Convulsions During Anesthesia

Cassels, W. H.; Becker, Therese; Seevers, M. H.

doi:10.1097/00000542-194007000-00006

Cited by 7 publications

(3 citation statements)

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“…The baling Dr. Jekyll/Mr. Hyde nature of this phenomenon was initially attributed to fever or occult medical problems [71,72] . The causative role of CO 2 was soon recognized [73] , but practitioners were reluctant to abandon the utility of CO 2 supplementation.…”

Section: Shortcomings Of the Crile/henderson Techniquementioning

confidence: 99%

“…Based on extensive animal experiments, Dr. Henderson had recommended 5% CO 2 supplementation during anesthesia to prevent postoperative respiratory depression, atelectasis and nausea, but practicing anesthetists quickly embraced mixtures of 25% CO 2 and 75% O 2 that produced superior clinical results [30,76,77] . Reports of mysterious convulsions and deaths during anesthesia soon appeared [71] , but these disasters were initially attributed to fever and occult medical problems [72,73] . Dr.…”

Section: The First Paper:" Carbon Dioxide: Its Place In Anesthesia"mentioning

confidence: 99%

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Four Forgotten Giants of Anesthesia History

Coleman¹,

Internationals²

2016

JAS

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Introduction Does wisdom perhaps appear on the earth as a raven, which is inspired by the smell of carrion? --Friedrich NietzschePast is prologue. Carbon dioxide confusion has played a pivotal role in the evolution of modern anesthesia. Professional anesthesiology organizations have persistently neglected CO 2 management standards in favor of lesser issues [1][2][3][4] , so that the anesthesiology profession remains mired at the crossroads of revolutionary advance and ongoing self-destruction that can only be understood in historical context. Dr. Ralph Waters founded the profession on the basis of a practical new technique that introduced elective intubation and hyperventilation to abolish CO 2 toxicity disasters, but the harmful habit of hyperventilation has distorted anesthesia beliefs, habits, and practices; derailed research; halted professional advance; discouraged opioid treatment; abolished the therapeutic beneits of CO 2 ; exaggerated morbidity and mortality; and introduced a host of vexing clinical problems. It has indirectly fostered the iction that further improvements in anesthesia safety are impossible, which has undermined reimbursement, emasculated staf privileges, devastated morale, discouraged professional membership A , and rationalized the replacement of anesthesiologists by nurses.Meanwhile, the confusing chemistry, physiology, and pathology of carbon dioxide have yielded their secrets, modern anesthesia machines have eliminated the toxicity problem, modern agents have eliminated explosions, and modern monitoring AbstractThe anesthesiology profession may one day serve as a cautionary tale of how power, politics and privilege can perturb science and progress. Previous anesthesia practitioners possessed a superior understanding of physiology and pharmacology, but overenthusiastic CO 2 supplementation with inadequate monitors and machines caused asphyxiation disasters that were improperly attributed to CO 2 toxicity. Dr. Ralph Waters founded the anesthesiology profession on the basis of a practical new anesthetic technique that introduced elective intubation and hyperventilation to eliminate CO 2 toxicity, but mechanical hyperventilation dangerously depletes CO 2 tissue reserves and exaggerates morbidity and mortality. The beneits of CO 2 supplementation were forgotten, and consequent CO 2 confusion has derailed research, discouraged opioid treatment, damaged patient safety, and disrupted professional progress. Anesthesiologists can no longer claim to provide superior service, and hospital administrators are replacing them with nurses. Professional membership is in decline, and professional survival is in question. Modern machines have eliminated asphyxiation, and modern monitoring enables safe and beneicial hypercarbia that complements opioid treatment and minimizes surgical morbidity and mortality. CO 2 reform promises revolutionary advance but faces formidable opposition. [5] . The restoration of past principles using modern capnography, pulse oximetry, synthetic opioids, and improved inha...

