About the Department of Anesthesia, Critical Care and Pain Medicine

On October 16, 1846, the first successful public demonstration of ether anesthesia’s use in surgery was performed at Massachusetts General Hospital by Boston dentist William T.G. Morton, making pain-free surgery possible. At Mass General, which opened its doors in 1821, only one operation a week was performed in the years preceding the ether demonstration. After this historic event, operations not only increased significantly, but Morton's work spread quickly throughout the world and forever changed the surgical experience of patients.

Henry Isaiah Dorr was designated the first chair of anesthesia in the world by Harvard Medical School (HMS). In July 1941, the dean of HMS appointed Henry Beecher, MD, to the Henry Isaiah Dorr Chair in Anesthesiology, creating the first endowed chair of anesthesiology in the United States.

Henry Beecher, MD, published the groundbreaking publication, “The Powerful Placebo.” He advocated for the placebo effect to be tested in all clinical trials, in what he called double-blind placebo controlled studies (studies in which new drugs are tested against a placebo, and neither the doctor nor patients knows whether a patient is receiving a placebo or the drug being tested). His publication was widely hailed and laid the foundation for a new generation of medical trials and testing around the world.

Critical care began at Mass General with the establishment of the first five-bed Respiratory Intensive Care Unit (RICU) in the United States. Today, Mass General has more than 130 critical care beds, which are organized into nine different intensive care units.

Mass General researchers George Battit, MD, Henry Beecher, MD,  and colleagues, proved the positive therapeutic and psychologic benefits for patients who receive a preoperative visit from an anesthetist, which includes less drowsiness and an increased sense of calm on the day of operation.

Henry Beecher, MD, published a landmark paper called “Ethics and Clinical Research” in the New England Journal of Medicine, which is considered to be one of the most influential papers written about experimentation involving human subjects. Dr. Beecher’s work laid the foundation for the Institutional Review Board (IRB) and guidelines on informed consent.

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At Mass General, the definition of “brain death” had been debated for decades. In 1968, Henry Beecher, MD, chaired an HMS committee on this subject and authored an article in the Journal of the American Medical Association (JAMA) in which he proposed a new set of criteria for brain death (which became known as the Harvard Criteria). Most of the clinical indications he proposed were the driving force behind the first formal enunciation of the criteria for definition of brain death and were subsequently adopted by the medical community.

Up until 1969, the use of anesthesia during cardiac surgery (even low doses) was hazardous and generally only performed on patients with valvular or congenital heart disease and severe heart failure. However, after an outside study in the dog heart-lung preparation showed that morphine actually did not weaken the heart muscle, Mass General physician-scientists Edward Lowenstein, MD, Phillips Hallowell, MD, Daggett Willard, MD, W. Gerald Austen, MD, and colleagues, intravenously administered 1-3 mg/kg doses of morphine into surgical patients with heart failure. The morphine was supplemented with a neuromuscular blocker and a very low dose of inhalation anesthetic to prevent the patient from sensing the operation, maintain proper circulatory function and create excellent conditions for exposing the organs in the chest and thorax during surgery. This became known as "morphine anesthesia," and was the predominant form of anesthesia for cardiac surgery until the introduction of coronary surgery.

The use of extracorporeal membrane oxygenation (ECMO) commenced in early 1971 under the leadership of Warren Zapol, MD. ECMO is a technique of providing both cardiac and respiratory support oxygen to patients with severe acute respiratory failure. Dr. Zapol submitted a National Institutes of Health (NIH) grant in support of a controlled study for the use of ECMO in the treatment of acute respiratory failure. The grant was funded in 1971.

The Train of Four monitor was developed by Mass General’s Hassan Ali, MD, and his colleagues at Harvard University as a way to enhance the assessment of the depth of neuromuscular response in a patient under anesthesia using electrical stimuli. This method helps to ensure proper medication dosing following surgery and avoid post-operative complications.

A group of investigators including John Savarese, MD, Salvatore Basta, MD, Hassan Ali, MD, Nick Goudsouzian, MD and Jeevendra Martyn, MD, synthesized, patented and tested mivacurium, a short-acting and non-depolarizing muscle relaxant. Throughout the following decade, the team studied the safety and efficacy of mivacurium—as well as other short acting competitive muscle relaxants, atracurium and cis-atracurium—as a way to relax skeletal muscles during surgery and facilitate mechanical ventilation for critically ill patients in the intensive care unit (ICU).

