MONITORING OXYGENATION

Cyanosis was used for a century after dentists began pulling teeth under 100% N(2)O in 1844 because brief (2 min) severe hypoxia is harmless. Deaths came with curare and potent anesthetic respiratory arrest. Leland Clark's invention of a polarographic blood oxygen tension electrode (1954) was introduced for transcutaneous PO2 monitoring to adjust PEEP and CPAP PO2 to prevent premature infant blindness from excess O2 (1972). Oximetry for warning military aviators was tried after WW II but not used for routine monitoring until Takuo Aoyagi (1973) discovered an equation to measure SaO2 by the ratio of ratios of red and IR light transmitted through tissue as it changed with arterial pulses. Pulse oximetry (1982) depended on simultaneous technology improvements of light emitting red and IR diodes, tiny cheap solid state sensors and micro-chip computers. Continuous monitoring of airway anesthetic concentration and oxygen also became very common after 1980. Death from anesthesia fell 10 fold between 1985 and 2000 as pulse oximetry became universally used, but no proof of a causative relationship to pulse oximetry exists. It is now assumed that all anesthesiologist became much more aware of the dangers of prolonged hypoxia, perhaps by using the pulse oximeters.