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Sixty-Two Years Ago In

Anesthesia & Analgesia

Abstract

The introduction of clinically practical methods for effectively removing carbon dioxide from air represents one of the most important advances in the history of clinical anesthesia. Without CO₂ absorption, anesthesia machines as we know them today would be impossible. Previous articles by D. E. Jackson (Lab Clin Med 1916;2:94) and by Waters himself (Curr Res Anesth Analg 1924;3:20) dealt with the principles upon which carbon dioxide absorption is based. This article by Waters, at the time an anesthetist in Kansas City, Missouri, describes the clinical use of a canister filled with soda lime for absorption of carbon dioxide. Patients exhaled through the canister (placed as near as possible to the patient's airway) into a reservoir bag and inhaled the next breath, free of CO₂, from the reservoir bag, passing again through the canister (i.e., a to-and-fro canister). This revolutionary innovation meant that inhalation anesthesia could be given without dilution by room air; nitrous oxide, for example, could be more effectively administered. High concentrations of oxygen could be given. Heat was conserved. Pollution of the operating room air was avoided (pollution was a problem even in 1926). The principle of CO₂ absorption using the to-and-fro canister was eventually supplanted by soda lime canisters for circle systems. The to-and-fro canister, however, set the stage for the subsequent introduction of cyclopropane and, even later, halogenated inhalation anesthetics that could not be given using open techniques. The stage was also set for initiation of assisted and, finally, controlled respiration, the need for which did not become apparent for another 25 years.