History of general anesthesia

Throughout recorded history, attempts at producing a state of general anesthesia can be traced back to the writings of ancient Sumerians, Babylonians, Assyrians, Akkadians, Egyptians, Persians, Indians, and Chinese.^{[1][2][3][4][5][6][7][8][9][10][11][12]}

Despite significant advances in anatomy and surgical techniques during the Renaissance, surgery remained a last-resort treatment largely due to the pain associated with it.^[13][14] This limited surgical procedures to addressing only life-threatening conditions, with techniques focused on speed to limit blood loss. All of these interventions carried high risk of complications, especially death. Around 80% of surgeries led to severe infections, and 50% of patients died either during surgery or from complications thereafter.^[15] Many of the patients who were fortunate enough to survive remained psychologically traumatized for the rest of their lives.^[16] However, scientific discoveries in the late 18th and early 19th centuries paved the way for the development of modern anesthetic techniques.

The 19th century was filled with scientific advancements in pharmacology and physiology. During the 1840s, the introduction of diethyl ether (1842),^[17][18][19] nitrous oxide (1844),^[20][21] and chloroform (1847)^[22][23] as general anesthetics revolutionized modern medicine.^{[1][2][3][4][13][20][24][25][26]} The late 19th century also saw major advancements to modern surgery with the development and application of antiseptic techniques as a result of the germ theory of disease, which significantly reduced morbidity and mortality rates.^[15]

In the 20th century, the safety and efficacy of general anesthetics were further improved with the routine use of tracheal intubation and advanced airway management techniques, monitoring, and new anesthetic agents with improved characteristics. Standardized training programs for anesthesiologists and nurse anesthetists emerged during this period.

Moreover, the application of economic and business administration principles to healthcare in the late 20th and early 21st centuries led to the introduction of management practices, such as transfer pricing, to improve the efficiency of anesthetists.^[27]