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Anesthesia ( ancient Greek ἀναισθησία , insensibility ') is a state of numbness in medicine for the purpose of an operative or diagnostic measure and at the same time the medical procedure to bring it about.

Anesthesia as a medical specialist discipline is a sub-area of anesthesiology , which also includes the areas of intensive care medicine , pain therapy and emergency medicine .

In hospitals, performing anesthesia is usually reserved for a doctor specializing in anesthesiology . In Germany, the so-called specialist standard applies . If the anesthesia is carried out by a non- specialist colleague, he or she is under the supervision of a specialist in anesthesiology . As a rule, the anesthetist is supported by a specialist nurse for anesthesia and intensive care medicine .

Systematics of the forms of anesthesia

Systematics of the anesthetic procedures

The classification of the types of anesthesia is usually based on the sites of action of the drugs used. The forms of application ( inhalation , intravenous , infiltrative, ...) often play a role in the further classification . Combinations of different methods are also described. The terminology is often of historical origin.

General anesthesia

As a general anesthesia or general anesthesia (colloquially often called "anesthesia") is refers to the production of a tolerance of diagnostic or surgical procedures by an attack on the central nervous system. Traditionally, this is understood to mean the combination of central nervous pain elimination ( analgesia ), elimination of consciousness (hypnosis) and dampening of vegetative functions , possibly extended by muscle relaxation ( muscle relaxation ). Usually this is accompanied by a memory gap ( amnesia ). A strict separation of these components is not possible, and the exact anatomical sites of action and molecular mechanisms are not yet fully understood.

These distinguishable qualities are caused by different drugs ( anesthetics ): loss of consciousness through hypnotics , sedatives or inhalation anesthetics , analgesia through highly effective painkillers ( opioids or ketamine ), relaxation through muscle relaxants . These drugs are administered intravenously or by inhalation, or a combination of both methods, the balanced anesthesia.

Local anesthetic procedures

As local anesthesia (local anesthetic) and regional anesthesia , commonly known as a local anesthetic called, the local anesthesia in the area of Nervenbahnen- and / or -endigungen is understood without impairment of consciousness. This is done primarily through drugs that - injected directly to the respective site of action - reversibly suppress the electrical conductivity of the nerves for nerve impulses , the local anesthetics .

The term local anesthesia is often used inconsistently. From a historical and pharmacological point of view, it is often used as an umbrella term from which local anesthetics are derived as drugs that can be used for local or regional anesthesia, local anesthesia in the narrower sense only stands for the blockage of a narrowly limited area (local anesthesia).

Performing a spinal anesthesia

In local anesthesia, a distinction is made between surface anesthesia , in which the local anesthetic is applied to the body surface, and infiltration anesthesia , in which the tissue is injected directly in the operating area, from regional anesthesia or conduction anesthesia.

An essential feature of conduction anesthesia is the direct search for a conduction pathway that supplies the operative target area with sensitive supply (in the spinal cord or in the peripheral nerve cord) with a hollow needle, followed by the injection of the local anesthetic. The result is a reversible line block, i. H. the interruption of the pain stimuli transmitted from the operative target area, which no longer reach the brain. The regional anesthesia procedures are therefore divided into spinal or neuraxial ( spinal anesthesia , epidural anesthesia ) and a variety of peripheral procedures , for example the various forms of local anesthesia in dentistry . A special form is intravenous regional anesthesia, in which local anesthetic is injected into the empty venous bloodstream of an extremity that has previously been tied with a cuff .

