Burger King: Home of the Whopper & Nitrous Oxide

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I’m glad I went into anesthesia.  I really enjoy the technical aspect of what I do:  the nerdy, geeky, and science-y side of all the gadgets that we have at our disposal to take care of patients.  I also really get into the operating room dynamics and the fluidity of every situation:  keeps things interesting and no case is ever exactly the same as another.  But what I really love is the interaction I have with people – the patients – and the obvious difference I am privileged to make in their otherwise stressful, fright-filled experience.  Being an anesthesia professional is really rewarding, fun and cool.

But for many people who choose anesthesia as a career, one of the attractive attributes is the amount of exposure to actual patients…more specifically, how little interaction there actually is with walking and talking patients.  It’s one of the six NPC specialties listed in Samuel Shem’s The House of God.  NPC = No Patient Contact.  I imagine that there’s a significant proportion of anesthesia folks who like being able to put patients to sleep just so they don’t have to talk to them.  More and more though, this is changing.

I joke all the time that everything I know about anesthesia I learned on Wikipedia.  And my entire self-taught ultrasound-guided regional anesthesia fellowship consisted of watching YouTube videos.  The point is that all this knowledge is out there for anesthesia professionals and their patients alike.  At least in my neck of the woods, patients are coming into preop with more knowledge than ever before, having read up on their conditions, the proposed surgical treatment, and their anesthetic options.

Talking to patients and involving them in the clinical decision-making process is of paramount importance these days.  Acknowledging the perspective that patients bring to the table based on information that they’ve gleaned from the internet is a significant advantage for the patient-provider relationship.  Haven’t we all at some point wished that patients would take better care of themselves or be interested in what we are telling them to do to get healthier?  Today, all we have to do is to further build on the knowledge foundation that each patient brings to his or her own situation.

And that’s sort of where the relationship between Burger King and anesthesia is rooted. Patients have an abundance of tools and information to make decisions about the anesthetic plan you have chosen for them.  Just like Burger King offers to its Whopper-consuming patrons, we should also be more and more willing to encourage patients to “Have It Your Way“.

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“So I get it, let the patient decide what kind of anesthesia they want.  But what’s this about Burger King and Nitrous Oxide???”

Turns out that there is an interesting link between anesthesia and the royal burger restaurant.  To explain this, we have to delve into the history of one of our most beloved anesthetic gases:  nitrous oxide…

3c04753vThe discovery of nitrous oxide is widely attributed in history to Joseph Priestly in 1772.  He heated ammonium nitrate and captured the resulting “nitrous air” in a jar.  Aside from noticing that candles burned brighter in the gas and mice appeared to be less lively (and eventually died) when placed in a jar of nitrous air, he really didn’t think much of it and instead went on to discover the much more important gas he called “oxygen” in 1774.

page19-image01-sir-humphry-davyIt wasn’t until a 20-year-old Humphry Davy took up the gas almost 30 years later that anyone took a second look at nitrous.  Davy conducted many experiments with the gas to prove that it was safe to breathe.  Conspicuously, he performed all of his experiments on himself and his friends, and they became fixated on the high they felt when inhaling the gas.  It was estimated that Davy himself inhaled upwards of 25 liters of nitrous air each day. 16340282 And although he is credited for describing the pain-relieving effects of breathing nitrous, he became more interested in quantifying its ability to prevent pain as it related to alcohol-induced hangovers.  Davy did write an almost-600 page tome about nitrous oxide.  Sadly it is only at the end of the book on Page 556 that he makes his now famous pronouncement about the possible use of nitrous oxide in surgery:

“As nitrous oxide …appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place… “

As riveting as a 500+ book about nitrous oxide sounds, very few people made it to Page 556 in a lucid state, so for the next half-century surgeons continued to be judged by their speed and surgeries continued to be associated with agonizing pain.

 In the meantime, the recreational use of nitrous oxide exploded, and yet everyone kept missing the enormous potential of using nitrous for surgery.  Travelling “laughing gas parties” along with “ether frolics” were the norm for the young and fashionable of high society.  It wasn’t unusual to see carnival sideshows with their boisterous showmen giving crowd-pleasing demonstrations of the gas’s “exhilarating features.”

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cartelcopia3brIt was at one of these carnival demonstrations in 1844 that Horace Wells, a dentist from Hartford, Connecticut, saw the effects of nitrous oxide for the first time and realized the potential that it held for revolutionizing dental surgery.  The very next day, Horace convinced a dentist friend to pull one of his teeth after inhaling some nitrous oxide.  Wells shouted out afterwards:

“It is the greatest discovery ever made! I didn’t feel as much as the prick of a pin!”

wellsHe performed about 15 successfully painfree dental extractions with nitrous oxide and traveled to Harvard University to share this amazing discovery.  Unfortunately, at the demonstration, the patient screamed throughout the tooth extraction and Wells was shouted down and hissed and denounced as a fraud.  Although later the patient woke up and denied feeling pain or even remembering the extraction, it was too little, too late.  Horace Wells was disgraced, his reputation never recovered, and he committed suicide 2 years later.

tnsil14-d5-04Barely 9 months later, in the same operating theater that Wells had given his embarrassing nitrous oxide demonstration, another dentist, William T.G. Morton, successfully demonstrated using a mixture of ether and air to render a patient unconscious and senseless to the pain of a dental extraction.  This was the dawn of modern anesthesia, and the rest is history.

Despite his perceived failure, today we recognize Horace Wells as the Father of Surgical Anesthesia for being the first to use nitrous oxide to provide analgesia for surgical purposes.  There are many homages to Horace Wells in Hartford, Connecticut, but perhaps the most interesting is this commemorative plaque that is placed in the location of his original office on Main Street:

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Created by Enoch S. Woods in honor of Horace Wells, erected in 1894 and placed at the site of  his primary office location at 805 Main Street (formerly 180 1/2 Main Street) to commemorate the discovery of anesthesia


So if you’ve read this far, I’m sure you are still wondering what the connection is between Burger King and nitrous oxide.  In the first part of this article, I talked about how the practice of anesthesia is changing in response to the sheer availability of information on the internet and how patients are starting to demand and expect to have input on the making of the anesthesia plan, just like Burger King’s slogan to “Have It Your Way” when it comes to what they put on a Whopper.

And now that you’ve heard about the history of how nitrous was discovered and how it spent almost 3/4 of a century as a recreational drug, you can better appreciate the accomplishment of Horace Wells.  Nitrous oxide might have been forgotten were it not for Horace Wells.  And whenever you see a Burger King, I hope you think of Horace Wells and nitrous oxide and “having it your way“.  Why?  I’ll tell you…if you go on Google Maps and do a street view search for “Burger King Main Street Hartford CT”…this is what you will find:

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Yep, it’s good ole Horace Wells hanging out at the Burger King for all to see.  Thousands of people must walk past this plaque everyday and never realize it, much less understand how significant an event it commemorates.  But now you’re in on the secret.  I know it’s nothing too exciting, but it’s a nifty piece of anesthesia trivia illustrating that anesthesia references are indeed all around us.

Burger King:  Home of the Whopper & Nitrous Oxide

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