Address correspondence and reprint requests to Dr. Maurice S. Albin at the University of Texas Health Center, Department of Anesthesiology, 7703 Floyd Curl Drive, San Antonio. TX, 78284, U.S.A.

Key Words: History: Neuroanesthesiology-Neurosurgical Anesthesiology -Neuroanesthesiology-Neurosurgical Anesthesiology; NSA: Neuroanesthesia Society; SNANSC: Society of Neurosurgical Anesthesia and Neurological Supportive Care; SNACC: Society of Neurosurgical Anesthesia and Critical Care

The decade of the sixties was seminal for the development of neuroanesthesiology as a definitive subspecialty. During those years, standardization of techniques for measurement of CBF, CMRO2, ICP and neurochemical moieties were introduced. The physiologic basis of cerebrovascular dynamics was being established and instrumentation design was spurred by developments in electronics and engineering. Of equal importance, research groups of anesthesiologists and neurosurgeons were coalescing in Europe and North America to examine the effects of anesthetics on cerebral blood flow and metabolism, on cerebrovascular responses of the traumatized brain, and the dynamics of intracranial hypertension-to name but a three areas of investigation. This multidisciplinary approach was spurred as neurosurgeons and anesthesiologists came to realize that they had common ground in their need to clarify essential pathophysiologic problems relating to patient care. Along with those advances, new findings in neurochemistry and the beginning of important developments in the (then) new subspecialty of neuroradiology increased the background of intellectual ferment that heralded great strides in the decade of the seventies.

This is not to say that significant advances or discoveries had not been made prior to the sixties. We are forever indebted to the works of Amussat, Sherrington, Bernard, Horsley, Macewen, Halsted, Cushing, Kety, and Schmidt, among many others. A fine review of the background to the history of neuroanesthesiology can be found in a recent work by Frost (1).

The academic purview of neuroanesthesiology was promoted in 1964 by publication of the first neuroanesthesiology textbook written in English by Professor Andrew R. Hunter from Manchester (Fig. 1) (2). This was followed in 1966 by the first Canadian book in neuroanesthesiology edited by R.G.B. Gilbert (then Chair of the Department of Anaesthetics at McGill University and Director of Anaesthesia at the Montreal Neurological Institute) together with Fred Brindle and Anibal Galindo (3). During this time period (1965), Dr. Allan Brown of Edinburgh and Professor Hunter founded the Neuroanesthesia Traveling Club of Great Britain and Ireland, an organization dedicated to furthering the development of the neuroanesthesiology as a recognized subspecialty. Also of interest was the formation in 1961 of a North American working group called the Commission on Neuroanesthesia, sponsored by the World Federation of Neurology, and initially composed of Howard Terry (Mayo Clinic), Jack Michenfelder (Mayo Clinic), Maurice Albin (Case-Western Reserve), and chaired by R.G.B. Gilbert (McGill). A rapid development of knowledge relating to neuroanesthesiology from centers in Philadelphia, Glasgow, Rochester, Richmond, San Francisco, London, New York, Cleveland, and Montreal was soon to follow.

FIG. 1. Professor Andrew R. Hunter, pioneering neuroanesthesiologist, author of the first book on neuroanesthesia in English (1964), and cofounder of the Neuroanesthesia Traveling Club of Great Britain and Ireland in 1965.

FIG.2. Maurice S. Albin, M.D., M.Sc. (Anes), one of the original organizers (1972) and founders (1973) of NAS and its 2nd President.

 FIG.3. Thomas W. Langfitt, M.D. The neurosurgical "Guru" of North American Neuroanesthesia-both founder and organizer of NAS in 1972 and 1973.