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Section: Shortcomings Of the Crile/henderson Techniquementioning

confidence: 99%

Section: The First Paper:" Carbon Dioxide: Its Place In Anesthesia"mentioning

confidence: 99%

Four Forgotten Giants of Anesthesia History

Coleman¹,

Internationals²

2016

JAS

View full text Add to dashboard Cite

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“…5). In the literature, many factors were advanced as causes and conflicting evidence was noted, wxth authorities incriminating the following precipitants for convulsions asr wzth general anaesthesia: epileptic liability (8--4), toxaemia, septicaemia, excess or deficiency of CO2, impuritie~ in ether and in CA_NADIAN ANAESTHETISTS' SOC'ETY ]OU-flNAL oxygen, deep or hght anaesthesia, faulty methods of anaesthesia, hypoglycaemm, atropine, alkalosis, overbreathing, disturbance in calcium metabolism, ketosls, cerebral anaemia, cerebral injury or accident, increased cerebral blood flow, hydration of protein partacles m the plasma, convulsant poisons, hyperthermia (5), hyperpyrexia and respiratory acidosis (6), or that the underlying cause was a temporary, easdy reversible derangement of physiolo[~, rather than ~t convulsive dlathesis (7). COMMENT We have found the electroencephalogram to be an excellent tool wath winch to check the constancy and depth of anaesthesia.…”

Section: S~'c [ So~ Vmentioning

confidence: 99%

Electroencephalographig warning of impending localized cerebral disorder during anaesthesia

Sadove

Yarbrough

Murray

et al. 1959

Canad. Anaesth. Soc. J.

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Dr_mlNa Tm~ LAST TWO Y~ARS continuous electroencephalograms have been taken during surgmal cases m an effort to correlate the changes in the brain wave patterns with the depth of anaesthesia We have had the opporttmlty to study a variety of anaesthetm agents, and to observe the more or less gradual development of various critical conditions in a number of ,our cases One of these we have reported (1), but the present ease is bastcally different and o~ sufficient general interest to warrant a detailed descnpt_ton As will be explained in the body of tl~s report, we were able to watch the development of a locahzed ,epfleptac dlscharge m a patmnt with a pre-exastmg neurological lesmn. Apparently the anaesthetic techmque and/or the operative procedure aggravated the focal disorder and precipitated the cerebral symptoms A retropubic prostatectomy was performed on a poor i lsk pataent with a lalstory of an old cerebrovascular accident The electroencephalogram was used for purposes of study and as a control to keep the pataent at an analgesm level it has been our experience that the electroencephalogram is an excellent tool winch aids the anaesthesmloglst m mamtamlng a patient at the desired level of analgesia or surgical anaesthesm It was during tins surgical procedure that the electroencephalogram recorded a right cortmal seizure fully two minutes before ,t left-sided Jacksoman seizure was noted chmeally PATIENT'S HISTORYA 67-year-old white male was admitted April 12, ]958 with a diagnosis of acute urinary retention Physical examination revealed blood pressure of 180/75 and a regular -gulse There was a left lower facial paresis, and some deviation of the head to the _-eft Pupils were equal and reacted to light and aceommodat~Lon Extra-ocular movements were normal Control of fine movements was absent m the left hand and there was residual weakness of the left side of his body The remainder of the neurologmal examination gave normal findmT, s for the patmnt's age Prostate was found to be 2 to 8 plus enlarged and nodular k~he electroeardlograpme tracing revealed coronary msufl~cmncy and ventncular strata Serology was negatwe wa~ blood count and urinalysis reported within normal hmlts The -~atmnt had a history of hyoertensmn and cerebrovascular accident in 1947 at whm a t~me there was a h~rpoaestnesm of the left side of the face Corneal reflexes were apparent on the left "~Vhen the pataent's law was opened, there was a deviation to the right There was left faeml droop and the tongue devmted left with some tremor The shoulder muscles were weak on the left. Hypoaesthesm existed on the left and the deep tendon reflexes were absent that side 1Dwlslon

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