Evolution of anesthesia for cardiac surgery
Since anesthetic techniques and concepts of patient management evolve only in response to new surgical treatments of disease, the evolution of cardiovascular anesthesia has been dependent on the successful application of surgical techniques for the treatment of heart disease. In the evolution of both, however, there was a large disparity in time in the course of events that mark the conceptual evolution of the therapy and its actual technical success in treating patients. Thus the concept of surgical treatment of mitral stenosis was at least 25 years old before its success in the late 1940s. And the concept of an extracorporeal circuit to permit operations within the great vessels preceded its successful application by 20 years. Similar lags preceded the general acceptance of tracheal intubation during anesthesia and the control of respiration to ensure carbon dioxide homeostasis. In recounting the evolution of anesthesia for cardiac surgery, therefore, it is necessary to recognize the credit due the conceptual innovators and assume proper humility for progress that was primarily attributable to the products of technological development and growth of new knowledge not directed specifically to improvement of cardiac anesthesia. Just as cardiac catheterization and angiography did not develop for the purpose of facilitating surgical therapy, so the development of nonflammable anesthetic agents and high quality operating room monitors was not a direct response to the needs of cardiac anesthesia. The evolution of cardiac anesthesia is primarily a history of the special application of technical and conceptual advances in the management of all . . .