Up to the end of World War II, less than 10% of the general anaesthetics administered were with intravenous barbiturates. The remaining 90% of anaesthetics given in the USA were with diethyl ether. In the United Kingdom and elsewhere, chloroform was also popular. Diethyl ether administration was a relatively safe and simple procedure, often delegated to nurses or junior doctors with little or no specific training in anaesthesia. During the Japanese attack on the US bases at Pearl Harbor, with reduced stocks of diethyl ether available, intravenous Sodium Pentothal(®), a most ‘sophisticated and complex’ drug, was used with devastating effects in many of those hypovolaemic, anaemic and septic patients. The hazards of spinal anaesthesia too were realised very quickly. These effects were compounded by the dearth of trained anaesthetists. The anaesthesia tragedies at Pearl Harbor, and the discovery in the next few years of many other superior drugs that caused medical and other health professionals to realise that anaesthesia needed to be a specialist medical discipline in its own right. Specialist recognition, aided by the foundation of the National Health Service in the UK, the establishment of Faculties of Anaesthesia and appropriate training in pharmacology, physiology and other sciences soon followed. Modern anaesthesiology, as we understand it today, was born and a century or more of ether anaesthesia finally ceased.
It was estimated that the use of sodium thiopentone (Pentothal®) anaesthesia caused 1178 perioperative deaths in the hundreds of casualties who required emergency surgery in the 24 hours following the attack.
The World War II medical tragedies, especially those at Pearl Harbor, were a wake-up call for surgeons and the medical profession generally throughout the world. There was a realisation that it was no longer appropriate for any junior doctors or nurses to administer ‘sophisticated’ anaesthetic drugs for many types of surgeries and to critically ill patients. This had been known for many years in thoracic surgery and neurosurgery, but in the years after the war it was clear that appropriately trained anaesthetists were required, who had the knowledge and skills to use advanced drugs such as thiopentone and the new techniques and equipment which had rapidly developed in the 1940s.
The significance of the results of attempts of nurse and doctor anaesthetists to use thiopentone anaesthesia in military casualties who were hypovolaemic was very clear. Cardiovascular collapse and respiratory arrest with a lack of oxygen supplies, resuscitative skills and knowledge of thiopentone’s pharmacology and dosage, along with the insufficient numbers of skilled anaesthetists, clearly resulted in many tragedies. Some spinal anaesthetics also contributed to the perioperative mortality. So it was not too long during that fateful day in 1941 before surgeons and others reverted to using ‘drip ether’ as the principal anaesthetic technique and restricted the use of the available local anaesthetics, procaine and tetracaine, to infiltration only—mainly in burns patients. Exactly how many anaesthetic deaths resulted from intravenous thiopentone and hexobarbital will probably never be known as there were no defined classifications of such deaths as we have today.
In summary, the greatest significance of the anaesthetic events at Pearl Harbor, and more broadly throughout World War II, was that the surgeons, the medical profession generally and health authorities recognised the need for appropriately trained and skilled specialist practitioners of anaesthesia. Modern anaesthesia, or anaesthesiology as I believe we should refer to it, was born soon after Pearl Harbor and World War II, and the ‘ether century’ began to expire, although ether continued to be used into the 1970s for many simpler surgeries in less developed centres.
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