History of anesthesia

Johann Friedrich Dieffenbach introduced ethereal anesthesia in general in Germany in 1847 with his book The ether against pain

Time before 1846

The desire to pain alleviating whether for injuries, illness or in the context of surgery, is often been the first motive heal innovative actions. Already in antiquity, numerous peoples (such as the Assyrians , Egyptians , Greeks or Romans ) knew the pain-relieving or numbing effect of morphine-containing poppy seeds , from which opium (see also opium tincture ) was obtained in antiquity , the nightshade mandrake (mandragora) (Mandrake wine from Pliny around 79 AD in Rome and before that from the Greek doctor Dioscurides , who practiced in Rome , who recommended half a glass of mandragora wine around 54 BC before operations and punctures to achieve “anesthesia” ) and henbane as well as water hemlock and a number of other plants. The word "anesthesia" comes from ancient Greek. With Plato it is around 400 BC BC the term ἀναίσϑητος was first used.

An early application of poppy seed juice and other alkaloids for local anesthesia on the eye can be found around 990 by the Baghdad doctor Jesus Haly . As a local anesthetic, e.g. B. applied as a plaster , pepper , henbane and the common mandrake have been documented since the 12th century .

From the Middle Ages to the early modern period, anesthetic plant extracts were not only administered orally or applied locally, but also inhaled and absorbed through the mucous membranes of the nose, mouth and throat, especially to relieve surgical pain. For this purpose, a sponge was moistened with the plant extracts (mostly as a mixture of several plant species), dried and, if necessary, moistened with hot water and placed on the patient's mouth and nose (spongia somnifera). This use of sleeping sponges soaked with narcotics ( such as opium, henbane, mandrake, unripe mulberries, possibly deadly nightshade , hemlock, ivy, lettuce seeds and basement throat seeds ) was used by Heinrich von Pfalzpaint , in addition to that of alcohol as a drink and rapid surgery , from the 11th century to the late Middle Ages, occasionally up to the early modern period, one of the few common and at the same time effective methods of limiting surgical pain, was abandoned again by the middle of the 19th century - probably because of serious incidents. However, narcotic potions were also administered - for example, according to a recipe written in the 14th century by the Strasbourg surgeon Johann von Molsheim, using opium poppy and bulbous mushroom mycelia, which was still handed down in the 15th century by the surgeon Johann Schenck von Würzburg has been. Early methods of localized elimination or relief of pain were also the use of short-term nerve compression (anesthesia or hypaesthesia through compression of the nerve trunks or the supplying nerves and vessels in Ambroise Paré around 1564 and in the Italian Valverdi around 1600) as a type of conduction anesthesia or the use of cold (1646 by Marco Aurelio Severino , who describes packs of snow and ice to achieve local anesthesia ), as it was suggested again in 1942 by Frederick M. Allen in New York as ice or cold anesthesia for amputations.

The Greek word for anesthesia was already used by Plato , but in a philosophical sense. Dioscurides used it to describe the effect of the plant mandragora (mandrake). The word was first used in modern times for ether anesthesia by Oliver Wendell Holmes in a letter to WTG Morton (see below).

In 1804 the Japanese surgeon Hanaoka Seishū performed an operation in which he used an anesthetic called Mafutsusan and based on the active ingredients scopolamine , hyoscyamine / atropine , aconitine and angelicotoxin. However, the Japanese policy of sakoku prevented it from becoming known in the West.

After the discovery of oxygen in 1774, the so-called "pneumatics" - medical professionals , but also artists and writers such as Samuel Taylor Coleridge and William Wordsworth - began to test the medicinal and mind-altering effects of various gases. In 1800, Humphry Davy found in a self-experiment that inhaling laughing gas (N 2 O) removes the sensation of pain. In a widely acclaimed publication, he suggested using this in surgical operations.

