Merlin Larson, MD

If it can happen, it will happen. A dislocated mandible (image) might develop after a routine oral tracheal intubation. Hippocrates described the treatment over 2000 years ago. Push the mandible down, then backward.

In his 1945 book “Clinical Anesthesia” John Lundy (Chair at Mayo) states (page 248) that this method of BP measurement has been used at Mayo since 1924.

OK. Tomorrow.

Measurement of blood pressure was performed with this method for over 50 years. Now a lost art. It also worked if the cuff was placed on the calf. Described in 1924.

This image shows Daniel Moore’s instruction (from 1961) on how to attach the syringe to the spinal needle. He also emphasized the use of a Luer Lok syringe tip to prevent detachment of the syringe from the needle when the solution is injected.

@CriticalCareNow I am confused here. What do you mean by “analgesia”? Do you mean opioids?

Stop sedation-only protocols. 🛑 Vented patients are in pain even without trauma. Propofol is a blindfold, not a painkiller. The Meat: Pain meds first. Lower sedative needs. Better stability. The "Don't": Assuming quiet = comfortable. Fentanyl or Propofol first? 🏥 #ICU #Nursing

When is a medical intervention 100% successful? Within one year after the discovery of anesthesia (1846) John Snow (1813-1858) learned that everyone can be anesthetized. Unfortunately, not all 100% woke up.

@brettachapman Notice that he is lean. Not fat like us.

This has always been one of my favorite historical pictures of Native Americans. This 1898 photo is of a Ponca man named Dust Maker. I like it because his regalia is very detailed, he has a confident look, and the photographer did a great job with the lighting—looks great!

If the muscles are paralyzed at the neuromuscular junction , the patient is wide awake and terrified (unless anesthetized). If all the sensory nerves are blocked by an inadvertent total spinal, the patient is asleep. This figure shows why.

Twilight sleep (morphine plus scopolamine) for labor analgesia was described by Carl Gauss 130 Year ago (insert). Parturients were given additional scopolamine if they had pain and were able to answer questions correctly 😩. The Soc. for OB Anes (SOAP) was founded in 1968.

100 years ago Johannes Muller laid the foundation for regional anesthesia. Today we take it for granted that is not the knife itself that causes pain. Rather, the knife activates a specific type of nerve fiber and the brain interprets that specific signal as pain.

First infrared pupillogram during anesthesia. Anesthesiology Review 1989, not published after 1995. Note use of “old drug”.

John Snow described deaths with chloroform in his 1858 book (image). Autopsies to determine the cause were unremarkable except for dark blood and empty heart chambers. Chloroform would rarely produce fatal arrhythmias but the EKG was not described until 1901 (see 4/21/22).

The median nerve is called the “precision nerve”. It innervates the thumb, index and middle fingers (image). These fingers are used to start IVs, direct block needles and ultrasound probes, and place epidurals. The median nerve can be damaged by carpal tunnel syndrome.

Maybe AI will not replace anesthesiologists!!

@DualSerpents Color is unreliable and pulses are difficult to feel if blood pressure is low.

@MerlinLarsonMD1 Didn’t take they BP or feel for a pulse then? Even look at the colour of the patient?

If you were giving anesthesia and the patient was: 1. paralyzed 2. under controlled ventilation and 3. without continuous EKG. How would you know if the patient was in cardiac arrest? A popular 1957 anesthesia textbook (image) asked that question. The answer: you wouldn’t know.

@cmdrbob558 Today (68 years later), we know. Why: 1. ET CO2, 2. Processed EEG, 3. Pulse oximetry, 4. Continuous EKG.

@MerlinLarsonMD1 Not an anesthesiologist but during my ambulance training OR clinicals in 1978 learning airway maintenance from them they had no ECG just manual BP cuff, manual pulse monitoring & assessing skin colour on the face & to did fine assessing if in distress .

Totally discredited over 100 years ago!!💥

Mesmerists would sometimes place a pointed finger over the closed eyelid (image). This allowed concentrated magnetic energy to flow into the pupil 😩, inducing a trance quickly. Dental surgery could then be performed - from John Elliotson (1791-1868), a disciple of Anton Mesmer.