Alberto Gutierrez

Biographical Timeline

• Born November 10, 1892 in Buenos Aires, Argentina. Son of Avelino Gutiérrez, a Spanish immigrant surgeon and professor of anatomy.
• 1911 – Entered the University of Buenos Aires School of Medicine.
• 1912–1917 – Appointed student assistant in the anatomy dissection laboratory while still an undergraduate.
• 1917 – Graduated MD. Defended thesis Topographic Anatomy of the Peritoneum
• 1922 – Joined staff of the Hospital Español, Buenos Aires in charge of the Women’s Ward. Returned to medical school to study physiology under Nobel laureate Bernardo Houssay (1887-1901). Proposed a radical reform of anatomical teaching, emphasising topographic and clinical anatomy over purely descriptive methods.
• 1929 – Appointed Chief of Surgery, Hospital Español.
• 1933 – First published description of the “sign of the hanging drop” (gota colgante) for identifying entry into the epidural space.
• 1939 – Founded and became editor of the Revista Argentina de Anestesia y Analgesia (later Revista Argentina de Anestesiología), official journal of the Argentine Federation of Anesthesia, Analgesia and Resuscitation Associations (Federación Argentina de Asociaciones de Anestesia Analgesia y Reanimación, FAAAAR).
• 1942 – Appointed Extraordinary Professor at the University of Buenos Aires.
• 1943 – Elected President of the Argentine Academy of Surgery. Became honorary member of anatomical societies in Paris, Madrid, and Rio de Janeiro
• Died February 23, 1945 in San Carlos de Bariloche, Argentina, aged 52.

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Medical Eponyms

Gutiérrez “Hanging Drop” sign (Gota colgante) (1933)

A method for identifying entry into the epidural (extradural) space by observing a droplet of fluid at the needle hub being drawn inward as the needle tip passes the ligamentum flavum and enters the epidural space. Designed to provide a visual confirmation of epidural space entry and reduce false placement when compared with “feel” alone.

Mechanism: A drop of local anaesthetic (or saline) is placed at the hub of an epidural needle. As the needle advances, the drop is aspirated into the needle when the tip enters the epidural space due to negative pressure and tissue recoil.

1933 (February, index case/observation) – While using loss-of-resistance with fluid, he disconnected the syringe after meeting resistance near the ligamentum flavum and noticed a drop of fluid hanging at the hub. “…disconnected the syringe and noted that a drop of the fluid was left hanging… suddenly noticed that the drop disappeared.”

He then confirmed correct placement by injecting incremental boluses of 1% procaine (5 cc aliquots), achieving rapid surgical anaesthesia (“above the umbilicus”) within minutes for varicose vein surgery.

Gutiérrez acknowledged the sign is not uniformly present; later summaries report a positive sign in roughly ~82% of cases, highlighting anatomical and technical variability.

Gutiérrez modified equipment to make the hanging drop sign easier to observe, including a needle/hub configuration intended to be steadier in the operator’s fingers: “…flat hub… for easier holding… without disturbing the hanging drop…”

1933 – First short communication in El Día Médico made March 27, 1933 followed later in 1933 by a more formal Revista de Cirugía paper.

On February 17, 1932, Angelo Luigi Soresi (1877–1951) published “Peridural anesthesia; a preliminary report” in the Medical Journal and Record, an early account of peridural/epidural technique that is frequently cited in later discussions of the “hanging drop” sign.

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Key Medical Contributions

Extradural (epidural) anaesthesia programme (1932–1939)

1932 – Began systematic investigation of epidural negative pressure (influenced by Janzen’s 1926 work) and undertook anatomical measurements relevant to epidural needle placement. He measured the skin-to-epidural distance in >2,000 patients, finding a range of 3.5–12 cm (≈80% <5.5 cm).

1933 – Published a series on “anestesia metamérica epidural”, integrating anatomy, physiology, technique, and clinical outcomes (multiple journals; later consolidated in larger reviews).

1938–1939 – Produced major syntheses on extradural anaesthesia (including a substantial Revista de Cirugía review/monograph), helping standardise extradural practice in Argentina.

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Major Publications

• Gutiérrez A. Clases sobre clínica quirúrgica. 1931
• Gutiérrez A. Anestesia local para la cirugía del abdomen. Tesis, Amorrurta, 1932
• Gutiérrez A. Anestesia metamérica epidural. Clase de Clínica Quirúrgica dictada 28 de Mayo, 1932. Día Médico. Agosto 1, 1932
• Gutiérrez A. Anestesia metamérica epidural. Revista de cirugía de Buenos Aires, 1932; 11: 665-682.
• Gutiérrez A. Anestesia metamérica epidural. Boletín Asociación Médica de Bahía Blanca 1933; 16: 791-3.
• Gutiérrez A, López–Rubido M. Resultados obtenidos con la anestesia peridural. Revista de cirugía de Buenos Aire 1933; 12: 93–101.
• Gutiérrez A. Valor de la aspiración líquida en el espacio peri-dural, en la anestesia peridural. Revista de cirugía de Buenos Aires, 1933: 12: 225-227
• Gutiérrez A. El valor de la aspiración líquida en el espacio epidural en la anestesia peridular. Día Médico; March 27, 1933.
• Gutiérrez A. Anestesia extradural. 1939
• Gutiérrez A. Sobre la relación entre el anestesiólogo y el cirujano. Rev Argent de Anestesia y Analgesia 1939; 1: 5.

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References

Biography

• Aldrete JA, Auad OA, Gutierrez V, Wright AJ. Alberto Gutierrez: beyond the hanging drop. Bull Anesth Hist. 2005 Apr;23(2):6-14.
• Aldrete JA, Auad OA, Gutierrez V, Wright AJ. Alberto Gutiérrez: además de la gota pendiente. Revista Argentina de Anestesiología. 2005; 63(5): 288-301

Eponymous terms

• Soresi AL. Peridural anesthesia; a preliminary report. Medical journal and record 1932; 135: 165-166. [February 17, 1932]
• Soresi AL. Episubdural Anesthesia. Anesthesia & Analgesia 1937; 16(6): 306-310
• Aldrete JA, Auad OA, Gutierrez VP, Wright AJ. Alberto Gutierrez and the hanging drop. Reg Anesth Pain Med. 2005 Jul-Aug;30(4):397-404
• Neruda B. The search for the originator of the hanging drop technique. Reg Anesth Pain Med. 2008 May-Jun;33(3):276-7; author reply 277-8.
• Cortés Román C. Anestesia epidural lumbar 1931-1936. Segundo debut [Lumbar epidural anesthesia, 1931-1936: a second debut]. Rev Esp Anestesiol Reanim. 2005 Mar;52(3):159-68.