Canadian Journal of Anaesthesia

, Volume 44, Issue 5, pp 535–542

Stethoscopy during anaesthesia

  • John W. R. McIntyre
Review Article

Abstract

Purpose

First, to determine when, following the description of stethoscopy by Laennec. it was used by anaesthetists in an operating room and. second, to describe the developing possibilities for stethoscope monitonng.

Methods

A manual search of the medical literature based onIndex Medicus and relevant publications were obtained and analyzed. Textbooks randomly available were also read.

Principal Findings

Stethoscopy was first described early in the 20th century but was not widely recommended for anaesthesia until the 1950s. The change in attitude to stethoscopy during anaesthesia was probably due to alterations in anaesthesia delivery: increasing difficulty in employing direct human sensing. However the complexity of practice often makes traditional stethoscopy ergonomically unsatisfactory. Substantial research in the sensing and analysis of lung sounds support the contention that cheap visual displays of information from suitably designed sensors could be made available for anaesthetists.

Conclusion

Current advances in sensing, analysis, and display of lung sounds could be used to create a simple and cheap device helpful for monitonng in the operating room.

Résumé

Objcctif

D’abord déterminer quand le stéthoscope tel que décrit par Laennec a été utilisé par les anesthésistes en salle d’opération, et deuxièmement, exposer les possiblité qu’il offre pour le monitorage.

Méthodcs

Recherche manuelle et analyse de la littérature médicale pertinente basée sur I’Index Medicus et la lecture de manuels choisis au hasard.

Principales consultations

L’usage du stéthoscope remonte au début du vingtième siècle mais n’a été réellement recommandé que dans les années 50. Ce changement d’attitude envers le stéthoscope est vraisemblablement dû aux modifications apportées à une façon d’administrer I’anesthésie qui est nuisible pour la surveillance immediate. Cependant, sur le plan de I’ergonomie, la complexité de I’anesthésie a rendu pénmé l’usage du stéthoscope traditionnel. Une recherche importante sur la réception et I’analyse des bruits pulmonaires supporte I’opinion selon laquelle les anesthésistes pourraient disposer d’un affichage visuel de I’information à partir de capteurs conçus spécialement et rendus disponibles à bon marché.

Conclusion

Des developpements recents en rapport avec la réception, I’analyse et I’affichage des bruits pulmonaires pourraient être utilisés pour fabriquer un dispositif simple et peu coûteux pour le monitorage en salle d’opération.

