Cocaine and Achieving Rapid Pulpal Anesthesia Prior to Extirpation.

Prior to the effective use of local anesthetics to achieve profound pulpal anesthesia before extirpation, whether in the form of a nerve block or infiltration, or in some cases the use of intrapulpal injections,1, 2 the clinician was faced with a challenge to ensure that the patient would be pain free during the procedure. In these cases the use of nitrous oxide and oxygen was common. Not so common was the use of cocaine or a solution of cocaine hydrochloride that was advocated to penetrate the dentinal tubules and create pulpal insensibility in the late 1800s.3, 4.

At the birth of pediatric anesthesia in Mexico: An interview with Dr. Estela Melman, a pioneering woman in medicine.

Dr. Estela Melman (1939-present), Professor in the Department of Anesthesiology, the American British Cowdray Medical Center, Mexico, is an influential pioneer who has shaped the scope and practice of pediatric anesthesia in Mexico and throughout the world. Her early work to reintroduce neural blockade into routine pediatric anesthetic care, particularly the caudal approach to the epidural space, helped to transform current anesthesia practice. Based on a series of interviews held with Dr. Melman between 2016 and 2017, this article reviews the remarkable career of a pioneering pediatric anesthesiologist.

[The History and the Future of Peripheral Nerve Block].

Peripheral nerve block became popular with the advance of the ultrasonic diagnostic equipment, and became one of the essential procedures in anesthesia. For the further development of this method, we have to learn the past and identify problems in this course. We have outlined the history of the peripheral nerve block and described the development of the method. Furthermore, we verified the recent change in periph- eral nerve block by searching the literature and exa- min the background. Lastly, we pointed out problems of the current peripheral nerve block and described its new application and its ideal future course.

The surgeons Halsted and Hall, cocaine and the discovery of dental anaesthesia by nerve blocking.

William Stewart Halsted is considered to be one of the most influential and innovative surgeons the USA has ever produced. His contributions to surgery are abundant, ranging from sophisticated surgical techniques in the field of breast surgery, surgery of the digestive apparatus and traumatological interventions, to the introduction of gloves in the operating theatre. Here we present Dr Halsted, together with his aide Dr Hall, as the discoverers of the technique for blocking the inferior alveolar nerve and the antero-superior dental nerve using cocaine as an anaesthetic. The anaesthetic technique, described perfectly by both surgeons in 1885, has been revolutionary in the practice of odontology since its introduction, offering dentists the possibility of performing invasive interventions to the maxillary without pain.

[History of the sacral epidural block]. / Historia de la anestesia epidural sacra.

Blockade of the sacral plexus is associated with an interesting chapter in the history of anesthesia. Use of this technique peaked in the difficult early decades of the twentieth century, a time when inhaled anesthesia was in decline and regional and local techniques were gaining ground as alternatives. This article analyzes the history of sacral epidural anesthesia, in particular the Spanish contribution. Names like Salvador Gil Vernet, Manuel Usandizaga, José Botella, Santiago Dexeus, José Miguel Martínez and José Estella should be remembered for the important pioneering roles these anesthetists played in research and clinical practice. Although Spanish surgeons were not enthusiastic about the sacral plexus block, the Spanish history of the technique has been similar to that seen in other countries: at first there was a certain degree of enthusiasm, later the technique was nearly forgotten, and finally interest has returned in recent years, initially in obstetric analgesia and more recently in pediatrics.

"Scalp block" during craniotomy: a classic technique revisited.

Local anesthesia of the nerves of the scalp is referred to as "scalp block." This technique was originally introduced more than a century ago, but has undergone a modern rebirth in intraoperative and postoperative anesthetic management. Here, we review the use of "scalp block" during craniotomy with its anatomic basis, historical evolution, current technique, potential advantages, and pitfalls. We also address its current and potential future applications.

The curse of discovery: pioneers of dental and medical anesthesia.

The current practice of dental local anesthesia remains founded upon drugs and techniques that were developed over 100 years ago. 2009 marks the 125th anniversary of the pioneering use of cocaine as a topical anesthetic and the introduction of nerve block injections in the oral cavity and facial region. Four famous clinicians are recognized in this article, each for their unique contributions to "modern" local anesthesia (Carl Köller, Sigmund Freud and William Halsted) and general anesthesia (Horace Wells), with the recognition of the adverse impact of drug dependence on their personal lives, which fortunately did not preclude their positively revolutionizing the practices of dentists and physicians and their patients every since.

Centennial of intravenous regional anesthesia. Bier's Block (1908-2008).

