The history of anesthesia is fascinating, stemming from “laughing gas” in the 1790s to the discovery of what was called “the blessed chloroform” later.
There is the well-known story of Charles Darwin and his experience in Medical school. He unsuccessfully attended Medical School at Edinburgh University. He reports remembering the surgeries his class observed in the operating theatre before utilizing anesthetics. He writes: “I attended the operating theatre and saw two terrible operations…but I rushed away before they were completed. Nor did I ever attend again, for hardly any inducement would have been strong enough to make me do so, this being long before the blessed days of chloroform. The two cases fairly haunted me for many a long year.”
We can imagine that the suffering Darwin witnessed was quite extreme. We think back to stories about soldiers having to “bite on a stick” while having their legs amputated during the Civil War. As dental students, we hear about early oral surgery procedures that were performed after the patient had consumed many liters of alcohol to “stupefy” themselves. In the 19th century, a simple fracture often led to the amputation of the offending limb and this would be performed on a conscious patient who may be somewhat “out of it” by having consumed alcohol or morphine. As can be postulated, many of these patients later died from shock.
It was known that early gases such as nitrous oxide (laughing gas) and ether caused a “dulling of the senses” and were utilized recreationally at parties during the late 18th and early 19th centuries. In 1790, the chemist Humphrey Davy described his use of nitrous oxide as “highly pleasurable, thrilling” and also noted that his toothache disappeared while using it. He failed to apply his observations, and it wasn’t until the 1840s that there were breakthroughs in anesthesia.
In 1842 a Georgia physician, Dr. Crawford Long, first utilized ether to remove a cyst from a patient’s neck. The operation was a success. Dr. Long never documented his use of it because he was never fully convinced that the anesthetic effects came from the ether or the patient’s imagination. In 1844, Dr. Horace Wells, a dentist, utilized nitrous oxide to remove a tooth and tried to show its efficacy at Mass General but was not wholly successful, according to his audience. His colleague, dentist Dr. William Morten was in the audience that day and later managed to successfully anesthetize a surgical patient at Mass General using ether. He did document this feat.
Ether did have its drawbacks, and, of course, the search for a more suitable alternative continued until chloroform was used in 1847. Queen Victoria was the first royal to utilize anesthesia during childbirth given by the famous father of Epidemiology, Dr. John Snow.
So why did it take so long for anesthesia to advance from providing recreational highs at parties to giving relief from the pain of surgical procedures? From a sociological point of view, we also have to go back and look at how pain was regarded during this period.
In the late 18th century- laypeople became more sensitive to pain. The rise of the humanitarian movement was also happening during this time, affecting society’s attitudes toward pain. For many years, the Christian church had the notion that pain was to be taken as something to be endured- it fortified the spirit. It was a trial sent by God that one was to bear. Wisdom through suffering. But society started to use pain meds during this period, as we know. Laudanum was developed in the 1690s as a tincture of sherry, opium, saffron, and cloves. From the medical perspective, the pain was seen as a good thing- “pain maintains vitality in the system and keeps the body alive when the systems may be depressed.” As time went on, the medical community realized that pain is NOT suitable as it causes suffering, should be diminished and causes the blood pressure to rise considerably.
In the 21st century, we take anesthesia for granted. As Pediatric Dentists, we see the need for general anesthesia when we have very young children or special needs patients that need full mouth rehabilitation or extensive oral surgery due to trauma or severe dental cavities. It is a most humane way to treat these children, adolescents, or special needs young adults. At one time or another, most of us will undergo a procedure where anesthesia will be needed- whether it is a local nerve block, an IV sedation, or a general anesthetic. Because of this, I am personally grateful to our anesthesiologists for taking the pain away.
With all that history aside, I want to talk about one of our favorite colleagues, Dr. Quen Ly. He is one of our Dental Anesthesiologists at Children’s Hospital of Colorado. Dr. Quen is also a gifted artist who utilizes his talent to help the children we treat feel more at ease when they see him in the OR. All of his colleagues highly respect him. Dr. Elodi Healy said, “We love Dr. Quen! He is a fantastic anesthesiologist as well as a talented artist and compassionate teacher. He had a significant impact on our anesthesia training, and he has empowered us to feel comfortable managing dental emergencies. Residency wouldn’t be the same without him! “.
Some background about Dental Anesthesiologists: The Dentist Anesthesiologist has an expertise in dental procedures, outpatient anesthesia, anesthesia outside of the operating room, and treating children and patients with special healthcare needs. In fact, dentist anesthesiologists are required to treat more children in their residency than physician anesthesiologists that do not go into the subspecialty of pediatric anesthesia.
Can you tell us a little about yourself?
