The evolution of airway management

  • Wood Library-Museum of Anesthesiology Lewis H. Wright Memorial Lecture: The History of Airway Management Through the Ages
  • 8-9:15 a.m. Sunday
  • South, Room 206

Airway management is the art of science and culture in evolution. Managing airways and providing anesthesia have as much to do with cultural acceptance as they do with scientific and technical advances.

“Tracheotomy was apparently used to relieve airway obstruction 5,000 years BCE by the Egyptians, and Homer alludes to it in the eighth century BCE,” said Kathryn E. McGoldrick, M.D., FCAI(Hon), FACA, Clinical Learning Environment Review Field Representative for the Accreditation Council for Graduate Medical Education, and Professor and Chair Emerita of Anesthesiology at New York Medical College. “But during the Dark Ages in Europe, tracheotomy fell into disrepute. It was considered barbaric, degrading, something that should not be done. A lot of babies were lost because physicians thought it was beneath them to do mouth-to-mouth ventilation. Midwives likely saved a lot of babies from asphyxia neonatorum in the 18thcentury by applying mouth-to-mouth ventilation, which physicians refused to perform. Medical practice often depends as much on culture as it does on science.”

Kathryn E. McGoldrick, M.D., FCAI(Hon), FACA, discusses the art of science and culture in airway management.

During the Sunday session “The History of Airway Management Through the Ages,” Dr. McGoldrick explores how the success of airway management is just as contingent upon our willingness to turn scientific advances into medical practice as it is on medical research and development.

“Ether was synthesized by Valerius Cordus in 1540, but it wasn’t until 1846 when a dentist, William Thomas Green Morton, demonstrated the use of surgical anesthesia for the first time in public,” Dr. McGoldrick said. “Airway management of the day was pretty primitive. If surgical patients didn’t die of infection, they were dying from airway mismanagement when tongues fell back to occlude the airway.”

Medical practitioners in Europe had developed somniferous sponges to ease pain by the 13thcentury, but the use of anesthesia to relieve surgical pain was not accepted until attitudes toward pain and suffering changed.

“It wasn’t until the 1800s that it was not considered immoral or sinful to seek relief from pain and suffering,” Dr. McGoldrick said. “You need both the scientific advances to ease pain and to manage the airway, and you need the appropriate zeitgeist to make it allowable to put those advances into practice.

“There was a brilliant British anesthetist, Sir Frederick William Hewitt, who wrote a very thoughtful treatise on patients who were at risk for airway obstruction around 1890,” Dr. McGoldrick said. “He named all of the populations who are still at risk for airway obstruction: patients with small, receding chins, large tongues and big tonsils. It took him almost 20 years to devise the first oral airway. That’s how glacially slow progress moved with regard to the airway in that era.”

The development of endotracheal anesthesia required more decades and the battlefield injuries of World War II. More recent conflicts have brought advances to airway management, blood volume resuscitation and other areas.

The laryngeal mask, introduced in the 1980s, was an inflection point in saving lives threatened by airway compromise.

“We are in a good place now with regard to airway management, but it has taken us a long time to get this far,” Dr. McGoldrick said.

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