As a result, proposals were made several times to the medical societies in London and Paris to test the anesthesia by inhaling various gases. The societies refused - so did the British Royal Society in 1824 , whose president was Humphry Davy. There were various reasons for the rejection. On the one hand, it was disputed what function the pain has and whether eliminating the pain is even desirable. The expressions of pain served the surgeons in particular as a guide during the operation. Furthermore, many surgeons refused to put any further strain on the organism, which was enormously stressed by the operation. The gas inhalation also had the smell of dubiousness. At the time, laughing gas was well known as a party drug among the urban upper classes : it had no place in the operating theater. Even after 1846, when inhalation anesthesia began to gain academic recognition, several medical professionals expressed their disconcertment that patients (patients are not mentioned in this context) would have immoral dreams while intoxicated. The opinion of the French surgeon Alfred Armand Velpeau that preventing pain through artificial methods was a chimera was hardly questioned in (European) academic circles, and anyone who ventured in this direction ran the risk of damaging his scientific reputation .

From 1829 the mesmerists played a role in the implementation of surgical anesthesia. Between 1766 and 1800 attempts were made in Germany and France to avoid pain through suggestion and hypnosis. The doctrine of animal magnetism was developed by Franz Anton Mesmer in the late 18th century . Patients were put into a trance (magnetic sleep) by painting over them . In 1829 this method was first used successfully to reduce pain during a surgical operation. The success reports increased as a result, in particular English surgeons in India allegedly operated often successfully painlessly around the mid-1840s.

In the debate about what should be recognized as scientific, mesmerism vacillated several times between recognition and rejection. In 1838, the mesmerists in London lost the favor of the influential specialist journal The Lancet after the patient slipped out of control by her doctor in a public mesmerist séance and began to address the dignitaries who were listening inappropriately. The Lancet then launched a violent anti-mesmerism campaign.

With their pain-free operations, however, the mesmerists now had a trump card in their hands that quickly spread thanks to media attention. While in Europe no non-mesmeristic doctor dared to attempt anesthesia, there were several low-ranking doctors and dentists in the USA who had no scientific reputation to lose. Morton, who will ultimately be considered to be the discoverer of inhalation anesthesia, probably had not only scientific but also commercial motives: He initially tried to hide the fact that the gas with which he anesthetized was "sulfur ether " (historical name for diethyl ether ). When the report of his ether anesthesia, demonstrated on October 16, 1846, reached Europe in December, many opponents of mesmerism saw it as the long-awaited opportunity to steal mesmerism's greatest asset. Robert Liston amputated a thigh painlessly with the new method on December 21st in London and exclaimed: “This brilliant idea of ​​the Yankees , gentlemen, is vastly superior to hypnosis (which means: mesmerism). How fortunate! We have conquered the pain! ”. Indeed, mesmerism soon disappeared from the scene.

The emergence of modern anesthesia

On March 30, 1842, the first ether anesthesia , also known, is used by Crawford Williamson Long . March 30th is celebrated annually as Doctor's Day . A few years later, on October 16, 1846, the first public ether anesthesia was performed by William Thomas Green Morton at Massachusetts General Hospital in Boston. With October 16, 1846 (Ether Day) , modern anesthesia has an official date of birth. For the first time at the beginning of the same year - after an unsuccessful attempt with laughing gas (N 2 O), which was very important for surgical anesthesia from the 1880s onwards - the dentist William Thomas Green Morton achieved a reasonably successful ether inhalation anesthesia on a patient with a tumor Neck. This was extirpated by one of the most famous surgeons of his time, Professor John Collins Warren , in front of the city medical notables who were present . Although the patient groaned and claimed to have felt pain after the operation (see: Alison Winter, Mezmerized !, Chicago 1998), the anesthesia was recognized as successful by the audience. Warren's comment after the end of the operation is recorded: “Gentlemen, this is no humbug!” (Gentlemen, this is no humbug). The place where it happened, an operating lecture theater at the University Hospital in Boston, Massachusetts, which is part of the Harvard Medical School , is now called the Ether Dome and can be viewed in its unchanged condition. After some back and forth, the name anesthesia, proposed by Oliver Wendell Holmes in his letter to Morton of November 21, 1846, was to prevail for this procedure.

