Abstract
Purpose
To describe the evolution of aspiration risk identification and prophylactic management during general anaesthesia as presented in the United Kingdom (UK) anaesthesia textbooks published 1900–1998.
Methods
The Cumulated Index Medicus, 1900–1997, was searched under the headings: anaesthesia, aspiration, and pneumonia for relevant articles. A classification of features was created using key words and phrases: fasting guidelines, gastric emptying, intestinal obstruction and peritonitis, gastro-oesophageal function, upper oesophageal sphincter, raised intra abdominal pressure, pregnancy, posture and difficult tracheal intubation. Finally, 46 20th century UK anaesthesia text books were stuthed for the presence or absence of these features.
Results
Throughout the century, intestinal obstruction was a recognized risk factor. Only in the 1940s did some authors mention many of the now known risk factors. Hazards for the pregnant patient were described and in the 1960s the importance of the cricopharyngeus muscle was identified. Prophylactic measures included food and water restriction recommendations, especially in the latter half of the century and gastric lavage and drainage were mentioned throughout the century, as was posture at induction. In the 1950s tracheal intubation began to be routinely recommended. In the 1960s, cricoid pressure appeared and then a burgeoning interest in pharmacological control of gastric content character. Awake tracheal intubation is not always mentioned in 1990–96 textbooks.
Conclusion
The consensus of information in textbooks since 1970 was lacking in the previous part of the century. Current textbooks are fewer and are published less frequently. Their role in contemporary anaesthesia education and update merits review.
Résumé
Objectif
Décrire, à partir des manuels d’anesthésie publiés au Royaume-Uni de 1900 à 1998, l’évolution de l’identification des risques d’aspiration et des mesures prophylactiques pendant une anesthésie générale.
Méthode
On a examiné l’Index Medicus cumulatif, 1900–1997, selon les rubriques suivantes: anesthésie, aspiration et pneumonie pour trouver des articles pertinents. On a créé une classification des articles selon des mots-clés et des expressions: ligne de conduite concernant le jeûne, évacuation gastrique, obstruction intestinale et péritonite, fonction gastro-œsophagienne, sphincter supérieur de l’œsophage, élévation de la pression intra-abdominale, grossesse, posture et intubation endotrachéale difficile. Finalement, 46 manuels d’anesthésie publiés au 20e siècle au R-U ont été examinés pour vérifier la présence ou l’absence de ces caractéristiques.
Résultats
Tout au long du siècle, l’obstruction intestinale a été reconnue comme un facteur de risque. C’est dans les années 1940 seulement que certains auteurs mentionnent de nombreux facteurs de risque connus aujourd’hui. Les risques pour les femmes enceintes ont été décrits et, dans les années 1960, l’importance du muscle crico-pharyngien a été identifiée. Les mesures prophylactiques comprenaient, surtout pendant la seconde moitié du siècle, la recommandation de restreindre l’eau et la nourriture, le lavage et le drainage gastriques, mentionnés tout au long du siècle, de même que la posture du patient lors de l’induction. Dans les années 1950, on a commencé à recommander l’intubation endotrachéale comme une pratique courante. Dans les années 1960, la technique de la pression cricoïdienne apparaît et, par la suite, un intérêt croissant pour le contrôle pharmacologique du contenu gastrique. Lintubation endotrachéale chez le patient éveillé n’apparaît pas toujours dans les livres publiés entre 1990 et 1996.
Conclusion
La généralisation des informations qu’on retrouve dans les manuels depuis 1970, était absente auparavant. Les manuels actuels sont moins nombreux et sont publiés moins souvent. Leur rôle dans l’enseignement de l’anesthésie contemporaine et dans la mise à jour mérite une révision.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Balfour GW. New cause of death by chloroform. Edinburgh Medical Journal 1862–3; 8: 194–5.
Duncum BM. The Development of Inhalation Anaesthesia. London: Oxford University Press, 1947.
Eastes G. Remarks on the Conclusions of the Report of the Anaesthetics Committee of the British Medical Association. BMJ 1901; i: 441–6.
Hewitt FW. The prevention of deaths under anaesthetics. Lancet 1908; 182: 873–4.
Report of inquiry into the question of deaths resulting from the administration of anaesthetics. (Presented to Parliament on the command of His Majesty) Lancet 1910; 184: 1087–9.
Buxton DW. Anaesthetics, 3rd ed. London: HK Lewis, 1900.
Gardner HB. Surgical Anaesthesia. London, Baillière: Tindal and Cox, 1909.
