Historical lessons for modern medicine
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When looking at the use of drugs in modern medicine, specifically anaesthesia and intensive care, it is important to realise that this is nothing new at all. The first attempts at general anaesthesia were most likely herbal remedies and opiates, evidence of which has been found as early as the third millennium BCE. Antiseptics, from the Greek words anti (against) and sepsis (decay) were also used in ancient times - with the Egyptians using resins, oils and spices to preserve bodies, and the Greeks and Romans quickly realising the antiseptic properties of honey, vinegar, and wine.
Today, when looking at medicinal and anaesthetic drugs - we shouldn’t forget those classed as ‘historical’. Despite agents such as ether and halothane no longer being in routine use in countries such as the UK, in other places they are still widely available. Furthermore, the lack of routine use of an agent does not preclude its inclusion within the pharmacological topics of an anaesthetic or intensive care examination. With this in mind, knowledge of discontinued drugs may prove extremely useful to a range of healthcare professionals.
Indeed, it could be argued that many more agents should still be used, as they have in the distant past, to treat commonly encountered conditions. For instance, take honey, white wine, flax and flour. A useful medical tool kit? Many wouldn’t think so, but they were all used to successfully treat a severe facial injury, suffered by Henry V. These ‘antiseptic’ agents, together with the skill of a surgeon (no anaesthetists, intensivists or microbiologists existed in the 1400s) led to the prince’s survival after he was hit by an arrow.
In more recent times, sodium pentothal, which is still used for the induction of anaesthesia, has for many years been associated with the statement:
More US servicemen were killed at Pearl Harbor by pentothal than by the Japanese.
Whilst I was taught this as a young trainee anaesthetist, the reality, as always, is somewhat different. Rather than deaths being caused by the drug itself, it was more the doses of pentothal being administered to patients that caused cardiovascular collapse. Although doctors were acting with their patients’ best interest at hearts, it was a lack of understanding of drugs and their impact, which led to the demise of so many.
So what can we expect in future anaesthetic drug development? A number of agents are currently in progress, and ‘duration of action’ is a key area that is being targeted. Agents based on ‘benzodiazepine receptor agonists’ are being studied - but with more rapid onset and a shorter duration of action. ‘Etomidate derivatives’ used for induction of anaesthesia are also being developed that do not have the problematic adrenocortical suppression that is associated with the former’s use.
Whatever the future may hold, drugs used in anaesthesia and intensive care will continue to develop and progress. Whether it is the newest technology or the most ancient of methods, it is as important as ever that health professionals have readily accessible and sound pharmacological information. This evidence-based approach not only improves patient safety, but also the efficacy and efficiency of treatment - lessons from history we can all benefit from.
Bennetts FE, Thiopentone anaesthesia at Pearl Harbor, BJA 1995, 75(3) pp366-8.
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