On January 19, 1847, James Young Simpson first used ether for obstetric anesthesia. Martin Pernick has shown that in US hospitals whites were anesthetized more often than blacks or Indians, and upper class members more often than workers. At Pennsylvania Hospital, one-third of all limb amputations in the decade 1853/1862 were still performed on the awake patient.

The first full-time anesthetist is the Englishman John Snow , who published a monograph on ether anesthesia in 1847. The first textbook on anesthesia, written by John Foster Brewster Flagg, appeared in the United States in 1851.

Until about 1890, in addition to ether, chloroform, which was generally introduced in 1847, was still used to perform inhalation anesthesia. Because of the more frequent undesirable side effects of chloroform, ether was then mainly used. (The first documented death from anesthesia occurred while performing chloroform anesthesia on the patient Hanna Greene in 1848.). In addition to diethyl ether, mixed preparations (consisting of alcohol, chloroform and diethyl ether) and other substances such as ethene , cyclopropane and “cypromethers” were tried out. From 1956 onwards, halothane became the most widely used inhalation anesthetic for many decades, followed by other halogenated hydrocarbon compounds.

As early as the 17th century, after the discovery of blood circulation, opium solutions were injected into arm and leg veins. The achievement of general anesthesia by injecting sleeping pills into veins was first made known in 1875 by Pierre Cyprien Oré (1828–1889). To do this, he injected chloral hydrate . Intravenous anesthesia then gained acceptance at the beginning of the 20th century after barbiturates such as veronal were used from 1902 . The short-acting Evipan was used successfully from 1932 .

A pioneer of balanced anesthesia , the combination of an inhalation anesthetic with the intravenous administration of anesthetics, was the Munich surgeon Johann Nepomuk von Nussbaum (1829–1890), who for the first time used supplementary morphine injections to extend and intensify chloroform anesthesia.

Alternatives to general anesthesia and local anesthesia have been available in the form of regional anesthesia procedures close to the spinal cord since 1899 with spinal anesthesia (simultaneously carried out by August Bier , Théodore Tuffier (1857–1929) and Dudley Tait with Guido Caglieri), since 1920 also with that of Fidel Pagés (military doctor at the Hospital Militar de Urgencia de Madrid ) available for the first time during an operation he had performed with epidural anesthesia (= epidural anesthesia, formerly also extradural anesthesia) (as early as 1885, the American James Leonard Corning had inadvertently succeeded in the first epidural anesthesia). The Italian surgeon Achille Mario Dogliotti (1897–1966) made a refined technique of extradural anesthesia by Pagés known in 1931. In 1940, the American William Lemmon introduced continuous spinal anesthesia , in which the local anesthetic is not just injected once, but instead is continuously replenished.

Developments in and from the German-speaking area

Surgery and anesthesia 1956

The report on Morton's success came with an expired on 3 December steamer on 16 December 1846 under special pressure with a written letter on November 28, Jacob Bigelow to Liverpool . The addressee of the letter, the doctor and botanist Francis Boott , received the letter on December 17th and probably tried Morton's method on himself on December 19th. On the same day, inspired by Boott, the London dentist James Robinson (1813– 1862) the ether anesthesia.

On January 1, 1847, Bigelow's report was also published by the Leipziger Deutsche Allgemeine Zeitung and later other newspapers in Europe. Then Hermann A. Demme performed the first ether anesthesia in German-speaking countries on January 23, 1847 in Bern . In Germany, the first ether anesthesia was applied on January 24, 1847 by Heinrich Eduard Weickert and Carl Friedrich Eduard Obenaus in Leipzig . On the same day - albeit unsuccessfully - Johann Ferdinand Heyfelder made use of this new medical technology in Erlangen .

The first ether anesthesia in Austria took place on January 27, 1847 while performing a leg amputation. This took place at the II. Surgical University Clinic in Vienna, which was headed by Franz Schuh. Before that, Schuh had successfully tried out the new product on two dogs and in a self-experiment on his assistants Ludwig von Markusowksy and Ernst Krackowitzer. Many more sulfur ether anesthetics in Vienna followed. This was the case at the I. Surgical Department on January 29, 1847 with a 28-year-old patient suffering from a tumor in the lower jaw.

