Abstract
The most recent and 10th International Symposium on the History of Anesthesia (ISHA) was hosted by the Japanese Society of Anesthesiologists (JSA) in June and web hosted until 13 July 2022. The 9th ISHA was held in Boston, USA, in 2017.
The 10th ISHA was delayed. It was different. It highlighted Japanese contributions to anaesthesia and challenged the idea that our specialty commenced on 16 October 1846 in North America. It also demonstrated the advantages and challenges of new technology. Finally, for those present, there was an intimate view of Japanese culture.
The International Symposia on the History of Anesthesia usually occur every 4 years. The 10th ISHA scheduled for 2021 was delayed because of the coronavirus pandemic. Sadly, ongoing border closures dramatically restricted physical international attendance in Kobe, which is located halfway between Kyoto and Himeji and is renowned for its magnificent temples, shrines, castles and gardens. Hiroshima is just 70 minutes by bullet train. I was privileged to attend.
The 10th ISHA used the Kobe International Conference facilities and the JSA held their 69th annual meeting in an adjoining venue. The 10th ISHA was conducted in English while the JSA meeting was mainly in Japanese. Both meetings used a hybrid meeting format with physical and online attendance. All presentations were prerecorded. There was the option for physical attendees to present live on the day, but most presenters chose to use their recorded presentation. The ISHA sessions were live streamed to a room in the JSA meeting area. On occasion the physical audience at the JSA meeting exceeded that at the ISHA site – this was not surprising given the JSA meeting had about 4000 registrants, with about half physically present. Australian presenters included Christine Ball, Monica Cronin and Andrew Walpole. The social events were shared with the JSA and included traditional Japanese music, ninja, juggling and Kobe beef.
Japan lays claim to several major advances in anaesthesia. The development of sevoflurane in the USA was abandoned because of concerns about fluoride toxicity. Maruishi Pharmaceuticals in Osaka purchased the right to develop sevoflurane in 1983 and the required clinical work was done in Japan. Pulse oximetry was originally developed by Nihon-Kohden (Japan) and separately by Minolta (Japan) in 1975. Stable pulse oximetry measurements awaited the addition of light emitting diodes. Further development occurred in the USA, with clinical introduction in the 1980s. The first transoesophageal echocardiogram (TOE) was performed in the USA by Dr Yasu Oka in 1978. Dr Oka was born in Japan and completed her initial medical training in Japan before moving to the USA. In 1978, she met a cardiologist from Japan with a thumb-sized echocardiogram transducer. It had proved impossible for an awake patient to swallow the transducer. She attached the transducer to an oesophageal stethoscope and introduced it under anaesthesia in a patient undergoing mitral valve surgery. Further development of TOE required technological assistance and came when Dr Oka had another chance meeting in 1986, this time with a nephew of the CEO of Toshiba Corporation of America. Dr Oka also co-authored the first textbook on TOE published in 1992. The designer of the laryngeal mask—Dr Archie Brain—was born in Kobe, Japan, in 1942.
On 13 October 1804 Dr Seishu Hanaoka administered a herbal preparation he had developed. Called mafutsusan, this preparation induced a coma in the patient. During the coma, Dr Seishu successfully performed a surgical operation to remove breast cancer. After this initial success Dr Seishu went on to complete 140 breast cancer operations using this form of anaesthesia by 1835. Not surprisingly there were several presentations relating to Dr Seishu and mafutsusan at this ISHA.
With the change in format to prerecorded presentations and the option of virtual attendance, speakers were more relaxed, and the presentations were more polished. It was apparent that in the curation of the recorded sessions it was necessary to ensure that speakers fit within session time frames. A few presentations exceeded the allocated time; sometimes the chairman stopped playback to keep to time and advised that the full version was available for viewing online. On other occasions the time for discussion was abandoned. Viewing presentations online is a useful option, but the author was disappointed there was not the option to adjust the playback speed. As has become increasingly common there were also many e-poster presentations in A3 format, and these are difficult to view on a standard computer screen.
Those that were there joined the JSA for their first face-to-face meeting since COVID-19 started. The Japanese hospitality from a welcome reception with a Japanese juggler, a speakers’ night with traditional Japanese orchestral music, and the gala dinner with a display by ninja anaesthesia, were all very enjoyable. The ISHA meeting concluded with a tour of the Japanese Museum of Anesthesiology (https://anesth.or.jp/english/museum/)—recommended to any anaesthetist planning a visit to Japan. Many stayed on for a visit to Seishu-no-Sato (https://seishunosato.com/en/learn) and Nara (also recommended).
As has happened following the nine previous International Symposia on the History of Anesthesia, the proceedings of the 10th ISHA will be edited and issued in print. It will also be available online. These proceedings will be available as a permanent record of the origins of anaesthesiology and a guide to the future. Great credit must go to the magnificent job done by the organising committee led by Shigeru Saito and the JSA through very trying times. The 11th ISHA will be held in France in September 2025.