Dr. Michael Gropper serves as editor-in-chief for the 10th edition of Miller's Anesthesia
Originally published in 1981, Miller’s Anesthesia remains the definitive text on anesthesia practice. In the 10th edition expert editors and authors address timely topics alongside basic science for an in-depth and comprehensive understanding of the field.
Dr. Mary E. Botsford awarded 1st faculty position in anesthesia at UCSF
In 1910, Dr. Mary Botsford (1865-1939) was appointed "assistant in surgery" and "anesthetist" at UCSF medical school and hospital, the first faculty position in anesthesia here.
Anesthesia at UCSF in the 1920s
In the 1920s and 1930s, hospital-employed physicians provided anesthesia services. Botsford led anesthesia within the Department of Surgery, which grew to include five women physicians by 1921. By 1925, Drs. Mary Botsford, Ethel Righetti, Mary Kavanagh, and Dorothy Wood were key in providing anesthesia at UCSF. This photo shows a surgery in UC Hospital in 1924.
UCSF Anesthesia and UCSF Pharmacology
Dr. Chauncey Leake (1896-1978) was Professor and Chair of Pharmacology at UCSF from 1928 to 1942 (Professor Emeritus). Dr. Leake conducted pioneering investigative work on anesthetic agents. He is pictured here with Edward Leong Way, PhD, whose work centered on the development of physical dependence and tolerance of opiates, and who was a professor and graduate of UCSF.
Arthur Guedel collaborating with UCSF
Arthur Guedel, MD (1883-1956), was an early anesthesiologist who made many important contributions to the development of anesthesiology. Guedel would travel from Los Angeles to UCSF for various research projects at UCSF in collaboration with Chauncey Leake and Mary Botsford. Explore the Arthur E. Guedel Anesthesia Collection, UCSF Archives and Special Collections.
Dr. Mary Botsford appointed Clinical Professor of Anesthesiology
In 1932, Botsford was appointed clinical professor of anesthesiology, UC's first professor of anesthesia.
Procurement of curare paste from Ecuador
In 1938, Richard Gill brought curare to the United States after learning about its use from an indigenous tribe in Ecuador, returning with about 25 pounds of the poisonous paste.
UCSF Division of Anesthesia established
In 1941, the Department of Surgery established a Division of Anesthesia and a residency program with 4 faculty members and 10 positions.
Dr. Frank Murphy appointed Chief of the Division of Anesthesia
Frank J. Murphy, M.D., C.M. (1900–1972), was UCSF's chief of Anesthesia from 1946 to 1958, known for inventing the "Murphy Eye" endotracheal tube. Before UCSF, he was Chief of Anesthesia at Pearl Harbor Naval Hospital (1944-45).
First 3-function blood gas analyzer
Dr. John Severinghaus unveiled the first Po2 and Pco2 blood gas analyzer at the 1957 ASA meeting. The pH probe was added in 1959. Read more in Gadgeteering for Health Care, the inaugural John W. Severinghaus Lecture on Translational Science.
UCSF Anesthesia Department founded
The Department of Anesthesia and Perioperative Care at UCSF was established in 1958 by Stuart Cullen, MD, who came from the University of Iowa. He accepted the chair on the condition that Anesthesia became independent of Surgery. Cullen and his faculty expanded the residency program to include obstetric anesthesia, ICU, and training at San Francisco General Hospital.
Dr. Stuart Cullen appointed Chair of Anesthesia
Cullen prioritized education for residents, including daily preoperative rounds, Saturday Grand Rounds, and Wednesday evening lectures. He believed anesthesia care should integrate knowledge from basic sciences like physiology, pharmacology, anatomy, and biochemistry
Discovery of central chemoreceptor
Robert Mitchell, MD, an internist, joined Dr. John Severinghaus' lab in 1958. Alongside Dr. Hans Loeschke, Mitchell discovered the medullary area regulating blood PCO2, maintaining spinal fluid pH. Mitchell's work remains critical today, particularly in understanding abnormal CO2 levels in conditions like COPD through his chemoreceptor research.
Dr. John Severinghaus, respiratory control and high altitude
Dr. Severinghaus had grown curious about how breathing and brain blood flow were regulated during acclimatization to the hypoxia of high altitude. Studies were performed on human volunteers after rapid ascent from sea level to the Barcroft laboratory at 12,470 feet in the White Mountains near Bishop, California, gifting John a near-disabling headache after spinal puncture to measure the pH of his cerebrospinal fluid. Read more. Watch a video of Severinghaus explaining these studies.
Minimum Alveolar Concentration (MAC)
In collaboration with colleagues Merkel, Saidman and Severinghaus, Dr. Edmond Eger coined the concept of Minimum Alveolar Concentration (MAC).
Dr. Morley Singer appointed first Director of the UCSF ICU
Dr. Morley Singer, pictured here lecturing to department members, became the first director of the UCSF Moffitt Hospital ICU.
