Anesthesia--past, present and future.

In 1680 Sydenham wrote, "Among the remedies which has pleased almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium." This appraisal is still true today. Morphine, the principal analgesic agent of the opium alkaloids, has provided the structural model from which modern synthetic opiates have been designed and synthesized. Morphine, as well as the synthetic opioids, has become a permanent part of the armamentarium of an anesthesiologist. The inhalational anesthetics (nitrous oxide and ether) were not introduced until the mid 1800s, and the cardiovascular stabilizing qualities of ether have led to the use of ether as the structural model for synthesizing many of the inhalational agents used today. Aside from the important discoveries of intravenous and inhalational agents, the introduction of capnograph and pulse oximeter in the 1980s has significantly improved morbidity and mortality in anesthesia. With the improved anesthetic management, surgeries have been pushed to new heights, which would have never been possible without creative and optimal anesthetic management. Unfortunately, surgery and anesthesia are continued to be pressured by medical economics to cut costs, while there is increased risk of managing the critically ill patients. This trend will continue; therefore, anesthesiologists today must rise to the challenge.