References

  1. 1.
    Sakula A. In search of Laënnec. J Roy Coll Physicians Lond 1981; 15: 55–7.Google Scholar
  2. 2.
    Sakula A. RTH Laënnec 1781–1826. His life and work: a bicentenary appreciation. Thorax 1981; 36: 81–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Hoyle C. The life and discoveries of René Laennec. British Journal of Tuberculosis 1944; 38: 24–35.Google Scholar
  4. 4.
    Keers RY. Laennec: his medical history. Thorax 1981; 36: 91–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Fox ERW. Mrs Laennec and the stethoscope. West J Med 1981; 134: 73–4.PubMedGoogle Scholar
  6. 6.
    Jarcho S. An early review of Laennec’s treatise. Am J Cardiol 1962; 9: 962–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Jarcho S. Scudamore on Monsieur Laennec’s method (1826), Am J Cardiol 1963; 11: 507–12.PubMedCrossRefGoogle Scholar
  8. 8.
    King LS. Auscultation in England, 1821–1837. Bull Hist Med 1959; 33: 446–53.PubMedGoogle Scholar
  9. 9.
    Sheldon PB, Doe J. The development of the stethoscope. An exhibition. Bull NY Acad Med 1935; 11: 608–26.Google Scholar
  10. 10.
    Solis-Cohen S. Exhibition of an oesophageal stethoscope, with remarks on intra-thoracic auscultation. Trans Coll Physicians Philadelphia 1893; 3.5 XV: 218–21.Google Scholar
  11. 11.
    Hale-White W. The history of percussion and auscultation. Lancet 1924; 1: 263–5.CrossRefGoogle Scholar
  12. 12.
    Young RA. The stethoscope: past and present. Trans Coll Physicians Philadelphia 1931; 54: 1–22.Google Scholar
  13. 13.
    Johnston AJ. Listening to the lungs (Editorial). BMJ 1978; 2: 1789–90.PubMedGoogle Scholar
  14. 14.
    Sakula A. Laennec’s influence on some British physicians in the nineteenth century. J Roy Soc Med 1981; 74: 759–67.PubMedGoogle Scholar
  15. 15.
    Andrews JL Jr, Badger TL. Lung sounds through the ages. From Hippocrates to Laënnec to Osler. JAMA 1979; 241: 2625–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Reiser SJ. The medical influence of the stethoscope. Sci Am 1979; 240: 148–56.PubMedCrossRefGoogle Scholar
  17. 17.
    Kirk R. On auscultation of the heart during chloroform narcosis. BMJ 1896; 2: 1704–6.Google Scholar
  18. 18.
    Duncum BD. The Development of Inhalational Anaesthesia. With Special Reference to the Years 1846–1900. Oxford University Press, 1947.Google Scholar
  19. 19.
    Gushing H. Technical methods of performing certain cranial operations. Surg Gynecol Obstet 1908; 6: 227–34.Google Scholar
  20. 20.
    Shephard DAE. Harvey Cushing and anaesthesia. Can Anaesth Soc J 1965; 12: 431–42.PubMedCrossRefGoogle Scholar
  21. 21.
    Kane EO. Wearing of branching stethoscope by surgeons and anaesthetist during operation. Surg Gynecol Obstet 1924; 39: 508.Google Scholar
  22. 22.
    Smith C. An endo-esophageal stethoscope. Anesthesiology 1954; 33: 566.Google Scholar
  23. 23.
    Pryor WJ. Oesophageal stethoscope. Anaesthesia 1964; 19: 295–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Cullingford DWJ. An endo-oesophageal stethoscope. Br J Anaesth 1964; 36: 524–6.PubMedCrossRefGoogle Scholar
  25. 25.
    tBaker AB, McLeod C. Oesophageal multipurpose monitoring probe. Anaesthesia 1983; 38: 892–7.CrossRefGoogle Scholar
  26. 26.
    O’Dea J, Hall I. Oesophageal stethoscope (Letter). Anaesthesia 1987; 42: 1337–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Laycock JD. Auscultation in anaesthesia. BMJ 1954; 1: 151–2.Google Scholar
  28. 28.
    Cole F. A new stethoscope for the anesthesiologist. Anesth Analg 1954; 33: 143–4.Google Scholar
  29. 29.
    Anand JS. A simple pediatric constant-monitoring device. Anesth Analg 1972; 51: 387–8.PubMedCrossRefGoogle Scholar
  30. 30.
    tKainuma M, Shimada Y. A breathing-circuit stethoscope for continuous monitoring of breath sounds. Anesth Analg 1987; 66: 1057–8.CrossRefGoogle Scholar
  31. 31.
    Doyle JD, Teves LY, Jhwar BS. Phonocardiographic monitoring using a special endotracheal tube. Can J Anaesth 1990; 37: S105.PubMedCrossRefGoogle Scholar
  32. 32.
    Marshall BM. Air embolus in neurosurgical anaesthesia, its diagnosis and treatment. Can Anaesth Soc J 1965; 12: 255–61.PubMedCrossRefGoogle Scholar
