Lucien E. Morris

The University of Oklahoma: The First Independent Academic Anesthesia Department?

John Alfred Moffitt, M.D., was the Head of the Department of Anesthesiology at the Oklahoma Medical Center when it became the first ever academic independent Department of Anesthesia. Photograph courtesy of the University of Oklahoma Bird Library Medical History Archives at the OU Health Sciences Center by Mr. Jack Wagner. Introduction The true independence of a teaching department in an academic setting is based on its organizational separation from other departments with which it is affiliated. In academic anesthesia, such independence was unheard of for three quarters of century after the introduction of clinical anesthesia in 1846. The struggle for academic independence and authority for anesthesiology reached a high point in the second quarter of the 20 century when Dr. Ralph Waters established an academic anesthesia teaching center in Madison, Wisconsin in 1927. Yet, despite his vision and the sympathetic endorsement of his surgical colleagues, Dr. Waters’ division of anesthesia at the University of Wisconsin remained, not as an independent teaching program in the form of a department, but a section under the department of surgery. It took another quarter century for this beacon of anesthesia education to achieve full independent status in 1952. Organized medicine worldwide was slow to recognize the importance of anesthesia as a specialty. An inevitable question will be asked; if the Wisconsin program was not the beginning of true independent academic anesthesia teaching for medical students in 1927, when and where did such a program begin, and how? To date, all indications point to the University of Oklahoma, when a trained anesthesiologist from the Wisconsin program joined the faculty of the medical school in Oklahoma City as an instructor in anesthesia and assumed the leadership of the first truly independent Department of Anesthesia in 1930.

Inspired humidity in anaesthesia breathing circuits: comparison and examination of effect of Revell circulator

Humidity levels of respired gases in spontaneously breathing patients were measured with a quadrupole mass spectrometer (Medishield Model MS-2) and compared between various anaesthetic systems during clinical anaesthesia. In studies of high flow rebreathing non-absorption systems the mean inspired absolute humidity averaged approximately16 mg.l-1 (range 14.7 to 16.1 mg.l-1) compared to a semiclosed circle absorption system (BOC MK 111) in which values for absolute humidity varied from 6.8 ± 5.1 mg.l-1 for children through 9.5 ± 3.0 mg.l-1 for adults, and the closed circle absorption system in which values of 20.5 ± 2.3 mg.l-1 were only gradually reached. Addition of a functioning Revell circulator to the circle absorption system provided immediately markedly higher levels of inspired humidity during clinical use, either semiclosed (15.4 ± 5.1 mg.l-1 in children to 18.8 ± 2.4mg.l-1 in adults), or closed (23.3 ± 1.8mg.l-1 in adults). These markedly higher inspired levels of absolute humidity were attained during forced circulation of respired gas provided by the Revell circulator without the concomitant disadvantages of rebreathing or the potential hazards associated with some humidifying devices.RésuméA l’aide d’un spectromèlre de masse, on a mesuré l’humidité absolue des gaz respirés spontanément à travers différents montages d’anesthésie par des patients sous anesthésie.Pour les systèmes à grand débit de gaz avec réinspiration sans absorption de CO2, l’humidité absolue moyenne était de 16 mg par litre (14.7 à 16.1 mg par litre). Pour le système demi fermé avec absorption (BOC MK 111), ces mêmes valeurs étaient de 6.8 ±5.1 mg par litre pour les enfants et 9.5 ± 3mg par litre pour les adultes. Pour le système fermé avec absorption, l’humidité absolue parvenait graduellement à 20.5 ± 2.3 mg par litre. L’inclusion, dans les circuits avec absorption, d’un circulateur de Revell, élevait rapidement les niveaux d’humidité à 15.4 ± 5.1 mg par litre chez les enfants et à 18.8 ±2.4 mg par litre chez les adultes pour le circuit demi fermé et à 23.3 ± 1.8 mg par litre pour le circuit fermé. Ces niveaux êlevés d’humidité absolue sont possibles grâce au circulateur de Revell qui permet d’éviter les désavantages des systèmes avec réinspiration et les complications toujours possibles de certains appareils d’humidification.

Copper kettle revisited

An increasing dissatisfaction with available equipment for the vaporization of liquid anesthetics led to a focused effort to design a new and improved vaporizer. Deficiencies in existing apparatus were identified as a lack of vernier control over small increments for gradually increasing the concentration of the vapor, and the lack of a steady reproducible vapor output due to the wide variation in temperature of the vaporizing liquid Therefore a new apparatus has been designed to provide reproducible conditions for effective vaporization and vernier control over small increments in concentration of vapor offered to the patient. The important modifications for attaining these desired conditions are in the circuit design, the liquid container, and the vaporizing surface. Since there are still many occasions for which liquid anesthetics are being used as the agent of choice, it seems desirable to have available a device that provides the physician with discrete control over the vapor volumes and concentrations of these agents.

Effects of Anesthesia on Irradiated Animal

The relative influences of various anesthetics were investigated in mice and rats given whole-body irradiation of 200-1100 and 600-750 r respectively. The LD50 of radiation was 650 r in mice and approximates 700 r in rats. The 30-day mortality in rats was 0% at 625 and 650 r; 40% at 675 r, and 100% at 750 r. All of the anesthetic agents tested increased the mortality or morbidity, depending on the radiation dose. Chloroform and trifluoroethyl vinyl ether was most detrimental, halothane was least injurious, whereas cyclopropane and ethyl ether showed intermediate toxicity in irradiated animals. Hypercarbia and hypoxia developing during anesthesia did not appear to enhance mortality or morbidity following irradiation, however, burns (dipping rats in water at 62 deg C for 5 min) enhanced these effects in anesthetized-irradiated animals. Intravenous injection of lidocaine produced a higher mortality when carried out within a few hours after irradiation than 3 days later. It is concluded that halothane is the most satisfactory anesthetic agent following irradiation and that it is best given 24 hr or later after exposure. (H.H.D.)