The
Pioneers
 
Some Precursors of Obstetric Anesthesia
James Young Simpson

(1811-1870)

Scottish physician considered the father of obstetric anesthesia. Performed the first labor pharmacological analgesia when administering ether by inhalation to a pregnant women with a pelvic deformity in 1847, just few months after the public demonstration by Morton on 10.16.1846 (Figures above - reproduction of Morton’s demonstration and the replica of his  inhaler).

 
John Snow

(1813-1858)

English physician who administered chloroform to Queen Victoria for the birth of her last two of nine children (Leopold in 1853 and Beatrice in 1857). This "regal" acceptance of labor analgesia was a milestone for the popularization of these techniques, helping to overcome the resistance imposed by traditional medicine and in particular by the more conservative Christian and Anglican Church.

 
Virginia Apgar

(1909-1974)

American anesthesiologist considered the initiator of modern neonatology. Her research on the newborns vitality in the delivery room, held in 1953, became one of the most important milestones in this area at all times. Even today, more than half a century later and despite the modern critical to its real value, the Apgar score is still used in obstetric and maternity units around the world.

 

Oskar Kreis

Swiss anesthesiologist who administered in 1900, for the first time, spinal anesthesia for labor analgesia. In his study (figure below), he reported the administration of cocaine in the subarachnoid space of six pregnant women with complete cervical dilation. Despite the state of neonates is not mentioned, Kreis reported that mothers were fully awake and cooperative, unlike other forms of systemic analgesia us
ed at that time.
 

Richard von Steinbüchel

Austrian physician pioneered in the use of opioids for labor analgesia. In 1907, he described the technique called the "twilight sleep", which consisted of using systemic morphine and scopolamine (figure below). Studies in subsequent years from two German doctors, Carl Gauss and Kronig Bernhardt, popularized this technique that has been used for several decades. It does not promote a complete analgesia, but the scopolamine enhances the morphine and induces amnesia. Currently, the use of systemic and, in particular, spinal opioids is a cornerstone of modern obstetric anesthesia.

 
Walter Stoeckel

(1871-1961)

German doctor who first described the use of epidural anesthesia for labor analgesia. In 1909, he published 141 cases of caudal epidural analgesia in pregnant women with intense pain and advanced labor. After his report, a series of works by other authors have followed in subsequent decades. The epidural analgesia and anesthesia are still widely used around the world in labor and also in the cesarean section.

 
Eugene Aburel

(1899-1975)

Romanian physician who advocated the use of continuous epidural labor analgesia through a malleable needle in 1931. He began the study of sensory innervation of the uterus and the perineum, using this anatomical and physiological basis to defend his proposal. The continuous epidural techniques, widely used in obstetric anesthesia, due to his pioneering their description and the start of use.

 
John Cleland

(1890-1980)

American physician who presents his classic work on uterine routes innervation in 1933. Advocates for the first time, the use of paracervical block for analgesia in the first stage of labor. His studies on the subject continue in subsequent years. In 1948, he publised an article on the Canadian Medical Association Journal entitled Anatomical Basis for Continuous Caudal and Other Forms of Regional Blocks in Obstetrics. His pioneering researchs contributed fundamentally to the anatomical and physiological bases of modern obstetric anesthesia.

 
Robert Hingson

Waldo Edwards

American physicians who reported, in 1943, the use of continuous caudal epidural anesthesia for labor analgesia using catheters instead of the traditional soft needles used so far. Launch this way, the foundations of modern obstetric analgesia. We observed, since then, enormous changes and improvements in technique, materials and drugs used until we could reach the currently level of excellence and quality.

 
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