Over these years, Dr. Martyn also reported on the molecular and cellular mechanisms that resulted in distinct aberrant pharmacological responses to depolarizing and non-depolarizing relaxants amongst some critically ill and ICU patients, such as fatal increase in potassium levels in the blood (hyperkalemia) and resistance to the non-depolarizing relaxants, respectively. He described that despite the intact nerve-to-muscle contact, the muscle behaved as if deprived of a nerve supply, resulting in muscle wasting (myopathy). His basic work to understand how critical illness-induced myopathy can be mitigated and corrected continues to this day.

Mass General investigators Letty Liu, MD, Charlie Coté, MD, John Ryan, MD, and Nick Goudsouzian, MD, et al, conducted the first prospective study describing the association between anesthesia and post-operative apnea in former preterm infants (less than 60 weeks post conceptual age) undergoing elective surgical procedures, such as inguinal herniorrhaphy.

In the mid-and-late 1980s, a Mass General team led by Nathaniel Sims, MD, developed a series of innovations in drug infusion technology:

• The commercialization of a small syringe infusion pump that allowed for micro-infusion of concentrated life support medications and sedatives, ensuring that all patients could receive critical continuous infusions without fluid overload. These pumps, in combination with other advances in ICU monitoring such as pulmonary artery catheters, allowed Mass General clinicians to optimize a critically ill patient's overall physiological state
• The microinfusion syringe pump invented in October 1992 by the same team that paved the way for the smart drug infusion pumps. The clinical deployment of the first commercially successful smart drug infusion pumps occurred at Mass General in 1997, with a multidisciplinary team from several departments. Smart drug infusion pumps allow a hospital to upload their customized best practices for infusion of their entire formulary and provide guidance and alerts to ensure these best practices are employed at the front line of care, with every drug infusion

The first use of inhaled nitric oxide (NO) gas for the treatment of a critically ill newborn occurred on September 15, 1990. This trial occurred soon after the discovery of inhaled NO by Claes Frostell, MD, and Warren Zapol, MD, and extensive development in the Department of Anesthesia laboratories of the treatment gas and its delivery system for newborns. This first treatment was performed in the cardiac catheterization laboratory at Mass General by a team of physicians led by Jesse Roberts Jr., MD, including, David Polaner, MD, a pediatric anesthesiologist; I. David Todres, MD, chief of pediatric critical care; and Peter Lang, MD, a former Mass General pediatric cardiologist. The baby's lung function improved remarkably during the trial, spurring further development of the therapy that is now used worldwide to treat critically ill newborns.

Investigators in the Mass General Cardiac Catheterization Laboratory, Jesse Roberts Jr., MD, Peter Lang, MD, Luca Bigatello, MD, Gus Vlahakes, MD, MS, and Warren Zapol, MD, reported the first use of inhaled nitric oxide (NO) in patients with congenital heart disease. This finding firmly established the efficacy and safety of NO as a pulmonary hypertension treatment, which is used in the cardiac care of pediatric patients worldwide.

Mass General researchers identified how common drugs called NSAIDS, which include aspirin and other anti-inflammatories, act on the central nervous system to reduce pain.

With research starting in 2010, Patrick Purdon, PhD, and Emery Brown, MD, PhD, developed a systems neuroscience paradigm to describe how anesthetic drugs act in the brain to create the states of general anesthesia. Based on their findings, it is now understood why anesthetic drugs make patients unconscious and anesthesia caregivers can now use the electroencephalogram in a principled way to monitor their patient’s brain states under anesthesia.

Warren Zapol, MD, and Binglan Yu, PhD, of the Mass General Anesthesia Center for Critical Care Research developed a portable device to produce pure, therapeutic levels of nitric oxide from air to treat pulmonary conditions. Lorenzo Berra, MD, tested the new device for the first time in patients with chronic pulmonary hypertension.

For four decades, Mass General investigator Keith Miller, DPhil, and collaborators have been discovering the location of the different binding sites for various structural classes of general anesthetics on acetylcholine and most recently GABAA receptors and exploring how these binding sites allosterically affect receptor function. His lab’s work has led to findings that explain the molecular mechanisms by which general anesthetics act to produce the state of anesthesia and its side effects.

Under the leadership of Seun Johnson-Akeju, MD, MMSc, anesthetist-in-chief, and residency program leadership, the department launched an integrated four-year Anesthesiology Residency Program in which residents train across many specialties and departments. This integration was implemented with the goals of improving the educational experience of our trainees, enhancing the rigor of the residency program and improving the care of patients.