[Anesthesia before and after curare]

Before the advent of curare, muscular relaxation essential for upper abdominal and intrathoracic surgery adequate operating conditions, could only be provided by deep ether or cyclopropane anaesthesia. The required depth of anaesthesia frequently caused severe cardiovascular depression, metabolic and respiratory acidosis and alteration of kidney and liver function. Ether, and especially cyclopropane sensitized the heart to the development of arrhythmias and the danger of explosion was never far away. For fear of anaesthetic mortality essential, life saving operations were often abandoned in poor risk patients. The administration of anaesthesia was more an art, mastered by relatively few, than a science that could be taught to many. It is a tribute to the early masters of anaesthesiology that they were able to carry their patients through the dangers associated with the provision of anaesthesia for major surgical procedures, with relatively low morbidity and mortality. The introduction of curare into anaesthetic practice, by Griffith and Johnson, in 1942, caused profound changes in the efficacy and safety of anaesthesiology. It made possible the development of true balanced anaesthesia, and the elimination of the explosive inhalation anaesthetics and the profound metabolic disturbances associated with their use. The concept of "inoperability," due to severe pathology or extremes of age became obsolete. It would be hard to envisage how open heart, organ transplant and radical brain and cranio-facial surgery could have developed without muscle relaxants.(ABSTRACT TRUNCATED AT 250 WORDS)