Mass Eye and Ear is celebrating its 200th anniversary, and throughout the year, the Focus blog will feature stories on the hospital’s past, present and future. This month, Focus is spotlighting Mass Eye and Ear’s Anesthesiology Department, a dedicated and specialized service that has grown to 35 anesthesiologists on staff.
The story of Mass Eye and Ear began on October 1, 1824, when Drs. Edward Reynolds and John Jeffries began treating the eye diseases of the poor in a free public clinic. They rented one room in a building in Boston’s West End and called their new endeavor the Boston Eye Infirmary.
The surgery that established Dr. Reynolds’ medical career was cataract surgery. After his formal schooling, he spent two years in London and Paris studying medicine. Three months of that time was spent at the London Eye Infirmary. When he returned to Boston, he found that his father had become completely blind in both eyes due to cataracts. Dr. Reynolds had never actually performed cataract surgery himself, but had seen it done in London. He later wrote: “I offered a prayer to the deity for success, took a glass of sherry and went ahead to do my best.” The surgery was a success and word of it spread widely throughout the area. It formed the foundation of Dr. Reynolds’ extensive private practice and became the marquee surgery for Mass Eye and Ear.
Imagine you are a patient in 1824, coming in for cataract surgery. At that time, there was no such thing as general or topical anesthesia. The primary skill required of a surgeon was speed, as most patients could only tolerate a limited amount of pain. Surgical techniques were rudimentary by today’s standard. Cataracts were treated by a procedure called couching: using a long, sharp needle to push the cataract to the back of the eye, so that light could enter to improve vision.
Now imagine having that done without the benefit of anesthesia. Patients may have been restrained, given alcohol to drink and/or something to bite down on. Patients had to weigh the debility caused by the vision loss with enduring the excruciating pain of the surgery.
It would be more than 20 years after the founding of Mass Eye and Ear before the discovery of general anesthesia in the form of ether, first demonstrated right here in Boston at Massachusetts General Hospital (MGH). On October 16, 1846, Dr. John Collins Warren removed a vascular tumor from the neck of Edward Gilbert Abbott while dentist William Morton administered ether to the patient. This successful demonstration of the use of ether to prevent pain during surgery was the most important medical discovery of the 19th century. Prior to this event, only one major surgery a week was done at MGH. Without anesthesia, surgery was just too excruciating an experience for both patients and surgeons. Following the demonstration of ether, the number of surgeries performed at MGH increased quickly, as patients and surgeons alike could now tolerate longer and more invasive procedures.
The first use of ether at Mass Eye and Ear was not until May 12, 1847, for an enucleation or removal of the eye. The hospital summarized the case at that time: “The ether was administered at first with a sponge; but after inhalation for 15 or 20 minutes insensibility not occurring, but in its place an hysterical state, the tube was substituted, and complete unconsciousness was produced, which continued through the operation.”
In 1847, the first full year of ether, there were 83 operations performed at Mass Eye and Ear. Only eleven of them were done under the influence of ether. While hopeful of its promise, most patients and doctors were uncomfortable with this new technique. Patients would refuse it, as to them the idea of “going under” was equated with being dead. Many were unwilling to cooperate because of the anxiety of the new and unknown, and the fact that the fear of pain was less than the dread of losing their identity and consciousness for even a short period of time. The surgeons were beset with doubts because they did not understand the action of ether and were concerned with its side effects. It was difficult to regulate the amount a patient received, and they had little or no concept of adjusting for weight, comorbid health conditions, and all the other parameters anesthesiologists factor in today. Ether never became popular with ophthalmologists. With the exception of such painful procedures as enucleation, many eye surgeons continued to do their work without anesthesia.
For ophthalmic surgeries, the real revolution came with the 1884 discovery by ophthalmologist Dr. Karl Koller of Vienna, that topical cocaine could anesthetize the eye. Within one month of its discovery, topical ophthalmic anesthesia was rapidly adopted throughout the world, including at Mass Eye and Ear.
Opinions on the use of ether varied significantly between eye and ear doctors. The most common ear surgery performed at Mass Eye and Ear in the 1800’s was a mastoidectomy, using chisels and gouges to open the bone behind the ear, usually in a desperate attempt to save the life of a patient with a severe ear infection. Due to the nature of the surgeries they performed, topical anesthesia was not an option, so the Mass Eye and Ear ear doctors much preferred ether.
When ether and later topical cocaine became standard practice, it was the nurses who administered the anesthesia. The American Society of Anesthesiologists was founded in 1905 as the first professional anesthesia society in the United States. The first time there is any mention of an anesthesiologist in Mass Eye and Ear annual reports is in 1911, when Dr. Arthur M. Dodge from MGH was recorded as being a consulting anesthetist. Anesthesiology did not become an official department at Mass Eye and Ear until 1946, one hundred years after the first demonstration of ether at MGH.
Today, the Anesthesia Department is a vital component of every surgery done at Mass Eye and Ear. “Our goal is to provide each patient with the best possible experience and outcome”, says Benjamin Mizell, MD, chief of Anesthesia at Mass Eye and Ear. There are currently more than 35 anesthesiologists on staff, over 50% of whom are pediatric anesthesia fellowship-trained. Many are also complicated airway specialists. In addition, the anesthesia team includes Advanced Practice Providers (APP), comprised of Certified Registered Nurse Anesthetists (CRNAs) and Nurse Practitioners (NPs), and anesthesia technicians.
Kristin Linnenbank, Anesthesia Practice Manager, reports that the department’s leadership team is made up of anesthesiologists and APPs who focus on areas such as ambulatory surgery, pediatrics, quality and safety, pre-op services, patient access and more. “The example set by the leadership team drives the work that continually improves the patient experience”, she says.
The team works closely with the surgeons to create a fully customized plan for each patient. The patient’s age, medical history, and comorbidities are considered to ensure an optimal outcome. The anesthesiologists’ job is not just confined to the operating room. Prior to surgery, they speak with patients or their guardians to address all their questions and concerns. After the surgery, the patient is monitored closely to ensure a smooth and much less painful recovery. “We have a lot of collaboration, a lot of teamwork, and a culture that supports that”, says Linnenbank.
Teamwork, collaboration, patient outcomes, and patient safety drive the current Department of Anesthesiology at Mass Eye and Ear. “We pride ourselves on the superior care we provide, and we have a supportive hospital culture that is willing to invest in whatever we need to ensure the patients have the best possible experience,” says Dr. Mizell.
