This third installment of the history of basic airway management discusses the transitional—“progressive”—years of anesthesia from 1904 to 1960. During these 56 yr, airway management was provided primarily by basic techniques with or without the use of a face mask. Airway maneuvers were inherited from the artisanal era: head extension and mandibular advancement. The most common maneuver was head extension, also used in bronchoscopy and laryngoscopy. Basic airway management success was essential for traditional inhalation anesthesia (ether, chloroform) and for the use of the new anesthetic agents (cyclopropane, halothane) and intravenous drugs (thiopental, curare, succinylcholine). By the end of the era, the superiority of intermittent positive pressure ventilation to spontaneous ventilation in anesthesia and negative pressure ventilation in resuscitation had been demonstrated and accepted, and the implementation of endotracheal intubation as a routine technique was underway.
“As soon as anaesthetists learn to maintain a wide open airway and to keep the patient asleep without any cyanosis, anaesthetic deaths will become rarer.” Flagg PJ: The Art of Resuscitation, New York, Reinhold Publishing Corporation, 1944, p 177
“As soon as anaesthetists learn to maintain a wide open airway and to keep the patient asleep without any cyanosis, anaesthetic deaths will become rarer.”
Flagg PJ: The Art of Resuscitation, New York, Reinhold Publishing Corporation, 1944, p 177
The concept of the tongue obstructing the upper airway of the unconscious patient with minimal concern for epiglottic, nasal, and soft palate obstruction
The concept of airway obstruction occurring during inspiration with expiration obstruction largely ignored (usually generated by the soft palate)
Acceptance of the face mask harness without consideration of the airway obstruction induced by pushing the mandible downward
Acceptance of the harness collar on the face mask ventilation port without consideration of the fact that it limited the grip on the dome
The myth that the face mask grip with the little finger at the mandibular angle implemented mandibular advancement
The concept of the oropharyngeal airway as a passive device scooping the tongue off the posterior pharynx in the absence of an associated active airway maneuver
The concept of using a stepwise escalation of face mask ventilation technique adjusted to ventilation difficulties instead of a first optimal attempt tailored to the patient’s and provider’s specifics
Adrian A. Matioc; An Anesthesiologist’s Perspective on the History of Basic Airway Management: The “Progressive” Era, 1904 to 1960. Anesthesiology 2018;128(2):254-271. doi: https://doi.org/10.1097/ALN.0000000000001975.
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