On February 3, 1847, led Würzburg surgeon Cajetan of Textor (1782-1860) of by his assistant, who later became professor of ophthalmology with the help of Robert Ritter von Welz (1814-1878), developed ether inhaler the first documented operation in ether anesthesia at Juliusspital by . In the Aschaffenburg hospital, too, an "apparatus for inhaling sulfur ether" was already listed in the "budget year 1846/47".

Friedrich Trendelenburg invented the endotracheal, d. H. one inserted into the trachea tube , which he called tracheal cannula pad (1869) and a tracheotomy earned. He used the first " intubation anesthesia ", in which chloroform was fed into the blocked tracheostomy tube via a separate inlet. The first intubation via the mouth opening was described by William Macewen in 1878 and methodologically developed by Franz Kuhn . A method of tracheal intubation, described by Alfred Kirstein (1863-1922) in 1895, which was then further developed by British anesthetists in 1921, then led to endotracheal anesthesia with insertion of the tube using a laryngoscope .

In 1884 the Austrian ophthalmologist Carl Koller carried out an eye operation for the first time after surface anesthesia with the local anesthetic cocaine, which has been available since 1860, and in 1888 the German surgeon Maximilian Oberst named the conduction anesthesia of the finger nerves named after him. Carl Ludwig Schleich , a German surgeon and writer, presented the infiltration anesthesia (technique of intracutaneous injection of local anesthetics) developed by him in 1892 . Another German personality was Heinrich Braun (1862–1934). From 1899–1905 he worked as a senior surgeon at the Deaconess Hospital in Leipzig, and during this time began experimental studies on local anesthesia with cocaine. By adding adrenaline to cocaine in 1900, he made the use of infiltration anesthesia more practicable due to the extended duration of action. In 1905, Braun introduced the less toxic novocaine, synthesized in 1904 by the German chemist Alfred Einhorn , for use in spinal cord anesthesia, which he had developed together with the Leipzig pharmacologist Oskar Groß (1877-1947) (the basis for performing spinal cord anesthesia in The form of spinal anesthesia was the introduction of the lumbar puncture in 1891 by the German internist Heinrich Irenaeus Quincke ). In 1908 , August Bier invented the intravenous regional anesthesia, which he also performed with novocaine . In 1898, Bier developed spinal anesthesia at the same time, but probably independently, of Théodore Tuffier as well as Dudley Tait and Guido Caglieri. The Zwickau surgeon Dietrich Kulenkampff (1880–1967) opened up further possibilities for regional anesthesia with his blockade of the brachial plexus described in 1911 , including the splanchnic anesthesia introduced in 1923 by the Austrian surgeon Hans Finsterer (cf. major splanchnic nerve and minor splanchnic nerve ).

The anesthetic barbital (Veronal) mentioned above was synthesized by Emil Fischer in 1902 and Hellmut Weese introduced hexobarbital (Evipan) in 1932 . In 1805 Friedrich Sertürner was able to present the morphine contained in opium for the first time in pure form, whereupon further morphine derivatives could be developed. The synthetically produced opioid fentanyl was developed in 1958 by the Belgian Paul Janssen .

Intravenous ether anesthesia, first successfully used by Ludwig Burkhardt in Würzburg in 1909 , did not gain acceptance .

A modification of the epidural anesthesia, the paravertebral anesthesia, was first described in 1905 by the Tübingen gynecologist Hugo Sellheim and was also used by Arthur Läwen in 1909 . Läwen also introduced sacral anesthesia in 1910 .