In May of 1972, Thomas W. Langfitt (Professor and Chief of the Division of Neurosurgery at the University of Pennsylvania) was a visiting Professor at the University of Pittsburgh. During that sojourn he and I had many conversations concerning the need to form some type of organization for neuroanesthesiologists working closely with neurosurgeons (Figs. 2,3). On returning to Philadelphia, he spoke with James E. Harp (Department of Anesthesiology, University of Pennsylvania-Fig. 4) about our conversations and this resulted in a letter of June 6, 1972, and my reply of June 14, 1972 (Fig.5,6). Doctor Harp and I remained in contact during the remainder of 1972, and we collated a mailing list of individuals in the United States and Canada who might be interested in joining such a group. We decided that the perfect location for a preliminary meeting would be Philadelphia, in conjunction with the Sixth International Cerebral Blood Flow Symposium. We were also pleased to have Harvey Shapiro (University of Pennsylvania) join our neuroanesthesiology crusade (Fig. 7). The Philadelphia CBF venue was very important since many interested anesthesiologists and neurosurgeons were in attendance. A specimen letter from our committee, announcing the meeting and the suggested goals, can be seen in Figs. 8 and 9.

FIG.4. James Harp, M.D., one of the original organizers (1972) and founder of NAS (1973).

FIG. 5. Letter from James Harp to Maurice Albin concerning formation of a neuroanesthesia group.

Hosted by Drs. Thomas Langfitt and Harry Wollman (Department of Anesthesiology, University of Pennsylvania - Fig. 10), the first organizational meeting took place on June 15, 1973, at the Marriott Motor Hotel in Philadelphia. It was attended by 36 anesthesiologists and 4 neurosurgeons (Fig. 11). We named our group the Neurosurgical Anesthesia Society (NAS); a brief portion of the bylaws can be seen in Figure 12. One important outcome of this meeting was Dr. Langfitt's willingness to include NAS in the programs of the Harvey Cushing Society (subsequently named the American Association of Neurologic Surgeons).

FIG. 6. Letter from Maurice Albin to James Harp regarding plans for a neuroanesthesia group.

FIG. 7. Harvey Shapiro, M.D., one of the original founders of SNA, first Secretary and 4th President of SNANSC.

FIG. 8. Specimen letter concerning the preliminary organizational meeting of the Neurosurgical Anesthesia Society. This letter was sent out to anesthesiologists and neurosurgeons thought to he interested in the organization.

FIG. 9. The suggested goals for the proposed Neuroanesthesia Society.

FIG. 10. Harry Wollman, M.D., one of the founding members of NAS and a host of the 1973 organizational meeting in Philadelphia.

MEMBERS OF THE

'NEUROSURGICAL ANESTHESIA SOCIETY'

(Jun. 15, 1973)

M. Albin, M.D. Pittsburgh, PA
S. C. Alexander, M.D. Madison, WI
D. P. Becker, M.D. Richmond, VA
R. Bergland, K.D. He r hey, PA
V.L. Brechner, M.D. Los Angels, CA
G.F, Brindle, M.W. Sherbrooke, PQ
E.A. Brunner, M.D. Chicago, IL
R.C. Carroll, M.D. Pittsburgh, PA
J.G. Frazer, M.D. Cleveland, ON
A. Galindo, M.D. Seattle, WA
R.G.B. Gilbert, M.D. Montreal, CANADA
T.S. Gilbert, M.D. Durham, N.C.
A.J. Gissen. M.D. Boston, MA
G.A, Gronert, M.D. Rochester, MI
J. Harp M.D. Philadelphia
M. Helrich, M.D. Baltimore, HD
E.M. Kenwell. M.D. Philadelphia. PA
L.K. Kitathata, M.D., Ph.D. New Haven, CT
H.J. Khambatta, M.D. New York, N.Y.
V.E. Lamb K.D. Chicago, IL.
T.W. Langfitt, M.D. Philadelphia. PA
C.P. Larson, Jr., M.D. San Francisco, CA
J.D. Levitt, M.D. Philadelphia, PA
Brian Marshall, M.D. Toronto, ON
K.J. Matjasko, M.D. Baltimore, NO
J.H. Messick, Jr. M.D. Rochester, MI
J.D. Michenfelder, M.D. Rochester. MI
L.R. Orkin, M.D. Mew York , NY
A. Schettini, M.D. Gainesville, FL
M.H. Shapiro, M.D. Philadelphia, PA.
H.C. Slocum, M.D. Galveston, TX
A.L. Smith, M.D. San Francisco, CA
R. Smith, M.D. San Diego, CA
M. Sokol, M.D. Iowa City, IA
J. Tinker, M.D. Ft. Campbell, KY
D. Trop, M.D. Montreal, PQ
J.W. Wads, M.D. Winnipeg, KB
R.J. White, M.D. Cleveland, OH
H. Wollman, M.D. Philadelphia. PA
A. Yeakel, M.D. Hershey. PA

