Historic timeline of obstetric anaesthesia

Foremost in the history of obstetric anaesthesia was the introduction of inhalational analgesia by James Simpson in 1847, first with ether and then chloroform. Nitrous oxide was first used in obstetrics in 1880. Neuraxial anaesthesia in obstetrics began with spinal block by Oskar Kreis in 1900, and within 25 years included pudendal, caudal, and paracervical blocks. From 1902 there was a vogue for ‘twilight sleep’, which remained in use until the 1950s. Spinal anaesthesia only became popular with the advent of procaine in 1905; favour declined in the United Kingdom from 1948 and did not return until 40 years later. In 1930, Aburel described the pain pathways of labour. Continuous caudal analgesia for labour was popularized from 1942; it was superseded by the lumbar epidural approach in the 1960s. The arrival of lidocaine in 1950 was a major advance. Another important event in the 1960s was the elucidation of the supine hypotensive syndrome of late pregnancy. In the 1940s, intravenous barbiturates became popular. Mendelson published on the acid aspiration syndrome in 1946. It took 40 years to establish a reliable system of prevention, including fasting, antacids, and rapid sequence induction. This developed piecemeal, aided by recommendations from the British Confidential Enquiries into Maternal Deaths reports beginning in 1957. Neuraxial anaesthesia advanced: 24-hour epidural services (1960s), bupivacaine (1970s), epidural opioids (1980s), use of low-concentration bupivacaine with fentanyl mixtures, patient-controlled epidural and combined spinal–epidural analgesia (1990s), and pencil-point spinal needles (1990s). From the 1980s obstetric anaesthetists have assumed key roles in management of labour, preeclampsia/eclampsia, major haemorrhage, and perioperative care.