How chloroform anesthesia reached Lowell, Massachusetts: From Simpson's pamphlet to Gladwin's advertisement.

J.Y. Simpson of Edinburgh, Scotland discovered chloroform anesthesia in November 1847. During this time, W.T.G. Morton's agents had been collecting royalties for the use of ether across much of the United States. After reading about the advantages of chloroform as cited in C.T. Jackson's writings in the Boston Daily Atlas, S.F. Gladwin, a dentist in Lowell, Massachusetts, who had been reluctant to pay any ether royalties, demonstrated his independence and opportunism in swiftly adopting chloroform in his practice and publicizing its use through local advertisements.

Impending Paradoxical Embolism: Perioperative Management and Role of Transesophageal Echocardiography.

Impending paradoxical embolism is a rare but potentially life-threatening complication of venous thromboembolism that is usually associated with acute pulmonary embolism and a right to left atrial shunt. Patients may have associated right ventricular pressure or volume overload with subsequent failure. Transesophageal echocardiography is the preferred diagnostic test of choice in this patient group. Definitive management has yet to be clearly defined. However, emergent surgical removal of the entrapped intracardiac blood thrombus may be necessary. In this article, we review a case of impending paradoxical embolism managed surgically and describe the perioperative anesthetic considerations in this patient population, along with the role of intraoperative transesophageal echocardiography.