Evolution of Pediatric Anesthesia: A Historical Journey


  • The history of pediatric anesthesia is a remarkable narrative of progress and transformation.
  • The introduction of ether in 1846 and chloroform in 1847 marked a turning point in the field of pediatric anesthesia.

The Early Days of Anesthesia (1846-1900):

  • Prior to the discovery of anesthesia, children were subjected to surgery without pain relief.
  • The introduction of ether and chloroform offered hope for pain-free pediatric surgeries.

Emergence of Pediatric Anesthesia Pioneers (Early 20th Century):

  • After World War I, pioneers in pediatric anesthesia began to make significant contributions.
  • Dr. Robson, known as the father of pediatric anesthesia, defined key challenges and solutions.

Betty Lank and Robert Smith (1940s-1950s):

  • Betty Lank, Chief Nurse Anesthetist at Boston Children’s Hospital, contributed to several surgical firsts.
  • Dr. Robert Smith, head of pediatric anesthesia at the same hospital, was inspired by Betty Lank.

Evolution of Anesthesia Equipment (20th Century):

  • In addition to Ayre’s “T-piece,” the Fell-O’Dwyer apparatus played a crucial role. Dr. Fell-O’Dwyer designed a metal tube in 1882, which he inserted into the glottis to relieve airway obstruction in children with diphtheria.
  • Jackson-Rees’ modification of the “T-piece” in 1966 marked an important innovation.
  • High gas inflows were required for these devices, gradually replaced by CO2 absorption-based rebreathing circuits.

Understanding Pediatric Anesthesia Dosage (1950s-1970s):

  • In 1952, Deming’s research highlighted the need for different anesthesia dosages in children.
  • Belief in minimal anesthesia for infants continued until 1987 when Redbook magazine dispelled the myth.

Advancements in Airway Management:

  • O’Dwyer introduced a metal tube into the glottis in 1882 to relieve airway obstruction in children with diphtheria.
  • Budin established the first neonatal intensive care unit (NICU) in the 1890s, improving neonatal care.
  • Innovations in airway management included pediatric laryngoscopes, nasotracheal intubation for croup, custom-fitting masks, and the laryngeal mask airway.

Pioneering Pediatric Anesthesia Textbooks (1920s-1980s):

  • The first pediatric anesthesia textbook, “Anesthesia in Children,” was published in the UK in 1923.
  • France followed with “Précis Clinique et Opératoire de Chirurgie Infantile” in 1925.
  • The US saw the publication of Leigh and Belton’s book in 1948, and Dr. Smith’s comprehensive textbook in 1950.
  • Dr. Gregory’s “Pediatric Anesthesia” in 1983 was the first physiology-based textbook.

Formation of Pediatric Anesthesia Societies:

  • The Association of Paediatric Anaesthetists was established in the UK in 1973.
  • In the US, the Anesthesia and Critical Care section of the American Academy of Pediatrics began in 1966.
  • The Society for Pediatric Anesthesia was founded in North America in 1985.


  • The evolution of pediatric anesthesia is a testament to human ingenuity and compassion.
  • Today, pediatric anesthesia ensures the comfort and safety of young patients.
  • Pioneers and advocates have transformed pediatric anesthesia into a vital and ever-evolving specialty within the realm of medicine.


Leave a Comment