Robert M. Epstein MD | |
|---|---|
 Epstein in 2012 | |
| Born | March 10, 1928 |
| Education |
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| Occupation | Harold Carron Professor of Anesthesiology (emeritus) |
| Employer | The University of Virginia |
| Spouse | Lillian C. Epstein (m. 1950) |
Robert Marvin Epstein (born March 10, 1928) is an American anesthesiologist, a member of the National Academy of Medicine, and the Harold Carron Professor of Anesthesiology (emeritus) at the University of Virginia.
Epstein was born in the Bronx, New York on March 10, 1928, the son of immigrants from Slonim, in present-day Belarus. He attended primary school in the Bronx, and completed his secondary education in Miami Beach, Florida where the family moved in 1940. From there he attended the University of Michigan from 1944 to 1951, where he obtained both his bachelor's and MD degrees. [1] Epstein served as an attending anesthesiologist with a rank of 1st Lieutenant in the US Army Medical Corps, and was stationed first in Korea and later in Japan.
Epstein underwent residency training at Columbia University in the department chaired by Emanuel Papper, and subsequently joined the Columbia faculty.
He developed an early interest [2] in the causes and prevention of avoidable death due to anesthesia, and was an advocate for the mandatory implementation of specific improvements in anesthesia machines [3] and for the analysis of adverse critical incidents. [4] The technical improvements [5] were designed to prevent the inadvertent administration of oxygen-deficient mixtures of anesthetic gases. Although the hazards of such mixtures had been appreciated since the 1940s, [6] the work published by Epstein and coauthors in 1962 [2] represents the first oxygen "fail safe" apparatus proposed for inhalation anesthesia. The first oxygen "fail safe" device [7] to be custom built and employed in clinical practice following these principles is on display at the Wood Library-Museum. He was the first to predict and establish mutual effects of multiple gas interactions on rates of anesthetic uptake, the "second gas effect." [8]
Epstein became the chairman of the Department of Anesthesiology at the University of Virginia in 1972, and led the department for 24 years. [9] In honor of his service to the department, an endowed chair was created, the Robert M. Epstein Professorship in Anesthesiology. [9] During his tenure as chairman at UVa, he was instrumental to the establishment (and served as president) of the University of Virginia Health Services Foundation, an organization devoted to strengthening the medical faculty [10]
Member, IOM / National Academy of Medicine, elected 1989 [11]
Fellow of the Royal College of Anaesthetists (England), elected 1981 [12]
Director, American Board of Anesthesiology (1972 - 1984) [13]
President, American Board of Anesthesiology (1982 - 1983)
Board Member, Educational Commission for Foreign Medical Graduates (1991 - 1996)
Member, Editorial Board, Anesthesiology (5 year term) [1]
Past President, Association of University Anesthesiologists [1]
Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness. An individual under the effects of anesthetic drugs is referred to as being anesthetized.
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill, or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction.
Isoflurane, sold under the brand name Forane among others, is a general anesthetic. It can be used to start or maintain anesthesia; however, other medications are often used to start anesthesia, due to airway irritation with isoflurane. Isoflurane is given via inhalation.
Sevoflurane, sold under the brand name Sevorane, among others, is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used as an inhalational anaesthetic for induction and maintenance of general anesthesia. After desflurane, it is the volatile anesthetic with the fastest onset. While its offset may be faster than agents other than desflurane in a few circumstances, its offset is more often similar to that of the much older agent isoflurane. While sevoflurane is only half as soluble as isoflurane in blood, the tissue blood partition coefficients of isoflurane and sevoflurane are quite similar. For example, in the muscle group: isoflurane 2.62 vs. sevoflurane 2.57. In the fat group: isoflurane 52 vs. sevoflurane 50. As a result, the longer the case, the more similar will be the emergence times for sevoflurane and isoflurane.
General anaesthesia (UK) or general anesthesia (US) is a method of medically inducing loss of consciousness that renders a patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients.