  33. 33.
    Wilson ABK, Fothergill L, Taylor S. Some applications of a new electronic stethoscope. Lancet 1956; 271: 1027–8.PubMedGoogle Scholar
  34. 34.
    Feingold A, Lowe HJ, Holaday DA, Griem ML. Inhalation anesthesia and remote monitoring during radiotherapy for children. Anesth Analg 1979; 49: 656–9.Google Scholar
  35. 35.
    Sarnat AJ, Kemp JA. Monitoring ventilation during computed tomography scan (Letter). Anesthesiology 1985; 63: 729.PubMedCrossRefGoogle Scholar
  36. 36.
    Shane SM, Ashman H. An improved device to amplify the sounds of respiration of anesthetised patients. JAMA 1957; 163: 261.Google Scholar
  37. 37.
    Douglass R, Doddapaneni B. Esophageal stethoscope amplifier. Anesth Analg 1985; 64: 377–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Ginott N. Vacuum stethoscope attached to a tape recorder. A simple device for monitoring respiration and pulse rate. Anaesthesia 1977; 32: 896–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Redon D, DeTraglia MC. Inexpensive stethoscopic transmitter (Letter). Anesthesiology 1987; 67: 283.PubMedCrossRefGoogle Scholar
  40. 40.
    Rence WG, Cullen SC, Hamilton WK. Observations on the heart sounds during anesthesia with cyclopropane or ether. Anesthesiology 1956; 17: 26–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Huang KC, Kraman SS, Wright BD. Video stethoscope — a simple method for assuring continuous bilateral lung ventilation during anesthesia. Anesth Analg 1983; 62: 586–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Turnbull L. The Advantages and Accidents of Artificial Anaesthesia. Philadelphia: Lindsay and Blakiston, 1878.Google Scholar
  43. 43.
    Lyman HM. Artificial Anaesthesia and Anaesthetics. New York: William Wood and Company, 1881.Google Scholar
  44. 44.
    Gwathmey JT. Anesthesia. New York: D. Appleton and Company, 1914.Google Scholar
  45. 45.
    Flagg PJ. The Art of Anaesthesia. Philadelphia: J.B. Lippincott Company, 1919.Google Scholar
  46. 46.
    Blomfield J. Anaesthetics in practice and theory. London: William Heinemann (Medical Books) Ltd, 1922.Google Scholar
  47. 47.
    Hewitt Sir FW. Anaesthetics and their Administration. London: Hendry Frowde and Hodder and Stoughton, 1922.Google Scholar
  48. 48.
    Hadfield CF. Practical Anaesthetics. London: Bailliere, Tindall and Cox, 1923.Google Scholar
  49. 49.
    Maxson LH. Spinal Anesthesia. Philadelphia: J.B. Lippincott Company, 1938.Google Scholar
  50. 50.
    Flagg PJ. The Art of Anaesthesia. Philadelphia: J.B. Lippincott Company, 1939.Google Scholar
  51. 51.
    Goldman V. Aids to Anaesthesia. London: Baillière, Tindall and Cox, 1941.Google Scholar
  52. 52.
    Lundy JS. Clinical Anesthesia. Philadelphia: W.B. Saunders Company, 1942.Google Scholar
  53. 53.
    Minnitt RJ, Gillies J. Textbook of Anaesthetics, 7th ed. Edinburgh: E & S Livingstone Ltd, 1948.Google Scholar
  54. 54.
    Macintosh RR, Bannister FB. Essentials of General Anaesthesia, 5th ed. Oxford: Blackwell Scientific Publications, 1952.Google Scholar
  55. 55.
    Archer WH. A Manual of Dental Anesthesia. Philadelphia: W.B. Saunders Company, 1952.Google Scholar
  56. 56.
    American Medical Association: Fundamentals of Anesthesia, 3rd ed. Philadelphia: W.B. Saunders Company, 1954.Google Scholar
  57. 57.
    Knight RT, Tarrow AB. Management of the anesthesia.In: Haie DE (Ed.). Anesthesiology. Philadelphia: F.A. Davis Company, 1955: 225.Google Scholar
  58. 58.
    Proctor DF. Anesthesia and Otolaryngology. Baltimore: Williams & Wilkins Company, 1957.Google Scholar
  59. 59.
    Dornette WHL. The use of monitors in anesthesia.In: Hale DE (Ed.). Anesthesiology. Oxford: Blackwell Scientific Publications, 1963: 905.Google Scholar
  60. 60.
    Lee JA, Atkinson RS. A Synopsis of Anaesthesia, 5th ed. Bristol: John Wright and Sons Ltd, 1964.Google Scholar
  61. 61.
    Davenport HT. Paediatric Anaesthesia. Philadelphia: Lea and Febiger, 1967.Google Scholar
  62. 62.
    Morrow WFK, Morrison JD. Anaesthesia for Eye, Ear, Nose, and Throat Surgery. Edinburgh: Churchill Livingstone, 1975.Google Scholar
  63. 63.