Dr. Sol Shnider, anesthetic effects in a fetal lamb model
Shnider was a captivating lecturer, researcher and physiologist, who pioneered research to understand the effects of anesthetics in fetal lamb models.
Dr. William K. Hamilton appointed 2nd Chair
During his 16 years as chair of the Department of Anesthesia, Dr. Bill Hamilton enhanced operating room coverage, negotiated a balanced departmental agreement benefiting clinicians and researchers, and forged a strong partnership with the Department of Obstetrics alongside Sol Shnider. His charisma, influential leadership, and remarkable intellect attracted top talent and facilitated groundbreaking collaborations, leading to significant research advancements during his leadership tenure.
Dr. Joe Lee appointed first Director of the ICU at SFGH
He is pictured here in the department group photo from 1967, second from left in the third row, behind Drs. Sol Shnider and John Severinghaus.
Dr. Edmund "Ted" Eger II publishes 1st edition of Anesthetic Uptake and Action
Dr. George Gregory, CPAP for neonatal respiratory distress syndrome
Working in part from findings by a group in Boston about oxygen toxicity, Gregory - whose commitment to pediatric anesthesia is legendary - confirmed that oxygen toxicity was real and soon discovered that if you increased airway pressure with 30 percent oxygen, you could keep the airways open without harming the lungs. The result was Continuous Positive Airway Pressure (CPAP), which has saved the lives of countless children in respiratory distress.
Dr. Ronald D. Miller, complications and coagulation defects associated with massive blood transfusion
While on tour as a battlefield physician in Da Nang, Vietnam, Dr. Ronald D. Miller began his seminal work on blood transfusion. Read more about Coagulation defects associated with massive blood transfusions
Dr. Ronald D. Miller, pharmacology of neuromuscular blockade and reversal
After returning from Vietnam, Ron Miller collaborated with Ted Eger, initially monitoring neuromuscular function in volunteers studying isoflurane's effects. This led to three decades of research with talented residents, advancing knowledge of volatile anesthetics and muscle relaxants, crucial for safe anesthesia practice.
Drs. Peter Suter, H. Barrie Fairley, and Michael Isenberg: Optimum PEEP in acute pulmonary failure
In 1975, Dr. Barrie Fairley, then Chief of Anesthesia at San Francisco General Hospital, led several seminal research studies that provided the foundation for contemporary lung protective ventilation strategies.
Read about Optimum End-Expiratory Airway Pressure in Patients with Acute Pulmonary Failure
SFGH opens new facility
In 1967, when Dick Barber arrived in San Francisco, the anesthesia faculty at San Francisco General Hospital (SFGH) consisted of just three members: Earnest P. Guy, Robert Hudson Smith, and himself. Operating rooms lacked piped gases and vacuum, relying on large cylinders of nitrous oxide and oxygen mounted on anesthesia machines. Despite the challenges, SFGH served as the city's sole level one trauma center, requiring round-the-clock coverage from anesthesia and surgical specialties. Over time, increased staffing, updated equipment, and city support culminated in the mid '70s with the opening of a new, state-of-the-art hospital. The new hospital facilitated Barber and his colleagues' ongoing crucial work for an underserved population.
Mass spectrometry for multi-patient end-tidal gas monitoring in the OR
Gerald Ozanne, MD, technician Bill Young, and John Severinghaus, MD, developed a mass spectrometry system for use in the UCSF Moffitt Hospital’s 10–operating room suite. A single central mass spectrometer sequentially analyzed, through long sampling catheters, the inspired and expired gases from each of the operating rooms, providing the anesthesiologists with minute-by-minute analyses. For more, read, Gadgeteering for Health Care: The John W. Severinghaus Lecture on Translational Science.
1st Edition of Anesthesia for Obstetrics Published
Sol Shnider, a charismatic figure, leveraged his engaging showmanship to elevate a critical sub-specialty. While renowned for his pioneering studies on anesthesia's fetal impact in humans and animals, Shnider's greatest legacy lies in education. He authored the foundational textbook Anesthesia for Obstetrics, originally conceived as a resident refresher course.
Development of combined transcutaneous PCO2 and PO2 blood-gas electrode
Read about the development of the combined transcutaneous PCO2 and PO2 blood gas electrode in Gadgeteering for Health Care.
A combined transcutaneous PO2-PCO2electrode with electrochemical HCO3-stabilization
1st Edition of Anesthesia published
Since its original publication in 1981, Miller's Anesthesia has been the definitive textbook on anesthesia practice. The textbook is now in its 10th edition.
Transesophageal echocardiography (TEE) introduced into clinical practice
"We slipped the scope down and suddenly, in real time, saw a moving image of all four chambers of the heart. My jaw hit the ground and I knew right away this was a fundamentally better way to monitor patients." - Michael Cahalan, MD
1st Edition of Pediatric Anesthesia published
Since its original publication in 1983, Pediatric Anesthesia has been recognized as the definitive text on pediatric anesthesia and pediatric intensive care.