In the USA, the journal Current Researches in Anesthesia and Analgesia was published from 1922 . The first significant German anesthesiological specialist publication was the journal Der Pain , first published in Würzburg in January 1928 , which was merged in 1929 with the journal Anesthesia and Anesthesia , which was also created in 1928, on pain, anesthesia and anesthesia . The first issue of Der Anaesthesist first appeared in German-speaking countries in 1952. After a Society of Anesthetists had been founded in England in 1893 and the importance of anesthesia had risen sharply after the war, the German Society for Anesthesiology and Intensive Care Medicine (DGAI) was founded on April 10, 1953 . Only a few weeks later (May 27, 1953) the first German doctor completed his training as a specialist in anesthesia.

In Austria, the Austrian Society for Anaesthesiology, Resuscitation and Intensive Care Medicine ( ÖGARI ) was founded on October 19, 1951 . The non-profit association is a medical society for the promotion of anesthesiology and has over 1500 members.

After the use of muscle relaxants was established between 1942 and 1949, starting in Canada and Italy, KH Ginzel, Otto Mayrhofer and F. Chott proposed guaiacol - glycerine ether ( myocaine ) as a muscle relaxant in Austria in 1949 .

In 1960, the first German extraordinary chair for anesthesiology was established under Rudolf Frey in Mainz . Six years later, Hamburg received the first full chair for anesthesia. The first pain clinic was set up by Frey in Mainz in 1971.

See also


  • Walter Artelt : German dentistry and the beginnings of anesthesia and local anesthesia. In: Dental communications. Volume 54, 1964, pp. 566-569, 671-677, 758-762 and 853-856.
  • Marguerite Louise Baur: Recherches sur l'histoire de l'anesthésie avant 1846. Leiden 1927.
  • Ludwig Brandt (Hrsg.): Illustrated history of anesthesia. Edited with the participation of Hans-Karl Bräutigam, Michael Goerig, Gundolf Keil , Karl-Heinz Krauskopf, Csaba Nemes and Hans Nolte, Stuttgart 1997.
  • Marcel Hänggi : Stories of Progress. For a good use of technology. Frankfurt am Main 2015, ISBN 978-3-596-03220-4 , pp. 96-114, chapter "Sulfur ethers"
  • Marcel Hänggi: The beginnings of anesthesia in Switzerland (1847). (PDF; 554 KB) In: Licentiate thesis . Philosophical Faculty of the University of Zurich , November 2002, p. 94 , accessed on February 9, 2018 .
  • Thomas E. Keys: A chronology of events relating to anesthesiology and allied subjects. In: John S. Lundy: A manual of clinical anesthesiology. Philadelphia / London 1942, pp. 705-717; also in: Thomas E. Keys: The history of surgical anesthesia. New York 1963, pp. 103-125.
  • Thomas E. Keys: The History of Surgical Anesthesia. (= Anaesthesiology and Resuscitation. 23). Berlin / Heidelberg / New York 1968
  • Hans Killian : The development of anesthesia and anesthesia over the course of time. In: H. Killian, Hellmut Weese (Ed.): Die Anarkose. A teaching and manual. Stuttgart 1954, pp. 1-30.
  • Richard J. Kitz, Leroy D. Vandam: A History and the Scope of Anesthetic Practice. In: Ronald D. Miller (Ed.): Anesthesia. 3 volumes, Churchill Livingstone, New York / Edinburgh / London / Melbourne 1981, 2nd edition ibid. 1986, ISBN 0-443-08328-2 , Volume 1, pp. 3–25.
  • Huldrych M. Koelbing : Surgical pain - anesthesia - anesthesiology. Historical highlights. In: 30 Years of the Swiss Society for Anaesthesiology and Resuscitation 1952–1982. Bern 1982, pp. 7-28.
  • Franz-Josef Kuhlen: On the history of painkillers, sleeping pills and narcotics in the Middle Ages and early modern times. (= Sources and studies on the history of pharmacy. 19). Stuttgart 1983.
  • Reinhard Larsen: anesthesia. Munich / Vienna / Baltimore 1988; 8th (7th revised and expanded) edition: Urban & Fischer, Munich / Jena 2002, ISBN 3-437-22500-6 .
  • Swiss Association of Nursing Staff for Surgical Positioning
  • Jörg Mildenberger, Norbert Roewer: Würzburg in the history of anesthesia. In: AINS. 1999, supplement 4.
  • H. Orth, I. Kis: The prerequisite for the development of modern surgery: pain relief and anesthesia. In: FX Sailer, FW Gierhake (ed.): Surgery seen historically: beginning - development - differentiation. Dustri-Verlag, Deisenhofen near Munich 1973, ISBN 3-87185-021-7 , pp. 1-32.
  • U. Schirmer (Eds.): A. Heller, T. Koch, R. Litz, C. Lorenz, C. Spies, W. Schlack: Anesthesia in general surgery, urology, gynecology and obstetrics 2007. Deutscher Ärzte-Verlag, Cologne 2007, ISBN 978-3-7691-1206-1 .
  • Jürgen Schüttler (Ed.): 50 Years of the German Society for Anaesthesiology and Intensive Care Medicine. Tradition and innovation. Springer, Berlin 2003, ISBN 3-540-00057-7 .
  • Christoph Weißer: Anesthesia. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil, Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin 2005, ISBN 3-11-015714-4 , p. 54 f.
  • Alison Winter: Mesmerized. Powers of Mind in Victorian Britain. 1998.
  • G. Benad, M. Schädlich: Outline of anesthesiology. Verlag Volk und Gesundheit, Berlin 1989, ISBN 3-333-00063-6 .

