Charles McKinnon Holmes

Biography

• Born June 11, 1935 in Dunedin, New Zealand
• 1958 – MB ChB, Otago Medical School
• Died March 26, 2020 in Dunedin, New Zealand

Key Medical Contributions

Bier block (1908, 1963)

Intravenous regional anaesthesia (IVRA) provides a simple, safe technique for various surgeries on the upper and lower limbs. It was first performed by August Bier in 1908, but fell into disuse. It was rediscovered with new anaesthetic agents in the 1940’s and re-introduced by Charles McKinnon Holmes in the 1960’s.

In 1963, Holmes used a single sphygmomanometer cuff (high, proximal, and inflated to above the systolic blood pressure); a fine needle into a convenient vein (typically the dorsum of the hand); and 0.5% lignocaine as anaesthetic. He described a series of 30 patients, concluding the technique to be simple, safe and not requiring special training or extensive experience.

In the casualty and outpatient departments many operations are done on the limbs. Inevitably the patient is often ill-prepared for general anaesthesia, which is made all the more hazardous if delegated to a junior anaesthetist. This paper describes a safe and simple method of producing analgesia of the limbs. It is a modification of the technique of “venous anaesthesia” described by Bier.

All that is required is a supply of 0-5% lignocaine, a sterile syringe and a fine needle, a Gordh or Mitchell needle, a sphygmomanometer, and a broad Esmarch-type rubber bandage. The lignocaine should not include adrenaline which may impair its diffusion.

Charles McKinnon Holmes, 1963

Since Bier’s initial introduction of this method of anaesthesia it has been substantially modified and protocols for Biers block differ depending on the country, local protocols and which limb is undergoing the procedure.

Major Publications

• Holmes CM. Intravenous regional analgesia. A useful method of producing analgesia of the limbs. Lancet. 1963; 281(7275): 245-247.

References

Biography

• Obituary. Charles McKinnon (Mack) Holmes 1935-2020. NZMJ 2020; 133(1514): 95-96
• Obituary. Dr Charles McKinnon (Mack) Holmes. Otago Medical School Alumni

Eponymous terms

• van Zundert A, Helmstädter A, Goerig M, Mortier E. Centennial of intravenous regional anesthesia. Bier’s Block (1908-2008). Reg Anesth Pain Med. 2008; 33(5): 483-489.
• Löser B, Petzoldt M, Löser A, Bacon DR, Goerig M. Intravenous Regional Anesthesia: A Historical Overview and Clinical Review. J Anesth Hist. 2019; 5(3): 99-108.