The surgeon August Gustav Bier significantly influenced surgery, general medicine, and especially anesthesia. He was the father of spinal anesthesia (1898) and intravenous regional anesthesia (1908). Both anesthetic techniques are still valuable and widely applied in everyday anesthesia practices throughout the world, with a high degree of safety, efficacy, efficiency, and satisfaction. On the occasion of the centennial anniversary of the first use of intravenous regional anesthesia it is appropriate to recall Bier's contribution to the repertoire of anesthesiologists. The evolutionary history of both the injected drugs and the refinements of the technique are elaborated upon.

Cocaine and the eye: a historical overview.

Cocaine was brought to Europe after the discovery of America. In the 19th century, the active component of coca leaves, named cocaine, was extracted and several researchers started experimenting with the substance, describing many physiological and pathological effects of its action. The first scholar to practically demonstrate the possibility of using cocaine solution in medicine, mostly ophthalmology, was Carl Koller. Following this remarkable achievement cocaine became the substance most frequently applied for different types of anaesthesia. Halsted and Hall reported the first successful nerve block of the interior dental nerve with 4% cocaine solution. In 1892, Schleich published the results of his studies in which he used a 0.1-0.2% solution of cocaine hydrochloride intra- and subcutaneously, introducing the so-called infiltration anaesthesia. At the end of the 19th century it was, however, demonstrated that cocaine possessed many undesirable effects, including addiction, which triggered off interest in other, less toxic, anaesthetics.

Eulogy to August Karl Gustav Bier on the 100th anniversary of intravenous regional block and the 110th anniversary of the spinal block.

BACKGROUND AND OBJECTIVES: August Karl Gustav Bier introduced two important techniques in regional block: intravenous regional block and subarachnoid block, widely used nowadays. Since the first one celebrates its 100th anniversary and the second its 110th anniversary, it is only fair that we pay homage to this extraordinary physician who created them. CONTENTS: This report describes his family, school, academic course, and medical residency data, professional and university activities, personality, retirement, and death of A. K. G. Bier. It describes his countless contributions to Medicine and to Anesthesiology in particular. It discusses his research on intravenous regional block, many of them still valid nowadays or not completely explained. It mentions his initial studies and the controversies on his role in the creation of spinal block. It tells the experiences he had in both World Wars. It also mentions the great contributions of Bier to culture, sports, physical education and, especially, to ecology when he created the famous Sauen Forest. Finally, the well deserved honors he received in his home country and in other countries are mentioned. CONCLUSIONS: A. K. G. Bier created and introduced two notable and still current methods of regional blocks in Anesthesiology and was a great defender of the preservation of the environment. Therefore, since this year we celebrate the 100th anniversary of intravenous regional block, his biography deserves to be told as a tribute to this important German physician.

[The history of cocaine in medicine and its importance to the discovery of the different forms of anaesthesia]. / Historia kokainy w medycynie i jej znaczenie dla odkrycia róznych form znieczulenia.

The first description of the use of cocaine by humans can be found in the memoirs of the Florentine traveller Amerigo Vespucci (1451-1512). For the next 300 years mostly the advantages of cocaine use, also as a medication, were emphasized. In 1860 Albert Niemann (1834-1861) isolated an active ingredient of coca leaves, which he named cocaine. After his death, his work was carried on by his disciple Wilhelm Lossen (1838-1906), who finally, in 1865, determined its proper chemical formula. Although the first observations concerning the effect of cocaine on mucous membranes were made by Niemann and Lossen, the first experimental studies involving the application of cocaine to animals were performed by the Peruvian surgeon Moréno y Maïz. In 1880 Basil von Anrep (1852-1925) published the results of his studies concerning the application of cocaine to humans. In the conclusion of his work he recommended cocaine as a surgical anaesthesia. But it was finally Carl Koller (1857-1944) who, in 1884, empirically demonstrated the benefits of cocaine use in medicine, most of all in ophthalmology. Subsequently, within a couple of months, the medical world learnt about and got interested in the use of cocaine for local anaesthesia. William Stewart Halsted (1852-1922) and his collaborator Richard John Hall (1856-1897) began their own research on cocaine injections. Eventually they developed the nerve and regional blocking techniques. Nowadays, due to the potential harmful effects of cocaine and the risk of addiction, the indications for the use of cocaine as an anaesthetic are strictly limited.

