Abstract
Anesthesia outcomes research as large-scale clinical trials, began at anesthesia’s inception. Ether caused postoperative nausea and vomiting (PONV). By mid-twentieth century, many drugs were shown to decrease PONV. In 2004, Apfel reported that combining antiemetics with different actions enhanced efficacy. Beecher and Todd’s 1952 article on outcomes in 600,000 patients indicated that anesthesia killed 1 in 2000 patients, and that curare given without proper reversal increased the incidence 6-fold. The 1966 National Halothane Study of 856,515 patients, reported no increased mortality with halothane anesthesia but found rare cases of massive hepatic necrosis. Also in 1966, a 200-patient study connected methoxyflurane and renal injury, and in 1973 this was shown to be dose-related. Notwithstanding the absence of quantitative numerators and denominators, 1980s-2000s’ reviews of closed-claims data identified egregious anesthetic errors and prompted remedial measures. Similarly, in 1991, Rigler and Drasner found a cauda equina syndrome in 4 patients given 5% lidocaine through a new spinal catheter that localized the injected lidocaine. This led to a 1998 study that found a more subtle injury from intrathecal lidocaine in 1,863 patients.
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Acknowledgment
We gratefully acknowledge the stories and advice given us by Arthur Wallace, particularly concerning the outcome studies that examined factors affecting the safety of anesthesia in patients at risk of cardiovascular disease. His knowledge of SPI and McSPI was invaluable. Where the telling of these stories adds error, it is error that we have introduced.
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Westhorpe, R., Saidman, L., Eger II, E. (2014). The History of Outcomes Research in Anesthesia. In: Eger II, E., Saidman, L., Westhorpe, R. (eds) The Wondrous Story of Anesthesia. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8441-7_43
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