FIG. 11. Charter members of the Neurosurgical Anesthesia Society at its meeting on June 15, 1973. Four neurosurgeons were present including Becker, Bergland, Langfitt, and White

FIG. 12. A portion of the articles of organization and by-laws of the Neurosurgical Anesthesia Society.

FIG. 13. Part of the program at the 1975 AANS indicating two of the SNANSC contributions.

FIG. 14. Specimen of letter sent to all neurosurgical and anesthesia programs in the United States and Canada announcing its meeting in San Francisco on October 7, 1973.

This allowed our members to interact with neurosurgeons through panel discussions and workshops and through the presentation of papers on subjects related to our two specialties. An example of the participation of our membership is shown in the flyer for the 1975 meeting (Fig. 13).

After the first organizational meeting on June 15, 1973, an ad hoc committee of members Shapiro, Harp, and I sent a letter to all program directors in anesthesiology and neurological surgery concerning the formation of the Neurosurgical Anesthesia Society. The letter emphasized that this new group would be multidisciplinary, with an open membership (Fig. 14). It also mentioned that the first organized meeting of the Society would take place on October 7, 1973, in San Francisco, since the ASA was to meet there that year. In addition to Drs. Harp, Shapiro, and 1, the ad hoc committee also included Drs. Alan Smith (San Francisco), Stephen Wyte (Denver), Brian Marshall (Toronto), John Wade (Winnipeg), and Anibal Galindo (Seattle). We contacted all individuals whom we thought would have interest in NAS and invited them to attend. Our San Francisco contact at that time was Alan L. Smith (UCSF), who handled local arrangements as well as the dinner (which was an outrageous sum of $7.50 per head!) (Fig. 15). Annual dues at the 1973 meeting were $15.00 and this fee remained in effect for several years.

FIG. 15. Letter from Harvey Shapiro (acting secretary) concerning the members of the NAS, annual dues form, and mailing list.

FIG. 16. John Mitchenfelder, M.D., 1st President and a founder (1973) of NAS.

The meeting was important because it implemented a definitive organizational structure. The Neurosurgical Anesthesia Society was changed to the Society of Neurosurgical Anesthesia and Neurological Supportive Care (SNANSC) since it was felt that the new name would be more open, allowing for more disciplines to enter the organization and the name also more clearly defined our group aims. At this meeting, which was attended by more than 45 professionals, a constitution and bylaws were adopted and officers were elected. The officers were John D. Michenfelder, (Rochester, Minnesota) President (Fig. 16); Maurice Albin (Pittsburgh), President-Elect; Brian Marshall (Toronto), Vice-President; and Harvey Shapiro (Philadelphia) Secretary-Treasurer. A program committee was chosen for the Annual Conference and Meeting to take place on October 11, 1974, in Washington, D.C., prior to the annual ASA meeting. The program (Fig. 17) was enhanced by active participation of neurosurgeons-a hallmark of our organization since its inception. In fact, six of our Presidents have been neurosurgeons. I know of no other society in anesthesiology with this type of collaborative effort taking place on both sides of the table. The meeting fee (including luncheon and the educational materials) cost $15 for members and $20 for non-members. This successful meeting was attended by 150 registrants. Of particular note was the effort of Aaron Gissen (Boston) who developed protocols/questionnaires concerning anesthesia- neurosurgical problems and practices (Fig. 19).

Figure 17. Program of the first annual conference in 1974 at Washington D.C.

