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John Snow and research.

D A Shephard
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Abstract

John Snow's leadership in epidemiology as well as anaesthesia resulted from his research as much as his clinical practice. In anaesthesia, Snow's research concerned the regulation of concentrations of volatile agents and the development of efficient inhalers; the uptake and elimination of volatile agents; stages of anaesthesia; carbon dioxide metabolism and rebreathing; and metabolism in anaesthesia and the theory of anaesthesia. In epidemiology, Snow investigated the relationship of water supplies to mortality in cholera during the London epidemic in 1854, which led him to formulate an original and valid theory of the transmission of cholera. Snow's research, which has received less attention than anecdotes concerning his career (e.g., his anaesthetizing Queen Victoria and urging removal of the handle of a contaminated water pump), was always directed towards solving specific problems. The significance of his research is evident in its leading not only to improvements in health care but also to the evolution of anaesthesia and epidemiology as professional disciplines.

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Anesthesia, InhalationAnesthesiologyCholeraHistory, 19th CenturyHumansLondonBiographyHistorical ArticleJournal ArticlePortrait

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D A Shephard. 1989. John Snow and research.. https://doi.org/10.1007/bf03011450

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The effects of isoflurane, sevoflurane, and desflurane anesthesia on neurocognitive outcome after cardiac surgery: a pilot study.

BACKGROUND: Inhalation anesthetics such as isoflurane, sevoflurane, and desflurane are widely used in clinical practice; however, there is no study for comparing these drugs in cardiac surgery with respect to postoperative cognitive outcome and S100 beta protein (S100 BP) levels. In this study, we evaluated the effect of sevoflurane, isoflurane, and desflurane anesthesia on neuropsychological outcome and S100 BP levels in patients undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). MATERIALS AND METHODS: Forty-two male patients were prospectively randomized and classified into 3 groups according to the volatile agents used; isoflurane, sevoflurane, desflurane. All patients had a sufficient education level to participate in neuropsychological testing and a normal carotid Doppler ultrasonography. Blood samples for analysis of S100 BP were collected before anesthesia (T1), before heparinization (T2), 15 minutes into CPB (T3), following protamine administration (T4), postoperatively (T5), 24 hours after the operation (T6), postoperative day 3 (T7), and postoperative day 6 (T8). The neuropsychological tests, including Mini-Mental State Examination (MMSET) and visual-aural digit span test (VADST), were administered 1 day prior to surgery and on the third and sixth postoperative days. RESULTS: The postoperative third and sixth day MMSET scores and third day visual-written subtest scores in the sevoflurane group were significantly lower than in the isoflurane and desflurane groups (P < .05). S100 BP levels increased with the beginning of anesthesia in the sevoflurane and desflurane groups. Although S100 BP decreased to baseline levels on postoperative day 1 in the sevoflurane group, this was significantly higher on the third and sixth days postoperatively in the desflurane group (P < .05). In the isoflurane group, the S100 BP level was significantly higher than the baseline level only after CPB (P < .05). CONCLUSION: Our study suggests that isoflurane is associated with better neurocognitive functions than desflurane or sevoflurane after on-pump CABG. Sevoflurane seems to be associated with the worst cognitive outcome as assessed by neuropsychologic tests, and prolonged brain injury as detected by high S100 BP levels was seen with desflurane.

Anesthesia, Inhalation↗