Web links

Commons : Anesthesia  - collection of images, videos and audio files

Individual evidence

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  34. Christoph Weißer: The first ether anesthesia in Würzburg in 1847. In: Andreas Mettenleiter (Ed.): Tempora mutantur et nos? Festschrift for Walter M. Brod on his 95th birthday. With contributions from friends, companions and contemporaries. Akamedon, Pfaffenhofen 2007, pp. 393-398.
  35. Robert Ritter von Welz : The inhalation of the ether vapors in their various modes of action with practical instructions for those who use this means. Edited according to my own experience. Voigt & Mocker, Würzburg 1847.
  36. ^ Peter Brunner: Hospital and Clinic Aschaffenburg. A historical outline 1793–2014. Schmitt, Neustadt an der Aisch 2014, ISBN 978-3-87707-933-1 , p. 112.
  37. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 14.
  38. Museum Sybodo: Medical instruments and devices of nursing. Here: procaine .
  39. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 14.
  40. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 15.
  41. Splanchnikusanästhesie .
  42. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 14.
  43. PVA (paravertebral anesthesia ) .
  44. Anke Eckardt: Practice lumbar spine diseases. Diagnosis and therapy. Springer, Berlin / Heidelberg / New York, ISBN 978-3-540-88505-4 , p. 204.
  45. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 14 f.
  46. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 15.
  47. ^ Herbert Baar: On the development of anesthesiology at the University of Würzburg. In: Peter Baumgart (Ed.): Four hundred years of the University of Würzburg. A commemorative publication. (= Sources and contributions to the history of the University of Würzburg. 6). Neustadt ad Aisch 1982, pp. 951-956.
  48. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 14 f.
  49. ^ Otto Mayrhofer : Anaesthesie in Österreich (1847-1989). In: Herbert Benzer, Günther Putz (Ed.): 30 years of the University Clinic for Anesthesia and General Intensive Medicine of the Medical Faculty of the Leopold-Franzens University Innsbruck 1959–1989. Innsbruck 1989, pp. 74–83, here: p. 75.
  50. Ginzel, KH, O. Mayrhofer u. F. Chott: Myocaine as a muscle-relaxing aid in anesthesia. In: Vienna. clin. Wschr. 1949, p. 768.
  51. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 15.