By Lewis S. Coleman, MD

I noted the correspondence of Aaron I. Cohn, MD, titled “Questioning ‘Is This Patient Truly Difficult to Intubate?’” and am delighted to see that this subject is getting some of the attention it sorely needs. Back in 2015, I authored “Routine Mask Induction and Intubation Without Paralysis Optimizes Safety,” in which I argued that routine mask induction and intubation without paralysis may be safer than the presently prevailing and unquestioned habit of intravenous induction with hypnotic agents followed by paralysis to facilitate elective intubation, both of which are inherently hazardous and have caused numerous deaths.¹ I didn’t bother to submit the letter to “prominent” journals, such as Anesthesiology or Anesthesia & Analgesia, because I knew they wouldn’t entertain such a challenge to prevailing dogma.

There are numerous aspects of anesthesia practice that need to be scrutinized and reformed, including the following:

• the notion that opioids and carbon dioxide (CO₂) are toxic and harmful, when in fact both have powerful therapeutic properties and are totally lacking in toxicity;
• the notion that elective paralysis is essential to prevent broken teeth and vocal cord damage during intubation;
• the notion that blood pressure is the “driving force” of cardiac output and tissue perfusion;
• the notion that hyperventilation confers benefits of any sort^2-4;
• the assumption that inhalation anesthetic agents possess analgesic properties. They have no such properties. They abolish the ability of consciousness to perceive nociception as pain in a dose-related manner, but they do not prevent harmful surgical nociception that is conveyed via spinal cord pathways to sympathetic ganglia that inhibit organ perfusion and oxygenation during surgery unless anesthesia is supplemented with analgesia; and 
• the assumption that all stressful nervous activity is mediated via the brain and can be prevented by general anesthesia. Instead, anesthesia indirectly exaggerates harmful sympathetic hyperactivity by abolishing the corticofugal (descending) nervous signals that inhibit spinal cord nociception pathways.⁵

Most of this destructive dogma originated with the campaign of Ralph Waters, MD, and Chauncey Leake, PhD, to destroy the reputation of the nurse anesthetists who dominated anesthesia service in the aftermath of World War I and replace them with MD anesthesiologists.⁶ The available evidence suggests that their endeavors were generously rewarded by powerful medical corporations.^6,7 They devised specious animal experiments to confuse anesthesia with CO₂ asphyxiation, which can mimic anesthesia under narrow circumstances. Waters then vilified CO₂ as “toxic waste, like urine” that must be “rid from the body” using mechanical hyperventilation. He also published fictitious clinical reports claiming to demonstrate the toxicity of CO₂. This mischief produced a deadly hoax that prevails to the present day, has killed and maimed countless patients, derailed the era of stress research, and literally reversed medical progress. Before such derailment, the success of the nurses nearly revolutionized medicine because physicians were beginning to accept the therapeutic benefits of narcotics and CO₂—which work together like love and marriage—to treat heart attacks, strokes, carbon monoxide poisoning, smoke inhalation, drowning, inebriation, asthma, atelectasis, pneumonia, drug overdose, and newborn babies with breathing problems.^8,9

There are numerous ways to do something, but there is only one best way. While working in dental clinics, I routinely performed elective mask inductions and nasotracheal intubations without the help of either paralysis or intravenous hypnotic agents—this is detailed in my book.¹⁰ Samples of my computerized anesthetic records are available to the public.¹¹ Patients were often prepared for surgery within five minutes of the moment they set foot through the door of the OR. There were no patient complaints, broken teeth or damaged vocal cords.

The anesthesiology profession is now poised to realize priceless public prestige by reforming these shortcomings, promoting clinical studies to confirm the benefits of stress theory, re-revolutionize surgery and restore medical progress. Must this await the arrival of our great-great grandchildren? Why not us? Why not now?

Coleman is the chair of the Science and Education Board of The American Institute of Stress, in Weatherford, Texas. He reported no relevant financial disclosures. 

References
     1. J Anesth Surg. 2015;2:1-2.
     2. Anesth Analg. 2006;102:1290-1291.
     3. Intraoperative hyperventilation may contribute to postop opioid hypersensitivity. APSF Newsletter. 2009;24(4). https://www.apsf.org/article/intraoperative-hyperventilation-may-contribute-to-postop-opioid-hypersensitivity/
     4. Can J Anaesth. 2011;58:473-475.
     5. Science. 1965;150:971-979.
     6. J Anesth Surg. 2015;3:1-17.
     7. Oxygen transport and delivery. 2022. https://www.youtube.com/watch?v=efi9v86isSw&t=117s
     8. Science. 1936;83:399-402.
     9. Henderson Y. Cyclopedia of Medicine. Vol. 3. F.A. Davis; 1940.   
     10. 50 Years Lost in Medical Advance: The discovery of Hans Selye’s stress mechanism. The American Institute of Stress Press; 2021.
     11. TcO₂/TcCO₂ Anesthesia records of Dr. Lewis S. Coleman 2019-2020. Discovery of the Mammalian Stress Mechanism. 2020.