Robert M. Epstein MD | |
|---|---|
 Epstein in 2012 | |
| Born | March 10, 1928 |
| Died | July 23, 2024 (aged 96) |
| 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 (1928-2024) was 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. Such oxygen safety functions have been a required component of continuous-flow anesthesia machines since 1979.
In addition to his commitment to improvements in the safety of anesthesia equipment and practices, Epstein had a sustained research interest in mechanisms of the pulmonary uptake and circulatory distribution of anesthetic gases. With colleagues, Epstein was the first to establish the mutual effects of multiple gas interactions on rates of anesthetic uptake, known as the "second gas effect." [8] This refers to the phenomenon that when high potency anesthetics (e.g. halothane and chloroform) are administered at low concentrations, in mixtures with anesthetic agents administered at high concentrations (e.g. nitrous oxide), the high concentration component promotes the uptake of the low concentration component; in this setting, the low concentration component is known as the "second gas" and the acceleration of its uptake by nitrous oxide was called the "second gas effect".
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]
Nitrous oxide, commonly known as laughing gas, nitrous, nitro, or nos, is a chemical compound, an oxide of nitrogen with the formula N
2O. At room temperature, it is a colourless non-flammable gas, and has a slightly sweet scent and taste. At elevated temperatures, nitrous oxide is a powerful oxidiser similar to molecular oxygen.
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.
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. Depending on the procedure, general anaesthesia may be optional or required. Regardless of whether a patient may prefer to be unconscious or not, certain pain stimuli could result in involuntary responses from the patient that may make an operation extremely difficult. Thus, for many procedures, general anaesthesia is required from a practical perspective.
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.
An anesthetic or anaesthetic is a drug used to induce anesthesia — in other words, to result in a temporary loss of sensation or awareness. They may be divided into two broad classes: general anesthetics, which result in a reversible loss of consciousness, and local anesthetics, which cause a reversible loss of sensation for a limited region of the body without necessarily affecting consciousness.
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, as medical gas supply, is an inhaled gas used as pain medication, and is typically administered with 50% oxygen mix. It is often used 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.
An inhalational anesthetic is a chemical compound possessing general anesthetic properties that is delivered via inhalation. They are administered through a face mask, laryngeal mask airway or tracheal tube connected to an anesthetic vaporiser and an anesthetic delivery system. Agents of significant contemporary clinical interest include volatile anesthetic agents such as isoflurane, sevoflurane and desflurane, as well as certain anesthetic gases such as nitrous oxide and xenon.
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.
During induction of general anesthesia, when a large volume of a gas is taken up from alveoli into pulmonary capillary blood, the concentration of gases remaining in the alveoli is increased. This results in effects known as the second gas effect and the "concentration effect". These effects occur because of the contraction of alveolar volume associated with the uptake of the nitrous oxide. Previous explanations by Edmond I. Eger and Robert K. Stoelting have appealed to an extra-inspired tidal volume due to a potential negative intrapulmonary pressure associated with the uptake of the nitrous oxide.
Harold Randall Griffith was a Canadian anesthesiologist and a leader in the fields of anesthesiology.
The Outcomes Research Consortium is an international clinical research group that focuses on the perioperative period, along with critical care and pain management. The Consortium's aim is to improve the quality of care for surgical, critical care, and chronic pain patients and to "Provide the evidence for evidence-based practice." Members of the Consortium are especially interested in testing simple, low-risk, and inexpensive treatments that have the potential to markedly improve patients' surgical experiences.
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:
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.