Thos. Eakins masterpiece

Dr. Edmond I. Eger II, was a leader in the development of the universally used technique to determine the proper dose of anesthetic gas administered in operating rooms — an advance that has saved an untold number of lives and made surgery safer for everyone.   I once jokingly asked my late Uncle Arthur, also an anesthesiologist, though in Detroit, what was the big deal about anaesthesia — why did it pay so well  [fmn} and also by the way it has correspondingly astronomical malpractice fees [/fmn]  And he said “You want to wake up don’t you?”

Our header picture is The Gross Clinic by American master Thomas Eakins, who is shown in the painting in the upper left busy painting away. You can read more about the painting and its importance in art here on the NPR site.

The doctor died on September 20, 2017 from pancreatic cancer, said Dr. Steven L. Shafer, a professor of anesthesiology, perioperative and pain medicine at Stanford University, Palo Alto, California and editor of an up coming autobiography of Dr. Eger.  He was 86 years old.

A Mac Man

Inhaled gases like ether and chloroform had been in use as anesthetics for more than 100 years when Dr. Eger graduated from medical school in 1955, but there was still no clear standard for dosing, or for comparing the strength of one gas to another.

Without a systematic way to measure the effects of anesthesia, doctors looked for signs like changes in a patient’s muscle tone, breathing and pupil diameter. But those traits were of no use in research because they varied from patient to patient and did not occur in lab animals. As new anesthetic gases were developed, the need grew for a more precise way to test, compare and dose them.

Dr. Eger devised a method working with Dr. Giles Merkel, Dr. Lawrence Saidman and other anesthesiologists at the University of California, San Francisco. They identified one value to use as a benchmark: the concentration of anesthesia at which 50 percent of patients did not move in response to a painful stimulus, like being cut with a scalpel.

Other patients would require a slightly higher or lower concentration to achieve the same effect, but the variations were not large. That led to their introduction in 1965 of a concept, called the minimum alveolar concentration, or MAC, that quickly became the standard measure of potency for anesthetic gases. Because powerful anesthetics work best at lower concentrations and thus weaker version require higher doses, a lower MAC value would indicate a stronger drug. Anesthesiologists use MAC values when planning doses needed for surgery.

The values are highly consistent from one patient to another and even among animals. For any given drug, about the same concentration can anesthetize a 200-pound man, a smaller woman, a dog or a rat. The amount needed to reach that concentration differs depending on the patient’s size, but the effective concentration itself does not change.

Edmond "Ted" Eger
Dr. Eger in an undated photograph. Credit Richard Schlobohm

Dr. Shafer said the technique devised by Dr. Eger and his colleagues made the administering of anesthesia far safer and has saved millions of lives.In later work, Dr. Eger identified new drugs that could be used as anesthesia, such as isoflurane, sevoflurane, and desflurane, which are still the most widely used general anesthetics.

“Ted Eger revolutionized modern anesthetic practice, and led the way to the development of the anesthetic gases used tens of millions of times a year,” Dr. Michael A. Gropper, the chairman of the department of anesthesia and perioperative care at the University of California, San Francisco, wrote in an email.

A poor salesman

As a boy, Dr. Eger skipped at least one grade, became a whiz at checkers and led the Hyde Park High School checker team to two city championships. He graduated at 15, but, as a bored and indifferent student, wound up in the bottom 20 percent of the class.

“The ‘ah ha!’ moment, the thrill of solving the hardest puzzle in all of pharmacology, the biological mechanism that responds to anesthesia, awaits another investigator.”

Dr. Eger in his Autobiography

He was soon hired to sell women’s shoes, but after only one day on the job he decided he had had enough and resolved to apply for college. He was accepted at Roosevelt College in Chicago, where “he went from not working at all to working his butt off,” Dr. Shafer said. After a year, he transferred to the University of Illinois, where he majored in chemistry with a minor in math. He went to medical school at Northwestern University.

In 1955, the same year he graduated from Northwestern, he married Dollie Ross, a speech therapist. The marriage ended in divorce in 1983. In 1996, he married Dr. Lynn Spitler, an immunologist, who survives him. Dr. Eger is also survived by three daughters, Cris Cadence Waste, Doreen J. Eger and Renee R. Eger, and a son, Edmond Eger III, all from his first marriage; a half-brother, Larry Eger; two stepchildren; seven grandchildren; and six step-grandchildren.

After completing his internship and residency, Dr. Eger served for two years as a captain in the medical corps, based at the Army hospital at Fort Leavenworth, Kan. From 1960 to 2006 he was a faculty member at the University of California, San Francisco. He was an author of more than 500 scientific articles and an author or editor of seven books.

“He received every award known to man in his specialty,” Dr. Shafer said.

Dr. Eger spent the last 20 years of his career trying to understand how inhaled anesthetics work. The drugs and their effects remain a mystery. The same concentration that knocks out a person will anesthetize a sea slug or an amoeba, and will even paralyze a fern that normally curls up when touched, Dr. Shafer said. The universality of those reactions suggests the drugs are tapping into some biological mechanism that evolved eons ago

The Ted Chart

An interesting point in Dr. Eger’s chart is its low fire showing instead of inspiration, he relied more on intuitive (water) hunches born from enlightened (air) experience (earth), He also has no grand trine to unite various parts of the chart, but instead a Grand Cardinal Square

Dr, Eger’s Grand Cardinal Square often shows up in people who rely on their free will to deal with opposing forces in their life, thus like his original foray as a shoe salesman, that he was unsuccessful there was not important to him, but the experience of trying it out. It did not take long for him to see, the grand square “irked” him into making another career choice which would be aligned to the houses his grand square lies in : 12th house hospital, 6th house medicine, 2nd and 8th house dealing with other people’s bodies handling drugs to prevent death.

Thus his “karmic cross” required him to swallow his pride, and admit his mistake of not applying to college for a professional career, and playing to his strength — intellectual endeavours. Some with cosmic crosses cannot swallow their humility and try again on another track, forever stubbornly stuck in that pattern. Of course a lot of that depends upon whatever other aspects encourage the lethal intellectual arrogance; luckily Dr. Eger did not suffer from that particular problem.

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