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Exactly 150 years before the manuscripts that fill thisissue were accepted for publication in the journal, tobe more precise, the first succesful public demonstra-tion of anesthesia was perf o rmed in the MassachusettsGeneral Hospital in Boston on October 16, 1846. Thepatient was made unconscious with ether by the den-tist William Morton; the surgeon John Warrensubsequently removed a neoplasm from the jaw ofthe patient. The patient apparently did not experi-ence any pain; this was probably the first “human”surgical operation. Until that time surgical patientswere exposed to unbearable pains. The most com-mon method to handle a patient during surgery wasrestraining the patient by force. Surgery was regard-ed as a last resort and mainly used in emergency situ-ations (e.g. amputation of a limb or drainage of anabcess). Fine techniques were not possible in patientswho experienced severe pain. Through the ages allkinds of (sleep-inducing) agents such as hashish andopium derivates had been tried to alleviate the pain,but the only remedy that appeared to be more or lesseffective was the ingestion of massive amounts of eth-anol.

Further milestones in the history of anesthesia werethe use of cocaine as a local anesthetic by Koller in1884 and the use of cocaine to produce spinal anes-thesia by Bier in 1898. Other important improve-ments were the perfection of endotracheal anesthesiaby Magil and Rowbotham around 1920, the intro-duction of the barbiturates for induction of anesthesiain 1932 and the introduction of curare as a musclerelaxant in 1942. Before the introduction of musclerelaxants, muscular relaxation could be obtained onlywith deep levels of inhalational anesthesia or by highspinal anesthesia, techniques associated with respira-tory and cardiovascular depression and resulting inhigh morbidity and mortality. The introduction ofmuscle relaxants permitted the realization of ade-quate conditions for surgery with light levels of gen-eral anesthesia, minimizing the functional depressionof the vital organs. The introduction of muscle relax-ants also had its positive infuence on the evolution ofrelated fields, such as surgery and intensive and res-piratory care medicine. Although the modern neuro-muscular blocking agents have a high therapeuticratio and the use of neuromuscular blockade moni-tors allows the titration of the dose against thedesired effect, the potential for complicating interac-tions still exists, especially in patients with compro-mised renal or hepatic function or with electrolyteimbalance. To avoid complications it is necessary tounderstand the working mechanism of these potentagents. We are glad that in this issue of PWS ProfessorLeo Booij has written everything we always wanted toknow about neuromuscular blockers, but were afraidto ask.

EVERYTHING YOU ALWAYS WANTED TO KNOW.........• C . H . W. Koks

C.H.W. Koks. EVERYTHING YOU ALWAYS WANTED TOKNOW......... Pharm World Sci 1996;19(1): i.

© 1997 Kluwer Academic Publishers. Printed in the Netherlands.

C.H.W. Koks, Department of Pharmacy and Pharmacology,Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, TheNetherlands

Accepted January 1997

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