Historia del tratamiento del dolor crónico. La experiencia española (1900-1970) / History of the chronic pain treatment: the spanish experience

Un tratamiento racional y eficaz del dolor crónico no comenzó a ser utilizado en la clínica hasta los primeros años del pasado siglo XX. De manera paralela, se iniciaron las prácticas de las neurotomías, neurólisis y bloqueos terapéuticos de las estructuras nerviosas periféricas, craneales y aun intracraneales, y, algo más adelante, del sistema nervioso simpático, con el propósito de interrumpir la corriente nerviosa aferente transmisora de la sensación dolorosa. Estos tratamientos y ensayos clínicos comenzaron en Alemania, Francia, EE.UU. e Inglaterra y están bien documentados, al contrario de lo que ocurre en nuestro país donde la labor realizada por los médicos españoles es prácticamente desconocida. El propósito de este estudio es conocer y valorar adecuadamente qué implantación tuvieron, en España, los distintos procedimientos terapéuticos. Nuestra investigación abarca un periodo de 75 años –entre 1900 y 1975–, y está basada en la búsqueda, análisis e interpretación de un importante conjunto documental que hemos logrado reunir en bibliotecas y hemerotecas del estado. Aunque no pretende ser del todo exhaustiva –lo que se escaparía de los límites de este trabajo-, representa un segmento importante de la misma. Se hizo un ordenamiento cronológico de las técnicas de tratamiento a medida que estas iban introduciéndose en la clínica, y a efectos metodológicos fueron clasificadas según se actuase sobre el sistema nervioso central y periférico o sobre el simpático. Del análisis de esta documentación se deduce que el tratamiento del dolor crónico, rebelde al tratamiento habitual, tuvo en España una implantación temprana e importante, paralelamente a lo que acontecía en países de nuestro entorno. También se pudo constatar que, en muchos casos, nuestros médicos se anticiparon con sus investigaciones a los de países que, en aquellos tiempos, lideraban los más importantes estudios sobre el tratamiento del dolor

It was at the beginning of the twentieth century when a rational and efficient chronic pain treatment was first used. The practice of neurotomies, neurolisis and therapeutic blockades of peripheral, cranial and even intracranial nervous structures were initiated at the same time. A little bit later was the beginning ofthe sympathetic nervous system blockades with chemical substances with the intention of interrupt the afferent nervous current that transmit the pain sensation.This treatments and clinical essays were first employed in Germany, France, United States of America and Great Britain where many doctors were famous due to their good practice. Otherwise, the labour done by the Spanish doctors was practically unknown.The aim of this study is to know and evaluate the implantation of these treatments against chronic pain in Spain. Our investigation includes a 75 years period, between 1900 and 1975, and it is based on the search, analysis and interpretation of an important documental material that we could find in the libraries of our country. Even though it does not try to be exhaustive –it would exceed this study limits– it turns out to be a good representation of the chronic pain treatment topic. A chronological register of the treatment techniques was done as these were being introduced in clinic and they were classified in based of its actuation over central, peripheral or sympathetic nervous system. After the analysis of this documentation we deduce that the chronic pain, rebel to usual treatment, had an early an strong implantation in Spain, simultaneously to other countries of our environment. It was also possible to verify that in many cases were our doctors who overcame with their investigations the doctors of the countries that leaded the studies about pain

Neuromuscular block.

Descriptions of the South American arrow poisons known as curares were reported by explorers in the 16th century, and their site of action in producing neuromuscular block was determined by Claude Bernard in the mid-19th century. Tubocurarine, the most important curare alkaloid, played a large part in experiments to determine the role of acetylcholine in neuromuscular transmission, but it was not until after 1943 that neuromuscular blocking drugs became established as muscle relaxants for use during surgical anaesthesia. Tubocurarine causes a number of unwanted effects, and there have been many attempts to replace it. The available drugs fall into two main categories: the depolarising blocking drugs and the nondepolarising blocking drugs. The former act by complex mixed actions and are now obsolete with the exception of suxamethonium, the rapid onset and brief duration of action of which remain useful for intubation at the start of surgical anaesthesia. The nondepolarising blocking drugs are reversible acetylcholine receptor antagonists. The main ones are the atracurium group, which possess a built-in self-destruct mechanism that makes them specially useful in kidney or liver failure, and the vecuronium group, which are specially free from unwanted side effects. Of this latter group, the compound rocuronium is of special interest because its rapid onset of action allows it to be used for intubation, and there is promise that its duration of action may be rapidly terminated by a novel antagonist, a particular cyclodextrin, that chelates the drug, thereby removing it from the acetylcholine receptors.

Posterior lumbar plexus block: anatomy, approaches, and techniques.

Lumbar plexus is an effective but underused regional technique that was described nearly 3 decades ago. The original description has been modified several times based on advances in technology, localization, and imaging techniques. This review provides an overview of the history, anatomy, and techniques described to perform this block.