Anesthesiology
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Biography Historical Article
Horace Wells' Demonstration of Nitrous Oxide in Boston.
Horace Wells, a dentist in Hartford, Connecticut, first used nitrous oxide in dentistry in December 1844. A few weeks later he travelled to Boston, Massachusetts, to demonstrate to physicians and dentists the use of nitrous oxide in painful procedures. Wells' unsuccessful demonstration of nitrous oxide for the extraction of a tooth is well known, but other details of this trip are poorly understood. ⋯ The precise date and location of Wells' demonstration could not be determined. There is no primary evidence that Wells' demonstration occurred in the surgical amphitheater (Ether Dome) at Massachusetts General Hospital. Wells' demonstration of nitrous oxide probably occurred around the end of January 1845, in a public hall on Washington Street, Boston.
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Transcranial motor-evoked potentials (TcMEPs) monitor spinal cord motor tract integrity. Using a swine model, the authors studied the effects of vasodilatory hypotension, hemorrhage, and various resuscitation efforts on TcMEP responses. ⋯ Hypotension from hemorrhage, but not vasodilation, is associated with a decrease in TcMEP amplitude. After hemorrhage, restoration of TcMEPs with epinephrine but not phenylephrine indicates that CO and DO2 affect TcMEPs more than MAP. Monitoring CO may be beneficial in major spine surgery when using TcMEP monitoring.
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Next year marks the 100th anniversary of the founding of the Foregger Company, an important manufacturer of anesthetic equipment in the first half of the 20th century. Founded by Richard von Foregger in a barn in Long Island, New York in 1914, the Foregger Company developed equipment in collaboration with anesthesiologists. Their first product was the Gwathmey machine, built around the rudimentary flowmeter designed by the anesthesiologist, James Tayloe Gwathmey. ⋯ As the company grew, von Foregger formed other liaisons, joining forces with Ralph Waters to create the Waters to-and-fro canister for carbon dioxide absorption, and with Arthur Guedel, a variety of nontraumatic airways. The combined creativity of these three men ultimately led to the Foregger Midget. This portable machine extended the reach of the Foregger Company well beyond the shores of America, as far away as the isolated west coast of Australia.
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About half of malignant hyperthermia (MH) cases are associated with skeletal muscle ryanodine receptor 1 (RYR1) and calcium channel, voltage-dependent, L type, α1S subunit (CACNA1S) gene mutations, leaving many with an unknown cause. The authors chose to apply a sequencing approach to uncover causal variants in unknown cases. Sequencing the exome, the protein-coding region of the genome, has power at low sample sizes and identified the cause of over a dozen Mendelian disorders. ⋯ The authors found that using both exome sequencing and allele frequency data from large sequencing efforts may aid genetic diagnosis of MH. In a sample selected by the authors, this technique was more sensitive for variant detection in known genes than Sanger sequencing of complementary DNA, and allows for the possibility of novel gene discovery.