Arthur Ernest Guedel

Arthur Ernest Guedel (1883 – 1956)

Arthur Ernest Guedel (1883 – 1956) was an American anesthesiologist.

Guedel developed a training school for orderlies and nurses to administer ether anaesthesia. He created a chart to assess the depth of anaesthesia that went on to be used for over 50 years.

Guedel’s research background, combined with experience during peace and war, was the basis for: Inhalation Anesthesia A Fundamental Guide, first published in 1937

In 1933 Guedel designed a metal pharyngeal airway moulded in rubber to prevent occlusion by biting. The ‘Guedel’ airway has stood the test of time for nearly 80 years. Guedel also developed the first inflatable cuffs for endotracheal tubes from the fingers of rubber gloves, in the basement of his home


Biography

  • Born June 13 1883 in Indianapolis
  • 1886 – Lost three fingers from his right hand aged 13, but despite this he went onto become an accomplished pianist, organist and composer
  • 1903-1908 – Medical college of Indiana
  • 1909 – Opened his first general practice. To supplement his income he provided anaesthetic services to hospitals and dental offices
  • WWI – Anaesthetist in the American Expeditionary Forces in France; known as the “motorcycle anesthetist”
  • 1928 – Clinical professor of anaesthesia, University of Southern California
  • 1937 – Published: Inhalation Anaesthesia, a Fundamental Guide
  • 1941 – Henry Hill Hickman Medal, Royal Society of Medicine. First recipient from outside the British Isles
  • 1950 – Distinguished Service Award of the American Society of Anaesthesiologists
  • Died June 10, 1956

Medical Eponyms

Guedel-Waters Cuffed intratracheal tube (1928)
Guedel-Waters Cuffed intratracheal tube (1928)
Guedel-Waters Cuffed intratracheal tube (1928)

The catheter effectively prevents all air leaks and renders the respiratory system entirely closed, with a controllable to and fro respiratory exchange. Aspiration of foreign matter into the lungs is not possible with the catheter in place.

Guedel 1928

Guedel Oropharyngeal airway (1933)

In 1933 Guedel designed a metal pharyngeal airway moulded in rubber to prevent occlusion by biting. The ‘Guedel’ airway has stood the test of time for nearly 80 years.

Original description of the Guedel oropharyngeal airway

Guedel laryngeal plug (1934)

The laryngeal plug is a little-known device developed by Arthur E. Guedel in the 1930s. The device was an alternative to the inflatable cuff used on tracheal tubes. Guedel did not publish a description of the laryngeal plug and the most detailed description was published by Gilbert Reynolds Troup (1896-1962), an Australian anaesthetist.

Guedel laryngeal plug

This plug of Guedel is made of soft rubber; it fits round the catheter like the inflatable cuff and serves the same purpose. Guedel claims the catheter plus plug is easier to introduce into the trachea than the cuffed catheter…It causes less irritation than the inflatable cuff, the nidus of which is lower in the trachea…

Troup 1935

Guedel classification (1937)

The first classification system for general anaesthesia was proposed in 1847 by John Snow (1813-1858) as the 5 stages of etherization (narcotism); and furthered by Francis Plomley in the Lancet in the same year. Guedel proposed a four stage classification system to assess the depth of general anesthesia in 1937. This was designed for use with a single inhalational anesthetic agent (ether), in patients premedicated with morphine and atropine.

Guedel classification (1937)
  • Stage 1: Analgesia and amnesia. From induction of general anesthesia to loss of consciousness
  • Stage 2: Delirium and unconsciousness. From loss of consciousness to onset of automatic breathing
  • Stage 3: Surgical anesthesia. From automatic respiration to respiratory paralysis. (four planes of depth)
  • Stage 4: From apnoea (stoppage of breathing) to death.

In 1954, JF Artusio further divided stage 1 into an additional three planes of depth


Other Eponyms

Controversies

Guedel developed and overcame addictions to barbiturates and amphetamines to control his insomnia. He would later educate physicians regarding the risks of addiction.

Guedel performed the ‘dunked dog’ experiment. He anaesthetised, intubated and immersed his own dog (nicknamed ‘Airway‘) at the beginning of a lecture he was giving. Following the demonstration, he revived the dog, allowed him to waken, shake-off and exit the theatre to the applause of the audience.

airway the dog of Arthur Ernest Guedel
Airway, the dog of Arthur Ernest Guedel

Major Publications

  • Guedel AE. Nitrous oxide air anesthesia self-administered in obstetrics—a preliminary report. Indianapolis Med. J. 1911;14:476–479.
  • Guedel AE. Auscultatory control of vapor anesthesia. Am J Surg [Anesth Suppl] 1919;33:24–26
  • Guedel AE. Third stage ether anaesthesia: a sub-classification regarding the significance of the position and movements of the eyeball. Am. J. Surg. (Anesth Suppl.). 1920; 34: 53–57.
  • Guedel AE, Waters RM. A new intratracheal catheter. Anesth Analg 1928; 7: 238-239
  • Guedel AE. A nontraumatic pharyngeal airway. JAMA 1933; 100(23): 1862 [Guedel Airway]
  • Waters RM, Rovenstine AE, Guedel AE. Endotracheal anesthesia and its historical development. Curr Res Anesth Analg 1933; 12: 196–203
  • Guedel AE. Inhalation anesthesia – A fundamental guide. Macmillan. 1937 [Guedel Classification]
  • Guedel AE. Cyclopropane anesthesia. Anesthesiology 1940;1:13–25

References


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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