When and where the history of volatile anesthesia started and what was the story ? Whom was the triggering for discovering the effect of volatile anesthesia on human being ? How the volatile anesthesia developed year by year till reach the best and the most safe volatile anesthetic ? What were the complications of old volatile anesthetics ?

1. Inhalational Anesthetics
History
Mahmood Hasan Taha
HD/ Anesthesia
Zakho General H.
Aug/2022

2. Old Agent Release/
use
New Agent Release/
use
Ether 1846 Halothane 1956
Chloroform 1847-1848 Enflurane 1966
Cyclopropane 1936 Isoflurane 1979
Sevoflurane 1990
Desflurane 1992

3. History
• In 1845 Horace Well, attempted
unsuccessfully to demonstrate the analgesic
properties of Nitrous Oxide.
• T.G Morton American dentist (1819-1868).
With his former teacher, Boston chemist,
Charles Jackson, The tow discussed the use of
Ether (C2H5)2O.

4. • On September 30, 1846, Morton did first
painless tooth extraction using Ether.
• On October 16,1846, a demonstration of Ether
at the operating room of Massachusetts General
Hospital MGH.

5. Morton made the first successful surgery:
• Removing a tumour from the neck.
• Patient : Mr Edward Gilbert Abbott
• Surgeon Dr. John Collins Warren, in the same
theatre where Wells had failed nearly tow
years earlier using nitrous oxide.

6. • The entire medical community had been
shocked when the patient wasn't screaming.
• This theatre came to be known as the:
Ether Dome.
• The 16th of October being the Ether Day
which nowadays known as:
Anesthesia Day.

7. Ether Dome/MGH/Boston

8. • So, Ether was first brought to public attention
by …….?

9. Charles T. Jackson William T.G Morton

10. Unfortunately for Morton; other doctors tried
to claim that they discovered it before him, like
chemist Dr.Charles T. Jackson, and Dr. Crawford
Long, who claimed to have use it four or five
years earlier, but never showed it to the public.

11. Crawford Long

12. Replica of Morton Inhaler
(Morton Etherizer)

13. Early Inhaler for Ether

14. Advanced Etherizer

15. Chloroform (CHCl3)
First produced in 1831.
Simultaneously in the USA by Samuel Guthrie
and in France by Eugene soubeiran.

16. Samuel Guthrie Eugene Soubeiran
USA France

17. Dr. James Young Simpson
The first narcosis with Chloroform was
performed by Dr. James Young Simpson on
himself on November 4, 1847.

18. • The first fatality was a15 years old girl called:
Hnnah Greener, who died on January 28,
1848, after receiving a Chloroform for the
removal of toenail.
• The question remain of whether the
complications were solely due to respiratory
disturbance or whether Chloroform had a
specific effect on the heart ?!

19. Hnnah Greener, receiving a Chloroform
for the removal of toenail, January 28, 1848

20. • Between 1864 and 1910 numerous
commissions in U.K studied Chloroform, but
failed to come to any clear conclusions. It was
only in 1911 that A.G Levy proved in
experiments with animals that Chloroform can
cause ventricular fibrillation.

21. • Between about 1865 and 1920, Chloroform
was used in 80 to 95% of all narcosis
performed in U.K and German speaking
countries.

22. Chloroform inhaler devised in 1850 by John Snow

23. Levy- type regulating Chloroform Inhaler
England 1919

24. Murphy type Chloroform inhaler

25. • In 1934, Hans Franz Edmund Killian, gathered
all the statistics compiled until then and found
the chances of suffering fatal complications
under Ether were between 1:14000 and
1:28000, were as under Chloroform the
chance were between 1:3000 and 1:6000

26. Hans F. E.Killian

27. • The rise of gas anesthesia using Nitrous,
improved equipment for administering
anesthesia and the discovery of Hexobarbital,
an IV anesthetic in 1932 led to the gradual
decline of Chloroform narcosis.
• In 1947 Ralph M. Waters attempted to
reactivate Chloroforom, but failed. The story
of clinical use of Chloroform ended 1976.

28. Dr. Ralph M. Waters

29. Cyclopropane
C3H6
• Discovered in 1881 by August Freund
(a German chemist).
• Its anesthetic properties discovered in 1929
by Henderson and Lucas.
• Industerial production: 1936.
• Introduced into clinical use by the American
anesthetist Ralph M. Waters who used a
closed system with carbon dioxide absorption
to conserve this costly agent.

30. Physical properties:
• Relatively potent.
• Colorless.
• Highly flammable.
• Sweet petrol smell.
• Nonirritating to mucous membrane and does
not depress respiration.
• Applied by cylinders and flow meters were
colored orange.

31. Cyclopropane cylinder and flow rate

32. Cyclopropane cylinders, orange colored

33. • MAC is 17.5%.
• Blood/gas partition coefficient is 0.55.
• Induction and emergence from cyclopropane
anesthesia are usually rapid and smooth.
• Cyclopropane shock: prolonged anesthesia
sudden decrease in blood pressure, cardiac
dysrhythmia.

34. • Shock, as well as its high cost and its explosive
nature, it was latterly used only for the
induction of anesthesia.
• Its clinical use ended since the mid 1980s.