A.C.E. mixture

A.C.E. mixture (or ACE mixture) is a historical anaesthetic agent for general anaesthesia, which was first suggested by Dr. George Harley[1] and first used in England around 1860, and in 1864 it was recommended for use by the Royal Medical and Surgical Society’s Chloroform Committee. However it was used rarely after the 19th century, although used for slightly longer in Germany.[2]

It was a mixture of alcohol, chloroform and ether (diethyl ether)[1][3] which gives the mixture its name. Its actions were said to be between that of chloroform and ether and it was used as a good substitute when ether alone was contraindicated.[1] Its boiling point was given as 48°C[4] and it was measured in Drachm.[5][6]

Usage

A.C.E. mixture was most commonly made up in the ratio: 1 part alcohol, 2 parts chloroform, and 3 parts ether[2] although other ratios existed. See 'other preparations' below.

Chloroform (which was first used in 1847) used on its own produces myocardial depression, however the excitatory properties of the alcohol and ether contained with the choloroform in the A.C.E. mixture was believed to reduce this.[2] However, some did question this experimentally at the time.[7]

Many anaesthetists favoured A.C.E. mixture and one author in 1887 in the British Medical Journal considers the A.C.E. mixture, at the time, the best anaesthetic for general use and use in childbirth. He states one downside; the "excited" state of patients on regaining consciousness after the anaesthetic, due to the alcohol in the mixture.[8] Another downside of the mixture, as with most anaesthetics at the time, was its high flammability.

Deaths have been known to occur from the mixture.[5][9] However, at the time, deaths from A.C.E. mixture were reported less in number than the deaths from chloroform or ether.[6][10]

Other preparations

After widespread use of A.C.E. mixture, anaesthetists would try different mixtures for different patients and different procedures. C.E. Mixture omitted the alcohol and A.C. mixture omitted the ether.[1] One particular doctor documents using equal parts of alcohol with chloroform for minor operations and chloroform with Eau de Cologne (which has a high content of alcohol) for dental procedures (to make a more pleasant experience).[11]

Other mixtures were:[1]

Preparation Name as written in source Reduced ratio of Alcohol Reduced Ratio of Chloroform Reduced Ratio of Ether
Common mixture 1 part alcohol, 2 parts chloroform, and 3 parts ether 1 2 3
Richardson's mixture 20 parts alcohol, 12 chloroform and 8 ether 5 3 2
Vienna mixture 0 parts alcohol, 31 parts chloroform and 23 parts ether 0 31 23
Billroth's mixture 1 part alcohol, 3 part chloroform and 1 part ether 1 3 1
Linhart's Mixture 20% alcohol with chloroform 1 5 0
Methylene ("Bichloride of methylene") 30% methylic alcohol and 70% chloroform 3 7 0

Not included in table as they don't contain chloroform and they list two different ethers: Schleich's solutions for general anaesthesia (number one for light anaesthesia and number three for deep anaesthesia): No 1: 45 parts chloroform, 180 parts sulphuric ether, 15 parts petroleum ether. No 2: 45 parts chloroform, 150 parts sulphuric ether, 15 parts petroleum ether. No 3: 30 parts chloroform, 80 parts sulphuric ether, 15 parts petroleum ether. Wertheim's solution: 1 part chloroform, 1 part petroleum ether and 2 parts sulphuric ether

Usage in animal testing

A.C.E. Mixture was also used to anaesthetise animals, including in preparation for vivisection.[12]

Method of administration

A.C.E. mixture could be given through drops (from a drop bottle[5]) on a piece of lint (a towel), in a Rendle's mask, a cone, or through an inhaler.

Inhalers included: Allis' inhaler, Junker's inhaler (with a funnel mask) for children, Clover's inhaler with bag removed (this inhaler has to be constantly lifted from the face to allow 'free air' to be admitted). Ellis proposed an inhaler to blend vapours in exact proportions, however it was impractical, but Dr. Gwathmey modified his idea and created a practical apparatus. Tyrrell created a similar idea called the 'Tyrrell's double-bottle method'.[1]

References

  1. 1 2 3 4 5 6 Wilmot Buxton, Dudley (2009-12-09). Anaesthetics - Their Uses and Administration (Reprint of the first edition - 1888). Read Books. pp. 332–340. ISBN 978-1-4446-9013-2.
  2. 1 2 3 Wawersik, Juergen (1991). "History of anesthesia in Germany". Journal of Clinical Anesthesia 3 (3): 235–244. doi:10.1016/0952-8180(91)90167-L. PMID 1878238.
  3. ↑ "Everybody" (pseudonym) (1935). Everybody's Family Doctor. London: Odhams Press. p. 11. OCLC 558994903.
  4. ↑ Mccardie, WJ (1898-12-17). "On the administration of a certain mixture of chloroform and ether in gynecological operations by means of a Clover's inhaler without the bag". The Lancet 152 (3929): 1621–1624. doi:10.1016/S0140-6736(01)84517-7.
  5. 1 2 3 "Deaths under chloroform And A.C.E. mixture". The British Medical Journal 2 (1663): 1072–1073. 1892-11-12. JSTOR 20222445.
  6. 1 2 "Death Under Chloroform". The British Medical Journal 2 (1698): 143. 1893-07-15. doi:10.1136/bmj.2.1698.152. JSTOR 20225168.
  7. ↑ Simpson, J. Christian (1890-08-30). "Alcohol In Anæsthetic Mixtures". The British Medical Journal 2 (1548): 529. doi:10.1136/bmj.2.1185.529. JSTOR 20240176.
  8. ↑ Walters, J (1887-11-12). "A. C. E. Mixture". The British Medical Journal 2 (1402): 1078. doi:10.1136/bmj.2.1402.1078-a. JSTOR 20213635.
  9. ↑ "Deaths Under Anæsthetics. A.C.E. Mixture". The British Medical Journal 1 (1779): 282. 1895-02-02. doi:10.1136/bmj.1.2666.282. JSTOR 20231460.
  10. ↑ Levy, AG (October 13, 1923). "Ether Versus Chloroform". The British Medical Journal 2 (3276): 681. doi:10.1136/bmj.2.1447.681. JSTOR 20434527.
  11. ↑ Stephens, William J. (1888-01-07). "A Pleasant Anæsthetic Mixture". The British Medical Journal 1 (1410): 19. doi:10.1136/bmj.1.105.19. JSTOR 20214092.
  12. ↑ "Royal Commission On Vivisection. Fifth Report (Continued)". The British Medical Journal 2 (2481): 159–162. 1908-07-18. doi:10.1136/bmj.2.3577.159-a. JSTOR 25278404.

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