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OR MORE THAN a century it ha s com-F only been accepted thah genera l an-esthesia can safely protect an organismfrom surgical pain only if cortical andsubcortical centers are effectively de-pressed. T he efficacy of ag en ts used t oproduce such an an es th e t ic s ta te hasbeen judged according to how f a s t t he ycould induce op timal cerebral depressionwith minimal circulatory, respiratory,and metabolic derangements, and howreadily their effects could be overcome.Laborit l first drew attention t o t h eneed for revising the old conventionalapproach to general anesthesia when heintroduced a new concept based on selec-tive blocking of certain cellular, auto-nomic, and endocrine mechanisms nor-mally activated as a response to stress.Drug combinations capable of causingsuch multifocal inhibition were used to

GUENTHER CORSSEN, M.D.EDWARD F. DOMINO, M.D.ROBERT B. SWEET, M.D.Ann Arbor, Michigan*

produce a s ta te of rest in such struc-tures as the cerebral cortex, the dien-cephalon, certain hormonal relays, andvarious ganglionic and terminal synapses. Naturally this artificial hiberna-tion was often marked by circulatorydepression resulting fr om induced hom-eosta tic imbalance.The search for other means of selec-tively blocking the afferent systems in-volved in surgical stress has led to in-

creased emphasis on the possibility ofcombining analgesic ag en ts with agentsthat suppress vegetative reflexes. SinceJanssens introduction of a series ofhighly potent analgesic and neuroleptica n a n e s t h e t i c t e c h n i c h a sevolved, called neuroleptanalgesia ,6which renders the patient free frompain without affecting certain areas oft h e c e n t r a l n e r v o u s s y s t e m t h a t a r e*Departments of Anesthesiology and Pharmacology, The University of Michigan Medical Cen-ter, Ann Arbor, Michigan.Read a t the 38th Congress of the International Anesthesia Research Society, March 15-19,1964, Las Vegas, Nevada.Supported by a grant in aid from the McNeil Laboratories, Inc., F o r t Washington, Pennsyl-vania, and grant MY-02653, USHPS.

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