    Collins VJ. Principles of Anesthesiology, 2nd ed. Philadelphia: Lea and Febiger, 1976.Google Scholar
  64. 64.
    Saidman LJ, Smith NT. Monitoring in Anesthesia: New York: John Wiley & Sons, 1978.Google Scholar
  65. 65.
    Hug CC Jr. Monitoring.In: Miller RD (Ed.). Anesthesia. New York: Churchill Livingstone, 1981: 157.Google Scholar
  66. 66.
    Gravenstein JS, Paulus DA. Monitoring Practice in Clinical Anesthesia. Philadelphia: J.B. Lippincott Company, 1982.Google Scholar
  67. 67.
    Gregory GA. Pediatric Anesthesia. New York: Churchill Livingstone, 1983.Google Scholar
  68. 68.
    Hug CC Jr. Monitoring.In: Miller RD (Ed.). Anesthesia, 2nd ed. New York: Churchill Livingstone, 1986: 411.Google Scholar
  69. 69.
    Nunn JF, Utting JE, Brown BR Jr. General Anaesthesia, 5th ed. London: Butterworths, 1989.Google Scholar
  70. 70.
    Taylor TH, Goldhill DR. Standards of Care in Anaesthesia. Butterworth Heinemann, 1992.Google Scholar
  71. 71.
    Calverley RK. Anesthesia as a specialty: past, present and future.In: Barash PG, Cullen BF, Stoelting RK (Eds.). Clinical Anesthesia. Philadelphia: J.B. Lippincott Company, 1992: 3.Google Scholar
  72. 72.
    Maccioli GA, Calkins JM, Collins VJ. Monitoring the anesthetised patient.In: Collins VJ (Ed.). Principles of Anesthesiology, 3rd ed. Philadelphia: Lea and Febiger, 1993.Google Scholar
  73. 73.
    Runciman WB, Ludbrook GL. Monitoring.In: Nimmo WS, Rowbotham DJ, Smith G (Eds.). Anaesthesia, 2nd ed. Oxford: Blackwell Scientific Publications, 1994: 704.Google Scholar
  74. 74.
    Stevens MH, White PF.In: Miller RD (Ed.). Anesthesia, 4th ed. New York. Churchill Livingstone, 1994.Google Scholar
  75. 75.
    Blitt CD, Hines RL. Monitoring in Anesthesia and Critical Care Medicine, 3rd ed. New York: Churchill Livingstone, 1995.Google Scholar
  76. 76.
    McIntyre JWR. Implication of anaesthesiologists’ varying location during surgery. Int J Clin Monit Comput 1995; 12: 33–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Bosomworth PP, Dietsch JD, Hamelberg W. The effect of controlled hemorrhage on heart sounds and the magnitude of the peripheral pulse. Anesth Analg 1963; 42: 131–40.PubMedCrossRefGoogle Scholar
  78. 78.
    Williams CJB. On the acoustic principles of the stethoscope. London Medical Gazette 1837; 20: 349–53.Google Scholar
  79. 79.
    Johnston FD, Kline EM. An acoustical study of the stethoscope. Arch Intern Med 1940; 65: 328–39.Google Scholar
  80. 80.
    Rappaport MB, Sprague HB. Physiologic and physical laws that govern auscultation and their clinical application. The acoustic stethoscope and the electrical amplifying stethoscope and stethograph. Am Heart J 1941; 21: 257–318.CrossRefGoogle Scholar
  81. 81.
    Ertel PY, Lawrence M, Brown RK, Stern AM. Stethoscope acoustics. I. The doctor and his stethoscope. Circulation 1966; 34: 889–98.PubMedGoogle Scholar
  82. 82.
    Ertel FT, Lawrence M, Brown RK, Stern AM. Stethoscope acoustics. II: Transmission and filtration patterns. Circulation 1966; 34: 889–98.PubMedGoogle Scholar
  83. 83.
    Murphy RLH, Holford SK, Knowler WC. Visual lungsound characterization by timeexpanded waveform analysis. N Eng J Med 1977; 296: 968–71.CrossRefGoogle Scholar
  84. 84.
    Murphy RL. Auscultation of the lung: past lessons, future possibilities. Thorax 1981; 36: 99–107.PubMedCrossRefGoogle Scholar
  85. 85.
    Selig MB. Stethoscope and phonoaudio devices: historical and future perspectives (Editorial). Am Heart J 1993; 126: 262–8.PubMedCrossRefGoogle Scholar
  86. 86.
    Pasterkamp H, Kraman SS, De Frain PD, Wodicka GR. Measurement of respiratory acoustical signals: comparison of sensors. Chest 1993; 104: 1518–25.PubMedCrossRefGoogle Scholar
  87. 87.
    Shannon DC. “You see but you do not observe.” (Editorial) Chest 1993; 104: 1320–1.PubMedCrossRefGoogle Scholar
  88. 88.
    Dalmay F, Antonini MT, Marquet P, Menier R. Acoustic properties of the normal chest. Eur Respir J 1995; 8: 1761–69.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • John W. R. McIntyre
    • 1
  1. 1.Department of AnaesthesiaUniversity of Alberta HospitalsEdmonton

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