Hewitt FH. Anaesthetics and their Administration, 5th ed. London: Henry Frowde and Hodden and Stoughton, 1922.
Mackenzie JR. Practical Anaesthetics, 1st ed. London, Baillière: Tindall and Cox, 1944.
Minnitt RJ, Gillies J. Handbook of Anaesthetics, 7th ed. Edinburgh: E & S Livingstone Ltd, 1948.
Wyle WD, Churchill-Davidson HC. A Practice of Anaesthesia, 1st ed. London: Lloyd-Luke Ltd, 1960.
Evans FT, Gray TC. General Anaesthesia, 2nd ed. London: Butterworths, 1965.
Gray TC, Nunn JF. General Anaesthesia, 3rd ed. London: Butterworths, 1971:
Churchill-Davidson HC. A Practice of Anaesthesia, 4th ed. London: WB Saunders Company, 1978.
Churchill-Davidson HC. A Practice of Anaesthesia, 5th ed. London: Lloyd-Luke Ltd, 1984.
Nunn JF, Ulting JE, Brown BR. General Anaesthesia, 5th ed. London: Butterworths, 1989.
Healy TEJ, Cohen PJ, Arnold E. A Practice of Anaesthesia, 6th ed. London: Edward Arnold, 1995.
Prys-Roberts C, Brown BR. International Practice of Anaesthesia, 1st ed. London: Butterworth Heinemann, 1996.
Sykes WS. Essays on the First Hundred Years of Anaesthesia. Wood Library-Museum of Anesthesiology. Churchill Livingstone, 1960; V2.
Scurr CF. Evolution and revolution in anaesthesia training. Ann Roy Coll Surg Eng 1971; 48: 274–92.
Levy AG. Deaths under anaesthetics. Lancet 1927; 1: 173–4.
Edwards G. Death on the table. Br J Anaesth 1939; 15: 87–103.
Flemming AL. Fatalities from anaesthesia. BMJ 1923; ii: 804.
Chaldecott JH. Discussion on coroners’ inquests — the classification of deaths under anaesthetics as violent or unnatural. Proceedings of the Royal Society of Medicine 1923; 16: 33–41.
Jarman R. Deaths under anaesthesia from 1921 to the present date. Br J Anaesth 1939; 16: 100–6.
Flemming AL. A review of inquests concerning deaths during anaesthesia 1910–1913. Proceedings of the Royal Society of Medicine 1913; 7: 17–20.
Slot G. Deaths under anaesthetics, with special relation to their pathology. Proceedings of the Royal Society of Medicine 1923; 16: 901–8.
Hirsch CTW. Emergencies in anaesthetics. Br J Anaesth 1927; 4: 192–200.
Holland E. Discussion on anaesthesia in obstetrics. Proceedings of the Royal Society of Medicine 1928; 21: 1133–41.
Featherstone HW. Care of the lungs in anaesthesia. BMJ 1932; ii: 628–30.
O’Mullane EJ. Vomiting and regurgitation during anaesthesia. Lancet 1954; 1: 1209–12.
Parker RB. Risk from the aspiration of vomit during obstetric anaesthesia: BMJ 1954; ii: 65–9.
Morley AH. Forty years on. BMJ 1955; ii: 1351–4.
Editorial. Anaesthesia 1951; 6: 189.
Snow RG, Nunn JF. Induction of anaesthesia in the foot-down position for patients with full stomach. Br J Anaesth 1959; 42: 594–7.
O’Sullivan JV. The hazards of modem anaesthesia in emergency obstetrics. Proceedings of the Royal Society of Medicine 1962; 55: 931–3.
Wyle WD. The use of muscle relaxants at the induction of anaesthesia of patients with a full stomach. Br J Anaesth 1963; 35: 168–73.
Macintosh RR. Deaths under anaesthetics. Br J Anaesth 1949; 21: 107–36.
Association News Anaesthesia 1949; 4: 203–4.
Morton HJV, Wylie WD. Anaesthetic deaths due to regurgitation and vomiting. Anaesthesia 1951; 6: 190–205.
Author information
Authors and Affiliations
Additional information
Final revision prepared by Dr. B.T. Finucane. Dr. McIntyre thed after an accident in April, 1998
Rights and permissions
About this article
Cite this article
McIntyre, J.W.R. Evolution of 20th century attitudes to prophylaxis of pulmonary aspiration during anaesthesia. Can J Anaesth 45, 1024–1030 (1998). https://doi.org/10.1007/BF03012312
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03012312