Page 144 - JSOM Summer 2018

An Ongoing Series

Ether Anesthesia in the Austere Environment

An Exposure and Education

L. Brad Morgans, BSN, NRP, CRNA *; Nicholas Graham, NRP, ATP, FP-C 2
1

ABSTRACT
Medical services in the austere and limited environment of- anesthesia. To understand it further, we must know the his-
ten require therapeutics and practices uncommon in modern tory, profile, and applications of this interesting and often for-
times due to a lack of availability, affordability, or expertise gotten anesthesia agent.
in remote areas. In this setting, diethyl ether, or simply ether
anesthesia, still serves a role today as an effective inhalation History of Ether
agent. An understanding of ether as an anesthetic not only
illustrates the evolution in surgical anesthesia but also demon- Ether was first demonstrated to the world by Dr William T.G.
strates ether’s surviving function and durable use as a practical Morton on October 16, 1846, at Massachusetts General Hos-
agent in developing nations. Although uncommon, it is not pital in Boston Massachusetts, in a building later termed the
1
unseen, so a working knowledge should be understood if ob- Ether Dome. Although ether had been used recreationally
servation and advocacy for patients receiving this method of before this time and after, this demonstration changed sur-
anesthesia are experienced. gery as we know it. Ether was considered very safe compared
with the other early inhalational anesthetics of the day such
Keywords: austere; primitive; anesthesia; ether; diethyl-ether; as chloroform, even when administered by less experienced
inhalation agents; drawover; unconventional medicine hands. Ether was the primary inhalational anesthetic used in
the United States until the 1960s, when the nonflammable in-
halational anesthetics were discovered. But ether remains com-
monplace in many developing countries due to its wide safety
Introduction
margin, ease of use, and low cost. 2
Prolonged field care in austere environments challenges us to
consider possibilities not commonly used in Western medical The goal of anesthesia is amnesia, analgesia, and a quiet sur-
systems. Overconfidence in technology while ignoring the im- gical field (i.e., muscle relaxation), while maintaining auto-
portance of human factors can create serious situations when nomic stability of the patient. Autonomic stability at its basic
technology fails or simply is not available. Many limitations level is represented by stable vital signs of the patient. Ether
3,4
exist due to the resources available (or not) in certain envi- was considered the complete anesthetic in the day because it
ronments and operational and space constraints. These factors achieved all pillars of anesthesia as a single agent. Using ether
consistently force us to consider options not normally at the alone was deemed very reliable when achieving anesthetic
top of our medical toolbox or aid bag, and that, most often, depth. It would be rare to hear of an awake patient during a
are related to a lack of technology. We need to be flexible procedure supported by ether. Its muscle-relaxant properties
enough to solve operational problems creatively, as necessary. were an added benefit because, in those times, there were no
muscle relaxants. The depth required to achieve proper mus-
Providing anesthesia in austere environments with minimal re- cle relaxation with ether alone guaranteed a proper anesthetic
sources is challenging and often creates the need to access or depth for the patient. Later, when muscle relaxants were de-
observe what is common in that area. This may require relying veloped, new dangers were introduced when patients could
on one of the oldest inhalational agents in the world: diethyl become paralyzed, while still awake, due to administration of
ether, or simply, ether. Ether is still in use in many developing an insufficient amount of inhalational agent.
countries today, especially in more rural areas, mainly because
of its ease of use, safe profile, and inexpensive cost. It is pos- Historical Military Application
sible that while working with indigenous populations, their
care might reveal ether as the only viable option for austere Ether and chloroform both came into military use before the
anesthesia. Ether is at the historical root of the practice of US Civil War. Chloroform was very popular during the Civil
*Correspondence to lbmorgans@gmail.com
2
1 Mr Morgans was previously vice president of Gryphon Group Security Solutions and is currently owner of Invictus Tactical Solutions. Mr Graham
is a USAF Independent Duty Medical Technician, Navarre, FL.
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