59 - Cardiac arrest during anesthesia

Summary

Introduction

Without the inherent risk of cardiac arrest (CA), anesthesia might not have developed as an acknowledged medical specialty in its own right. Only a year after painless surgery was made possible in 1846 by W.T.G. Morton 's use of ether as an anesthetic, cases of death under inhalation anesthesia occurred in England. In 1848, Hannah Green, a young healthy patient undergoing a trivial procedure for removal of an infected toenail, became the first reported fatality from chloroform anesthesia and, even today, her name stands for every anesthesiologist 's nightmare.

John Snow, whose work on resuscitation is less well known than his contributions to the scientific foundations of anesthesia for infants, had by 1841 accumulated considerable expertise in the field of resuscitating asphyxiated stillborns. With his monograph On Chloroform and Other Anaesthetics published in 1858, John Snow became the world 's first scientific anesthesiologist, and with his review of 50 cases of fatal chloroform administration he also became the first researcher on the mechanism of critical incidents and the first promoter of modern resuscitation medicine. Some of his recommended techniques of resuscitation included use of the “tracheal tube,” administration of oxygen, mouth-tomouth or mouth-to-nostril ventilation, compression of the ribs and abdomen, and introduction of galvanic current. Thus, CA strongly influenced the professionalization of anesthetic practice, while at the same time anesthesia offered the hitherto unknown opportunity for investigating and treating a multitude of expected, observed, and, later on, monitored and instrumented cases of CA that have facilitated the successes in modern resuscitation medicine during the last 150 years.