“I was born in South Vietnam; my family fled to Singapore when I was seven years old. I moved to the U.S. in my teens. Most of my schooling and training were on the East coast. I have always wanted to move West since my two-week cross-country drive during college. In the final year of my anesthesia residency, I visited a dental school classmate training at the Children’s Hospital Colorado pediatric dental residency. Through mutual friends, I connected with some of the anesthesiology attendings at CHCO, who permitted me to observe surgeries at the hospital. I was introduced to the Anesthesiology Chair during my time at CHCO. He informed me of an open position for a dentist anesthesiologist and mentioned I should apply for it. I sent in my CV and started my career at CHCO six months later. It will be my 11th anniversary at CHCO in September this year”.
When did you first realize you wanted to become a dentist and then, most importantly, when did you realize you wanted to become a dental anesthesiologist?
“I graduated college with an art history and fine art degree. I then finished my master’s degree in Interactive Instructional Technology. I worked in the dot-com industry for six years until the tech bubble burst. At the same time, I was working multiple jobs after my tech career. One of them was an oral surgery assistant, working for my friend’s father, who later became my mentor. As someone that enjoys working with their hands, I found dentistry very rewarding- especially oral surgery. It took me two applications to get into dental school. My original plan was to pursue the specialty of oral surgery after dental school. Not matching oral surgery after dental school, I decided to complete a one-year General Practice Residency. I reapplied to oral surgery after GPR, but still no matches. I then applied to dental anesthesiology. I believe things happen for a reason. Not matching oral surgery led me to dental anesthesiology, which I discovered is my true passion.”
Have you always been creative and artistic throughout your life?
“I guess you can say I have always been creative. I have always enjoyed drawing and sketching since the age of five. I took my first painting lesson when I was eight years old, and I have been creating artworks ever since. I also enjoy playing the guitar and violin.”
Tell us about how you have integrated your gift for being creative and your art into helping children during these hard times when they have to go under general anesthesia.
“I had to have a surgical procedure when I was five years old. I still remember how traumatic the mask induction process was. Through my experience, I am very empathetic toward all my pediatric patients. Surgery is a stressful event, especially for a pediatric patient. Spending the extra two minutes creating a bond with my pediatric patient results in a dramatic lessening of anxiety for the parents and patient. I came up with the idea of drawing cartoons on the anesthesia machine’s rebreathing bag to reduce patients’ fear during anesthesia induction about ten years ago. Drawing cartoons of the patient’s favorite (familiar) animal or animated character helps comfort the patient with something familiar in an unfamiliar environment.”
**Here is some feedback from Dr. Quen’s patients and parents**
- “he personally drew a Pikachu on a balloon since the hospital didn’t have any Pokemon balloons and now my son REFUSES to ever discard it.”
- “he is awesome and has great art skills and my daughter carries the personalized balloon everywhere.”
Most of us realize that being both a dentist and an anesthesiologist gives you a unique insight when we see children for comprehensive dental care under general anesthesia. We feel very blessed to have you helping us when we do dental work in the OR. We love our medical anesthesiology colleagues, but we also think that your background and education give you more knowledge and insight into what we do as pediatric dentists. Can you explain this in better terms for our audience?
“Being a dentist and anesthesiologist helps me communicate with dentists and patients. I have a better understanding of the needs and requirements from a dentist’s point of view, for example, using a nasotracheal endotracheal tube, the preferred airway for patient positioning. A primary responsibility of an anesthesiologist is good airway management. Dentistry training provided me with a great understanding of head and neck anatomy and physiology. It helps me appreciate the dentition and surrounding tissues during airway management.”
How do you feel that this pandemic has changed you as a clinician? How do you think it has changed you as a person?
“The COVID-19 pandemic made health care disparity more apparent, especially between socioeconomic groups and the lack of care. I became more appreciative about working at Children’s Hospital Colorado because I can make a difference in the pediatric health care disparity.
All elective surgical procedures, including dental rehabilitations, were halted at Children’s Hospital of Colorado (CHCO) for almost two months during the beginning of the pandemic. Like most of the population stuck at home during the pandemic, it allowed me to reevaluate my work and life balance. I am very blessed to have a job that I genuinely enjoy doing. I can be somewhat of a workaholic, but I now truly value my downtime.”
Works Cited
Eger, E. (2014). The Wondrous Story of Anesthesia. Corr. 2nd Printing.
Rushman MB BS FRCA, G. B. (1996). A Short History of Anesthesia. Butterworth-Heineman.
Sykes, Keith., Bunker, John. (2007). Anaesthesia and the Practice of Medicine: Historical Perspectives 1st Edition. CRC Press: 1st edition
Dr. Kyoko L. Yoda’s Peds Dental Blog 
2 responses to “Pediatric Dental Anesthesiologists: Our Colleagues that Make the Pain Go Away”
May the Force be with you, Dr. Yoda! I thoroughly enjoyed your blog!
Thanks!