Other forms of anesthesia
that have developed, include regional anesthesia,
which developed as local anesthetics were created.
And one of the first people involved in this story
was Sigmund Freud, who thought that cocaine
would be both a useful medication
and felt that it would be particularly useful
in the treatment of depression. And unfortunately,
Sigmund Freud had to withdraw
this belief in a later period, because
one of his best friends, who was a very famous
American surgeon, became addicted to cocaine
and died from its use. In any case,
the use of cocaine and other simple
local anesthetics, led to the development
of spinal and epidural anesthesia. And we can now
provide complete loss of sensation to many
parts of the body, and particularly the limbs, for surgery.
Spinal anesthesia is the commonest form of anesthesia
for cesarean sections for instance. Whereas epidural
anesthesia is useful for pain relief during labour,
or after certain types of surgery.
Spinal anesthesia is often used for surgery of the legs.
With modern ultra-sound equipment,
it's now possible to pass a needle directly
to a nerve without perforating the nerve
or hitting blood vessels under direct vision
using ultra-sound. And this has revolutionized
the use of regional anesthesia over the last
five to ten years. Anesthesia is an extremely
safe medical specialty. It's one of the safest
interventions in modern medicine.
My practice started in 1980. At that time,
people used to die on the operating room table.
In 2014, it's extraordinarily
rare for this to happen.
In developed countries, the mortality rate
from general anesthesia is usually stated to be around
1:10,000 or maybe as high as 1:20,000.
The rate is much lower however in young,
healthy individuals. Also in developed countries,
the rate of permanent neurologic damage
from spinal or epidural anesthesia
is less than 1:100,000. So,
in a career, most anesthesiologists will never
see this happen. So our lecture series
is going to be laid out like this: an introductory lecture,
which you're hearing now. A lecture on physiologic
aspects of anesthesia, drugs used in anesthesia
and anesthetics systems. We'll then
move in to the more clinical aspects of the specialty
and talk about general anesthesia, regional
anesthesia, emergencies in the operating room,
intensive care of patients, pain
management and anesthesia for special population,
such as the pregnant patient, children,
thoracic anesthesia, neuro anesthesia.
And then, at the very end,
we'll summarize everything and we'll have a short
discussion about anesthesia and its use in other
medical disciplines and the future of anesthesia
and some of the opportunities for young anesthesiologists
opening into the future. So in this lecture,
we've summarized the history
of anesthesiology and given you a bit of an overview
of what general anesthesia and regional anesthesia
look like. We're going to go into a great more detail
in the subsequent lectures, and I hope you join us for those.