Vital Times 2020 - 107

HISTORY OF ANESTHESIA

History and COVID-19, Part II:
An Anesthesia Perspective
Jane S. Moon, MD

I

n what is now a
familiar refrain, many
of us in anesthesiology,
including Surgeon General
Jerome Adams, MD, MPH,
are on the front lines of
a global pandemic. This
is an historic moment
for our specialty.
As we reflect on this occasion, it is inspiring
to recall the anesthesiologists who have come
before us. Their past innovations-now key
components of COVID-19 care-have allowed us
to be in this position to serve. We are thus part
of a narrative that is larger than ourselves-one
that Edmond " Ted " Eger II, MD, Lawrence Saidman,
MD, and Rod Westhorpe, OAM, MB, MS, have
called " the wondrous story of anesthesia. " 1

An Epidemic and an Anesthesiologist
It was August 1952, and the infectious disease
hospital in Copenhagen was flooded with polio
patients. Within the first three weeks, nearly 90
percent of the 31 patients admitted with bulbar polio
had died. The hospital's modest ventilator supply,
consisting of one iron lung and six cuirass shells,

was quickly overwhelmed. These negative-pressure
machines were insufficient to treat full-blown
respiratory paralysis. Blood-gas analysis was
non-existent.
At this moment of desperation, it was an
anesthesiologist who saved the day. Bjørn
Ibsen, DrMed, rapidly determined that the
elevated blood carbon dioxide content of these
patients indicated not a primary alkalosis,
as traditionally thought, but rather a severe
respiratory acidosis. 2 Aggressive ventilation
was needed. His intuition came from a recent
experience with a tetanic child who had required
paralysis and manual bag ventilation to survive.
Dr. Ibsen's solution was to place a cuffed
endotracheal tube through a tracheostomy, and to
enlist 200 medical students to provide continuous
ventilation by hand. Some patients were treated
in this manner for weeks. Thanks to this extreme
measure, the Danes witnessed a miracle-mortality
dropped from ~90 percent to ~25 percent.
Thus, an anesthesiologist initiated the first
prolonged use of positive-pressure ventilation
for respiratory failure. This also marked one of
the first times that an anesthesiologist moved

Annual Publication 2020

| 107



Vital Times 2020

Table of Contents for the Digital Edition of Vital Times 2020

No label
Vital Times 2020 - Cover1
Vital Times 2020 - Cover2
Vital Times 2020 - No label
Vital Times 2020 - 2
Vital Times 2020 - 3
Vital Times 2020 - 4
Vital Times 2020 - 5
Vital Times 2020 - 6
Vital Times 2020 - 7
Vital Times 2020 - 8
Vital Times 2020 - 9
Vital Times 2020 - 10
Vital Times 2020 - 11
Vital Times 2020 - 12
Vital Times 2020 - 13
Vital Times 2020 - 14
Vital Times 2020 - 15
Vital Times 2020 - 16
Vital Times 2020 - 17
Vital Times 2020 - 18
Vital Times 2020 - 19
Vital Times 2020 - 20
Vital Times 2020 - 21
Vital Times 2020 - 22
Vital Times 2020 - 23
Vital Times 2020 - 24
Vital Times 2020 - 25
Vital Times 2020 - 26
Vital Times 2020 - 27
Vital Times 2020 - 28
Vital Times 2020 - 29
Vital Times 2020 - 30
Vital Times 2020 - 31
Vital Times 2020 - 32
Vital Times 2020 - 33
Vital Times 2020 - 34
Vital Times 2020 - 35
Vital Times 2020 - 36
Vital Times 2020 - 37
Vital Times 2020 - 38
Vital Times 2020 - 39
Vital Times 2020 - 40
Vital Times 2020 - 41
Vital Times 2020 - 42
Vital Times 2020 - 43
Vital Times 2020 - 44
Vital Times 2020 - 45
Vital Times 2020 - 46
Vital Times 2020 - 47
Vital Times 2020 - 48
Vital Times 2020 - 49
Vital Times 2020 - 50
Vital Times 2020 - 51
Vital Times 2020 - 52
Vital Times 2020 - 53
Vital Times 2020 - 54
Vital Times 2020 - 55
Vital Times 2020 - 56
Vital Times 2020 - 57
Vital Times 2020 - 58
Vital Times 2020 - 59
Vital Times 2020 - 60
Vital Times 2020 - 61
Vital Times 2020 - 62
Vital Times 2020 - 63
Vital Times 2020 - 64
Vital Times 2020 - 65
Vital Times 2020 - 66
Vital Times 2020 - 67
Vital Times 2020 - 68
Vital Times 2020 - 69
Vital Times 2020 - 70
Vital Times 2020 - 71
Vital Times 2020 - 72
Vital Times 2020 - 73
Vital Times 2020 - 74
Vital Times 2020 - 75
Vital Times 2020 - 76
Vital Times 2020 - 77
Vital Times 2020 - 78
Vital Times 2020 - 79
Vital Times 2020 - 80
Vital Times 2020 - 81
Vital Times 2020 - 82
Vital Times 2020 - 83
Vital Times 2020 - 84
Vital Times 2020 - 85
Vital Times 2020 - 86
Vital Times 2020 - 87
Vital Times 2020 - 88
Vital Times 2020 - 89
Vital Times 2020 - 90
Vital Times 2020 - 91
Vital Times 2020 - 92
Vital Times 2020 - 93
Vital Times 2020 - 94
Vital Times 2020 - 95
Vital Times 2020 - 96
Vital Times 2020 - 97
Vital Times 2020 - 98
Vital Times 2020 - 99
Vital Times 2020 - 100
Vital Times 2020 - 101
Vital Times 2020 - 102
Vital Times 2020 - 103
Vital Times 2020 - 104
Vital Times 2020 - 105
Vital Times 2020 - 106
Vital Times 2020 - 107
Vital Times 2020 - 108
Vital Times 2020 - Cover3
Vital Times 2020 - Cover4
https://www.nxtbook.com/allen/csvt/vital-times-2021
https://www.nxtbook.com/allen/csvt/2020
https://www.nxtbook.com/allen/csvt/2019
https://www.nxtbook.com/allen/csvt/2018
https://www.nxtbook.com/allen/csvt/2017
https://www.nxtbook.com/allen/csvt/2016
https://www.nxtbook.com/allen/csvt/2015
https://www.nxtbook.com/allen/csvt/2014
https://www.nxtbookmedia.com