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialized in anesthesiology is called an anesthesiologist, anaesthesiologist, or anaesthetist, depending on the country. In some countries, the terms are synonymous, while in other countries they refer to different positions, and anesthetist is only used for non-physicians, such as nurse anesthetists.
An anaesthetic machine or anesthesia machine is a medical device used to generate and mix a fresh gas flow of medical gases and inhalational anaesthetic agents for the purpose of inducing and maintaining anaesthesia.
Awareness under anesthesia, also referred to as intraoperative awareness or accidental awareness during general anesthesia (AAGA), is a rare complication of general anesthesia where patients regain varying levels of consciousness during their surgical procedures. While anesthesia awareness is possible without resulting in any long-term memory of the experience, it is also possible for victims to have awareness with explicit recall, where they can remember the events related to their surgery.
Desflurane (1,2,2,2-tetrafluoroethyl difluoromethyl ether) is a highly fluorinated methyl ethyl ether used for maintenance of general anesthesia. Like halothane, enflurane, and isoflurane, it is a racemic mixture of (R) and (S) optical isomers (enantiomers). Together with sevoflurane, it is gradually replacing isoflurane for human use, except in economically undeveloped areas, where its high cost precludes its use. It has the most rapid onset and offset of the volatile anesthetic drugs used for general anesthesia due to its low solubility in blood.
Nitrous oxide, is an inhaled gas used as a pain medication and together with other medications for anesthesia. Common uses include during childbirth, following trauma, and as part of end-of-life care. Onset of effect is typically within half a minute, and the effect lasts for about a minute.
Minimum alveolar concentration or MAC is the concentration, often expressed as a percentage by volume, of a vapour in the alveoli of the lungs that is needed to prevent movement in 50% of subjects in response to surgical (pain) stimulus. MAC is used to compare the strengths, or potency, of anaesthetic vapours. The concept of MAC was first introduced in 1965.
Methoxyflurane, sold under the brand name Penthrox among others, is an inhaled medication primarily used to reduce pain following trauma. It may also be used for short episodes of pain as a result of medical procedures. Onset of pain relief is rapid and of a short duration. Use is only recommended with direct medical supervision.
The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are:
Harold Randall Griffith was a Canadian anesthesiologist and a leader in the fields of anesthesiology.
The Fink effect, also known as "diffusion anoxia", "diffusion hypoxia", or the "second gas effect", is a factor that influences the pO2 (partial pressure of oxygen) within the pulmonary alveoli. When water-soluble gases such as anesthetic agent N2O (nitrous oxide) are breathed in large quantities they can be dissolved in body fluids rapidly. This leads to a temporary increase in both the concentrations and partial pressures of oxygen and carbon dioxide in the alveoli.
Throughout recorded history, attempts at producing a state of general anesthesia can be traced back to the writings of ancient Sumerians, Babylonians, Assyrians, Egyptians, Indians, and Chinese. Despite significant advances in anatomy and surgical technique during the Renaissance, surgery remained a last-resort treatment largely due to the pain associated with it. However, scientific discoveries in the late 18th and early 19th centuries paved the way for the development of modern anesthetic techniques.
The following outline is provided as an overview of and topical guide to anesthesia:
Mervyn Maze, MD, MB ChB has been a Professor in the Departments of Anesthesia and Pain Medicine, Intensive Care at the University of California, San Francisco since 1988. He has also served as Professor and Chair at Imperial College London.
Obstetric anesthesia or obstetric anesthesiology, also known as ob-gyn anesthesia or ob-gyn anesthesiology, is a sub-specialty of anesthesiology that provides peripartum pain relief (analgesia) for labor and anesthesia for cesarean deliveries ('C-sections').
James Edward Cottrell is the Chair Emeritus, Department of Anesthesiology at SUNY Downstate Medical Center in New York City. He serves as a member of the New York State Board of Regents and is an avid collector of contemporary fine-art.