Figure 18. A portion of the 1974 fall newsletter

The programs of the 1975 (Chicago) and 1976 (San Francisco) meetings (Figs. 20,21) illustrate the development, inclusiveness and intellectual depth of our undertaking. A review of the topics in both programs demonstrates the wide variety of our members' concerns relating to clinical, basic science, and educational objectives. The international aspect of our interests was evidenced by the number of European participants. A sense of déja vu is elicited by the title of the first topic for discussion at the 1976 meeting- "Pharmacologic Protection against Brain Injury." Starting, with the 1974 meeting, the scientific programs consisted of free papers covering experimental studies or clinical protocols. Eleven papers were presented at our 1976 meeting (Fig. 22). 1975-76 dues were $15.00, meeting registration was $25.00 for members, $30.00 for non-members, and the dinner cost had doubled to $15.00.

Neuroanesthesiology was formally recognized by the ASA as a subspecialty in 1976 while James E. Cottrell served as Chair of the ASA Subspecialty Committee. By the end of 1976, organizational aspects had stabilized and we could boast more than 160 members from institutions in the United States, Canada, and Mexico. Our membership now included anesthesiologists, neurosurgeons, neurologists, engineers, and neuroscientists. We had established a newsletter (Fig. 23), and our meetings were being reported in Anesthesiology. Anesthesiologists and neurosurgeons throughout the United States and Canada interested in neuroanesthesiology had been contacted, and SNANSC participated actively in panels and presentations at the American Association of Neurological Surgeons (Fig. 24). The educational component of our Society expanded in 1974 with guidelines developed by Aaron Gissen for the management of induced hypotension, carotid endarterectomy, and air embolism. Concomitantly, in 1975, James E. Cottrell was developing questions for a survey of the number and types of cases carried out by anesthesiology residents during their first two years of clinical training as well as the nature of neuroanesthesiology and surgical practices. Preliminary information in this area was presented during our 1976 meeting by Drs. Cottrell (New York), Harp (Philadelphia) and Jannetta (Pittsburgh). An educational subcommittee was organized to develop a bibliography pertinent to our research, clinical, and educational practices. We were in constant contact with our European colleagues and plans were made to meet with our British counterparts (Fig. 25). Those plans came to fruition during a joint meeting in Williamsburg, Virginia in 1979. A combined meeting was held a few years later in London, England. We had also developed a relationship with ASA vis-a-vis the role of subspecialty groups within the organization; sponsored and arranged the neuroanesthesia breakfast panel at the ASA; and achieved representation on the ASA Refresher Course committee.

FIG. 19. Letter from Aaron Gissen concerning evaluation of management of induced hypotension, carotid endarterectomy, and air embolism.

FIG 20. The 1975 program.

FIG. 21. The program for the October, 1976, meeting. The subject of brain protection and the problem of education in neuroanesthesia were highlighted.

The first U.S.A. textbook in neuroanesthesiology (4), now in its third edition (5), was published in 1980. By 1982 (our tenth anniversary), we had experienced considerable growth in membership and the participants obviously enjoyed the meeting (Fig. 26). This celebration was shadowed by the death of Brian M. Marshall (Toronto), one of our founding members and President from 1976-77; we dedicated this meeting in his memory. At our 1986 meeting, SNANSC became the Society of Neurosurgical Anesthesia and Critical Care (SNACC) in order to recognize the importance of critical care medicine to patients with severe neurological dysfunction.

FIG. 22. The eleven free papers presented at the 1976 scientific session.

FIG. 23. The 1976 summer newsletter. Note in the fifth paragraph that SNANSC sponsored a breakfast panel at the ASA which continues to this day.

FIG. 24. A portion of the 1976 SNANSC spring newsletter indicating our participation at the AANS meeting.

1989 saw the launch of the Journal of Neurosurgical Anesthesiology (JNA) with James E. Cottrell serving as Editor, John Hartung as Associate Editor, and Roberta Halporn as JNA's Editorial Office Manager (Figs. 27-29). This journal has since become the voice of SNACC, as well as that of the Association de Neuro-Anésthesiologie et Réanimation de langue Francaise, the Wissenschaflicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivemedizin, the Neuroanesthesia Society of Great Britain and Ireland, and the Arbeitsgemeinschaft Deutschsprachiger Neuroanäthesisten und Neurointensivmediziner.

