Founding Physicians of the Medical College of Georgia and Their Connections to Crawford Long and the First Surgical Anesthetic.

Milton Antony (1789-1839), an apprenticed trained physician, began educating medical apprentices in 1826 and helped to establish the Medical College of Georgia (MCG) in 1829. Antony recruited additional faculty, Louis Dugas (anatomy and physiology), and Paul Eve (surgery), and together they worked to promote the dissemination of new medical knowledge and enhance and reform medical education. As a result of their efforts, the Southern Medical and Surgical Journal (SMSJ) was established in 1836. The SMSJ became the most successful and widely read regional medical journal. Unfortunately, upon the death of Milton Antony because of the Augusta yellow fever epidemic, the SMSJ ceased publication in 1839. Paul Eve then became Dean of MCG and revived the SMSJ in 1844. Crawford Long (1815-1878) administered ether anesthesia for surgical removal of a neck tumor to James Venable in 1842. For several possible reasons, he did not publish his experience with ether until after Morton's demonstration of ether in Boston in 1846. Crawford Long did meet with Paul Eve, in Augusta at MCG, and was encouraged to publish his experiences with ether in the revived SMSJ, which he did in 1849. It is quite possible that if Milton Antony had lived, and the SMSJ had been continuously published, that Crawford Long may have published his use of ether well in advance of Morton's ether demonstration in 1846. Had that occurred, the great controversy during the mid-nineteenth century over who first used ether for surgical anesthesia would not have existed, and Crawford Long would have received appropriate credit during his lifetime.

20 Years of Human Pluripotent Stem Cell Research: It All Started with Five Lines.

November 2018 marks the 20th anniversary of the seminal human embryonic stem cell (hESC) publication, which reported the initial hESC derivations and launched the field of human pluripotent stem cell research. To commemorate this significant milestone, we reflect on the scientific, economic, and clinically relevant impact of this groundbreaking achievement.

The impact of intraoperative monitoring on patient safety.

There is much more to study and learn about prevention of anesthesia complications and how technology may improve the safety and outcome of anesthesia. Large trials have never shown that a specific hemodynamic monitoring technique improves outcome. In controlled situations, oximetry and capnography have demonstrated efficacy in early detection of events that could be harmful during anesthesia. The BIS monitor has been shown to affect early recovery outcomes and possibly be of value in decreasing long-term mortality. Through all the controversy one thing remains constant: the response to information coming from monitors depends solely on the person administering the anesthesia. Aids to practitioner vigilance probably can never be proved to possess independent benefit, but their role in improving practitioner performance cannot be argued.

Stimulation of the posterior cord predicts successful infraclavicular block.

Infraclavicular (IC) block is often performed by localizing one cord within the brachial plexus sheath and placing all the local anesthetic solution at that location. We hypothesized that posterior cord stimulation would be associated with a greater likelihood of IC block success. We enrolled 369 patients scheduled for surgery to the lower arm or hand in a prospective, nonrandomized observational trial. All underwent IC blocks using a standard technique, and the cord stimulated immediately before drug injection was recorded. Motor and sensory functioning were evaluated 15 min after injection. Compared with stimulation of either the lateral or medial cord, stimulation of the posterior cord was associated with rapid onset of motor block in significantly more nerves, as well as a decreased likelihood of block failure (motor and sensory block inadequate to perform surgery). Failure rates were 5.8% for posterior cord, 28.3% for lateral (P < 0.05), and 15.4% for medial (P < 0.05). The differences were highly significant when adjusted for multiple possible confounders, such as gender, body mass index, location of the incision, and level of training of the individual performing the block (P < 0.001, lateral versus posterior; P = 0.003, medial versus posterior). A low failure rate was also predicted by stimulation of more than one cord simultaneously (P < 0.05). We conclude that injection after locating the posterior cord or multiple cords predicts successful IC block.

Successful interscalene block with a nerve stimulator may also result after a pectoralis major motor response.

BACKGROUND AND OBJECTIVES: Interscalene block of the brachial plexus is a well-established anesthetic and analgesia technique for shoulder surgery. The endpoint for successful block using the nerve stimulator has been described by previous authors as a bicep motor response (twitch) and recently by a deltoid motor response. This retrospective observational case study of regular clinical practice examined the efficacy of using the pectoralis major motor response as an endpoint for a successful block. METHODS: A total of 120 patients who were scheduled for elective ambulatory shoulder surgery were retrospectively studied. All interscalene blocks were performed with aid of a nerve stimulator. Patients were categorized into 3 groups of 40 patients. Group 1 (biceps twitch), group 2 (deltoid twitch), and group 3 (pectoralis major twitch) were compared on success of the block. This retrospective study was conducted by reviewing interscalene block data sheets from the last 40 patients consecutively receiving interscalene block from either a bicep, deltoid, or pectoralis major motor response. A successful block was defined by the inability of the patient to raise their arm against gravity 20 minutes after injection of the local anesthetic. RESULTS: Pectoralis major motor response as an endpoint for local anesthetic injection was examined. Of 40 patients studied in this group, 38/40 were judged successful. This was comparable to the success rate in biceps (38/40 successful) and deltoid groups (37/40 successful). CONCLUSIONS: This retrospective observational case study of regular clinical practice suggests that a pectoralis major motor response can be a satisfactory endpoint for interscalene block.