusses the dangerous subdural injection and shows the spread of epidural dye in the subdural space (from 1985).

Adolph Hitler would not allow German citizens to receive the Nobel Prize. So he created his own prize: The German National Prize for the Arts and Science. One recipient of this prize (in 1937) was August Bier who was the first to describe spinal anesthesia (125 years ago).

Over 25 years ago an article in Anesthesiology (Vol 84, Pages 160-8) reported that sevoflurane at gas flows of 2L/min damaged the kidney. On this 2024 earth day it is time to reject this flawed concept and use this greenhouse gas (that damages the atmosphere) at low flow rates.

Comroe's 1959 book has this Table and text. A patient with restrictive lung disease has to breathe with rapid shallow breaths because of stiff lungs. To achieve alveolar ventilation of 4 L/min, the total ventilation must be 10 L/min because each breath has 150 cc dead space.

Comroe (1959) illustrates the several barriers that impede the diffusion of alveolar oxygen into the red blood cells. In his book 'The Lung' he mentions several diseases that prevent ambient oxygen from saturating hemoglobin in the pulmonary capillary bed.

1. Regional block. 2. Propofol. 3. LMA. 4. propofol infusion. Experienced physicians 100 years ago could omit the last 3 items by perfecting a calm demeanor (see Gwathmey, 1914).

Immobilon is a potent opioid that is 20,000 times more potent than morphine. It is used to immobilize large animals in the wild. This 12,000 lb elephant was given 4.5 milligrams through a 'flying dart' to take measurements and place ear tags. Human LD50 = 3 mcg.

A short message to those who think that science does not improve the human condition: Take the long view. Here is an illustration of how hand and thumb amputations were performed 350 years ago. No anesthetic. Notice the hot coal to heat the cauterizing irons.

Will the 21st century anesthesiologists make hypnosis work? It was used during surgery in 13th century Italy (image). And it was promoted in 1959 by Milton J Marmer, MD at UCLA (see tweet 6/4/22). But it is a slow process and does not provide muscular relaxation.

Adriani (1956) listed 24 items to consider while performing peripheral nerve blocks. Here are the last 10 and his reasons for listing each item.

Regional anesthesia was popular during the 1950s because GA agents were either flammable or produced hypoxia. In 1956, Adriani made a (24 item) list of precautions to consider when performing regional blocks. Number 7 (image) is related to inadvertent IV injection of LA.

The many 'pupils' of a colander project images of the partial sun eclipse on my granddaughter's hair (11:00 AM April 8, 2024). The principle of the camera obscura was discovered by an Islamic scholar (Alhazen) in the 11th century.

Claude Bernard (1813-1878) discovered that a low concentration of carbon monoxide (CO) is lethal. He burned coal and passed the gas into a box with a rabbit inside. His analysis of the gas detected O2, N2, CO2, CO, and methane. He then proved that the toxic gas was 0.54% CO.

To hyperventilate an infant during craniotomy, the anesthesiologist opened and closed the Ayer's T piece with his finger. Breath sounds were monitored using a precordial stethoscope. Illustration is from Leigh and Belton, 1960.

Sir William Osler (1849-1919) thought science would save humanity from extinction. His view changed when his only son was killed during WW1 (image). Quote: 'The war changed me into an ordinary barbarian. Human behavior is ruled by passion not reason.' Vote this November.