FIG.25. Letter to Gordon McDowall, an officer of the Neuroanesthesia Traveling Club of Great Britain and Ireland.

FIG. 26. A portion of the SNANSC newsletter of 1982, commenting on our 10th anniversary.

FIG. 27. James Cottrell, M.D., Founding Editor of Journal of Neurosurgical Anesthesiology in 1989 and 8th President of SNANSC.

Our twentieth anniversary meeting was celebrated in New Orleans in 1992. It had historical overtones as John D. (Jack) Michenfelder gave the Janssen Distinguished Lecture on "The Past, Present, and Future of Research in Neuroanesthesia." Jack is a founding member of NAS, our society's first President, a former editor of Anesthesiology and an eminent scholar, scientist, and neuroanesthesiology educator. Another extraordinary event took place that evening when Thomas W. Langfitt spoke about changes taking place in the American health care system. Dr. Langfitt is the neurosurgical founder and a charter member of our Society. The work on head injury and intracranial hypertension carried out in his laboratories remains outstanding in its originality and scope, and he trained many physicians who subsequently occupied, or still occupy, Chairs in Neurosurgery departments.

FIG. 28. John Hartung, Ph.D., Associate Editor of the Journal of Neurosurgical Anesthesiology since its inception.

FIG. 29. Table of Contents of Vol 1, No. 1, of JNA

FIG. 30. Listing of the Presidents of NAS, SNANSC, and SNACC

FIG. 31. M. Jane Matjasko, M.D., founding member of the NAS and the 10th President.

In 1972, only six anesthesiology training programs in the United States and Canada had a dedicated neuroanesthesiology division or section for residency teaching and fellowship training. As of 1989, there were sixty-four neuroanesthesia training programs in the United States and Canada. Looking back at the past 25 years, I cannot help but be impressed by the progress we have made both in clinical and investigative neuroanesthesiology, by the ability of our subspecialty to attract many of the best and brightest in our specialty, and by the capacity of our present leaders to point the way to the future. We have always been fortunate to have superb leadership, as scanning the list of past Society Presidents indicates (Fig. 30). We were also cognizant of the capabilities of our female members long before the term, "glass ceiling," was coined, with Jane Matjasko, Philippa Newfield, Elizabeth Frost, Judith Donegan, and Betty Grundy (Figs. 31-34) each making substantial contributions.

FIG. 32. Elizabeth A.M. Frost, M.D., early contributor to SNANSC

FIG. 33. Phillipa Newfield, M.D., 14th President of SNANSC.

FIG. 34. Elizabeth Grundy, M.D., early contributor to SNANSC.

Dozens of individuals have been responsible for the health and vigor of our neuroanesthesiology organization and space limitations do not allow for a more in-depth narration of their contributions. These individuals helped in various ways such as organizing meetings, serving on committees, reviewing the literature concerning neuroanesthesiology, judging abstracts, and performing the many thankless tasks that make our organization function-one can only salute them and thank them for their efforts.

We look forward to celebrating our thirtieth anniversary in 2002!

References

1. Frost EAM. History of neuroanesthesia. In: Albin, MS ed. Textbook of Neuroanesthesia with Neurosurgical and Neuroscience Perspectives. New York: McGraw-Hill, 1997:1-20.

2. Hunter AF. Neurosurgical Anesthesia. Philadelphia: F.A. Davis Co., 1964.

3. Gilbert RGB, Brindle GF, Galindo A. Anesthesia for Neurosurgery. London: J & A Churchill Co, 1966.

4. Cottrell JE, Turndorf H. Anesthesia and Neurosurgery. St. Louis: Mosby-Yearbook Inc, 1980.

5. Cottrell JE, Smith DS. Anesthesia and Neurosurgery. St. Louis: Mosby Yearbook, Inc, 1994.