History is not boring: consider how even the runner-up publications for the 20 most important publications for anesthesiology have shaped our field. (Image source: Thinkstock)
History is not boring: consider how even the runner-up publications for the 20 most important publications for anesthesiology have shaped our field. (Image source: Thinkstock)

All lists have runner-ups. And for the article,  Game Changers: The 20 Most Important Anesthesia Articles Ever Published, published in this month’s issue of Anesthesia & Analgesia, Dr. Paul Barash, Department of Anesthesiology, Yale University, New Haven, Connecticut, and coauthors note that there were other articles in contention for top position. In the discussion, most articles list study limitations. Thus, these authors note that the development of the list involved some subjectivism. They present a table in their manuscript that lists the “game changing” article as well as the article in leading contention for the title of “game changer.” Below we have listed the subject matter, the article selected from the list that appeared in the previous post, and the leading article that contended with the selected article. Again, we are eager to hear what you have to say about the choices.

1.  Public demonstration of ether anesthesia Bigelow HJ. Insensibility during surgical operations produced by inhalation. Boston Med Surg J 1846; 35:309-17.  Contender: First demonstration of ether anesthesia Long CW. An account of the first use of sulphuric ether by inhalation as an anaesthetic in surgical operations. Southern Med Surg J 1849;5:705-13.

2.  Clinical use of an organized anesthesia record Cushing H. On routine determinations of arterial tension in operating room and clinic. Boston Med Surg J 1903;148:250-56.  Contender Electronic anesthesia record  Block Jr FE, Burton LW, Rafal MD,Burton K, Newey C, Dowell L, Klein FF, Davis DA, Harmel MH. The computer-based anesthetic monitors: the Duke Automatic Monitoring Equipment (DAME) system and the microDAME. J Clin Monit 1985;1:30-51.

3.  The American Society of Anesthesiologist’s physical status grading system Saklad M. Grading of patients for surgical procedures. Anesthesiology 1941; 2:281-284.  Contender: Apgar score Apgar V A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953 Jul-Aug;32(4):260-7.

4.  Development of oro-tracheal intubation  MacEwen W. Clinical observations on the introduction of tracheal tubes by the mouth instead of performing tracheotomy or laryngotomy. Brit Med J 1880; 2:163-5; Jackson C. The technique of insertion of intratracheal insufflation tubes. Surg Gynecol Obstet 1913; 17:507-509; Guedel AE , Waters RM. A new intratracheal catheter. Anesth Analg 1928; 7:238-239.  Contender: Laryngeal mask airway Brain AI. Laryngeal Mask Airway The laryngeal mask–a new concept in airway management. Br J Anaesth. 1983 Aug;55(8):801-5.

5.  Hypodermic syringe Wood A. On a new method of treating neuralgia by the direct application of opiates to the painful points. Edinb J Med Surg 1855; 82:265-81. Contender Transcutaneous drug administration Jackson SH, Schmitt L, McGuire J, Hall M. Transdermal scopolamine as a preanesthetic drug and postoperative anti nauseant and antiemetic. Anesthesiology 1982; 57: A330 (Abstract).

6.  Use of anesthesia for childbirth Simpson JY. Notes on the employment of the inhalation of sulphuric ether in the practice of midwifery. Monthly J Med Sci 1847; 7:721-8 Contender Mendelson’s syndrome Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia Am J Obstet Gynecol. 1946 Aug;52:191-205.

7.  Neonatal pain perception Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987; 317:1321-9 Contender: Continuous positive airway pressure (CPAP) for neonatal respiratory distress syndrome Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 1971 Jun 17;284(24):1333-40.

8.  Ethics and clinical research Beecher HK. Ethics and clinical research. N Engl J Med 1966; 274:1354-60 Contender: Placebo effect Beecher HK. Experimental pharmacology and measurement of the subjective response. Science. 1952 Aug 15;116(3007):157-62.

9.  Standards for patient monitoring Eichhorn JH, Cooper JB, Cullen DJ, Maier WR, Philip JH, Seeman RG. Standards for patient monitoring during anesthesia at Harvard Medical School. JAMA 1986; 256:1017-20 Contender Preventable anesthesia mishaps Cooper JB, Newbower RS, Long CD, McPeek B. Preventable anesthesia mishaps: a study of human factors. Anesthesiology. 1978 Dec;49(6):399-406.

10.  Development of the academic anesthesia department Waters RM, Hathaway HR, Cassels WH. The relation of anesthesiology to medical education. JAMA 1939; 112:1667-71 Contender Academic anesthesia department model Beecher HK The Specialty of Anesthesia And its Application in the Harvard University-Massachusetts General Hospital Department. Ann Surg 1947 Oct;126(4):486-98.

11.  Clinical use of minimal alveolar concentration (MAC) in man Saidman LJ, Eger II EI. Effect of nitrous oxide and of narcotic premedication on the alveolar concentration of halothane required for anesthesia. Anesthesiology 1964; 25:302-6 Contender Kinetics of Inhalation Anesthetic Uptake and Distribution SEVERINGHAUS JW. The rate of uptake of nitrous oxide in man. J Clin Invest. 1954 Sep;33(9):1183-9.

12.  Clinical use of the neuromuscular blocker curare Griffith HR, Johnson GE. The use of Curare in general anesthesia. Anesthesiology 1942; 3:418-20.  Contender:   First large scale multi center study of anesthesia outcomes, in particular, complications related to curare BEECHER HK. A study of the deaths associated with anesthesia and surgery: based on a study of 599,548 anesthesias in ten institutions 1948-1952, inclusive. 1954 Jul;140(1):2-35.

13. Clinical use of intrathecal morphine Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology 1979; 50:149-51  Contender: Patient-controlled analgesia Sechzer PH: Objective Measurement of Pain Anesthesiology 1968;29:209-10.

14. The modern ventilator. Engstrom, CG. Respirator enligt ny princip. Svenska Lakartidningen 1953; 50:545-552 Engstrom CG. Treatment of severe cases of respiratory paralysis by the Engstrom universal respirator. Br Med J 1954; 2:666-9  Contender: Development of the intensive care unit Ibsen B, Kvittingen TD (1958) Arbedjdet pa en anaesthesiologisk observationsafdeling. Nordisk Med 38:1349–1355

15.  PO2 and PCO2 blood gas electrodes Severinghaus JW, Bradley AF. Electrodes for blood PO2 and PCO2 determination. J Appl Physiol 1958; 13:515-20  Contender: Pulse oximetry Aoyagi T, Kishi M, Yamaguchi K, Watanabe S. Improvement of an earpiece oximeter. In: Abstracts of the 13th annual meeting of the Japanese Society for Medical electronics and Biological Engineering. Osaka, 1974:90-1 (Japanese)

16.  The ABCs of CPR Safar P, Brown TC, Holtey WJ, Wilder RJ. Ventilation and circulation with closed-chest cardiac massage in man. JAMA 1961; 176:574-576  Contender: Closed chest cardiac compression Kouwenhoven WB, Jude JR, Knickerbocker GG Closed-chest cardiac massage. JAMA. 1960 Jul 9;173:1064-7.


17.  Use of high dose narcotic anesthesia Lowenstein E, Hallowell P, Levine FH, Daggett WM, Austen WG, Laver MB. Cardiovascular response to large doses of intravenous morphine in man. N Engl J Med 1969; 281:1389-93  Contender Intraoperative myocardial ischemia detection by transesophageal echocardiography  Smith JS, Cahalan MK, Benefiel DJ, Byrd BF, Lurz FW, Shapiro WA, Roizen MF, Bouchard A, Schiller NB. Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography. Circulation. 1985 Nov;72(5):1015-21.

18. Neuroanesthesia conceptualized Michenfelder JD, Gronert GA, Rehder K. Neuroanesthesia. Anesthesiology 1969; 30:65-100  Contender: Cerebral blood flow regulation LASSEN NA Cerebral blood flow and oxygen consumption in man. Physiol Rev. 1959 Apr;39(2):183-238