Dr. Ronald D. Miller, appointed 3rd Chair
After an extensive international search, Dr. Ronald D. Miller succeeded Dr. Bill Hamilton and interim chair Dr. Sol Shnider in 1984. Implementing a comprehensive strategy, Miller ensured the department remained a leader amid growing regulation and competition. Under his leadership, the department expanded and upheld its legacy of excellence, becoming globally renowned and among the largest in the field.
Ambulatory Surgery Center opens at UCSF Parnassus
The Outpatient Surgery Center at Parnassus provides same-day surgeries in a wide variety of specialties for patients 18 and older. Patients are scheduled through referring practices in endocrinology, general surgery, hepatology, neurosurgery, ophthalmology, otolaryngology – head and neck surgery, and urology.
LMA first used at UCSF
Dr. Martin Bogetz was the first anesthesiologist to utilize a laryngeal mask airway at UCSF.
Pharmacokinetic and pharmacodynamic research on intravenous anesthetics
Nearly four decades ago, Dennis Fisher and Steve Shafer independently encountered remarkable people changing the course of pharmacokinetic and pharmacodynamic modeling. Read more in The Wondrous Story of Anesthesia.
UCSF acquisition of Mount Zion Hospital
Read about the history and importance of UCSF Medical Center at Mount Zion.
Perioperative Thermoregulation - the importance of being normothermic
Dr. Daniel Sessler, starting from his residency at UCLA and continuing through his tenure at UCSF Anesthesia, conducted extensive research with his Outcomes Research Consortium. Their findings demonstrated that even slight hypothermia, common in unwarmed surgical patients, triples the risk of surgical wound infection, increases blood loss and transfusion needs, delays recovery, and prolongs hospital stays. It is now standard of care to keep surgical patients normothermic.
Management of pulmonary pseudomonas infection
"Dr. Wiener-Kronish has devoted much of her academic career to investigating the mechanism of acute lung injury produced by Pseudomonas aeruginosa, a gram negative bacterium that can infect patients in the intensive care unit." Read more about her investigations.
Dr. Kenneth Drasner, spinal neurotoxicity of local anesthetics
The most feared complication associated with the administration of local anesthetics is the profound and potentially lethal effect that these agents can have on cardiac conduction and function. Read Drasner's American Society of Regional Anesthesia (ASRA) practice advisory on local anesthetic systemic toxicity.
Dr. Philip Bickler, neuroprotection from hypoxia
Since 1958 when the legendary John Severinghaus, MD, founded the UCSF Hypoxia Research Laboratory, faculty, fellows and residents from the department have been journeying to the University of California’s White Mountain Research Station – a multi-campus research unit – to study the effects of hypoxia on humans. Learn more about Dr. Phil Bickler's work exploring the effects of hypoxia on human neurons.
Ambulatory Surgery Center opens at SF VAMC
Dr. Art Wallace was instrumental in its development.
Discovery of non-immobilizer
Read about Polyhalogenated and perfluorinated compounds that disobey the Meyer-Overton hypothesis.
Beta blockade to reduce perioperative mortality
Researchers at the San Francisco Veterans Affairs Hospital, led by Dennis Mangano with Martin London and Art Wallace (dubbed McSPI), conducted an epidemiological study revealing poor surgical outcomes in older, sick patients. Seeking modifiable risk factors, they aimed to achieve hemodynamic stability without inducing unconsciousness. In a major clinical trial, they tested 17 drugs, including beta blockers, Alpha 2 agonists, and various anesthetic agents. In a landmark piece of research they published in the New England Journal of Medicine, McSPI found that the generic beta blocker atenolol was the most effective at reducing the risk of both myocardial ischemia and mortality. More than a hundred hospitals across the country adopted the McSPI protocols. Perioperative beta blockade in select patients became a level one standard of care.
Cloning of capsaicin receptor
Read about The capsaicin receptor: a heat-activated ion channel in the pain pathway.
Dr. David Julius was the recipient of the 2021 Nobel Prize for this work.
Dr. James Marks, monoclonal antibody for treatment of botulinum neurotoxins
In 1993, Dr. Jim Marks initiated a search for a safer botulism antidote, as existing treatments derived from exposed hospital workers and horses had serious side effects. His team developed a novel combination of monoclonal antibodies targeting type A, B, and E Botulinum neurotoxins (BoNTs), with ongoing research progress.
Dr. Arthur Wallace, developer of endotracheal cardiac output monitor
The endotracheal cardiac output monitor (ECOM) is a device that uses an endotracheal tube with multiple electrodes to measure cardiac output (CO). It measures the changes in electrical impedance caused by pulsatile blood flow in the aorta. Read more: Endotracheal Cardiac Output Monitor
Dr. Mervyn Maze appointed 4th Chair
After overseeing the department's 50th anniversary celebration, Dr. Ronald D. Miller retired as chair. Dr. Mervyn Maze succeeded him, celebrated for his groundbreaking research on general anesthetics and co-invention of dexmedetomidine, a widely used sedative in perioperative and critical care settings. His pioneering work has garnered prestigious awards, including the American Society of Anesthesiology's Excellence in Research award.
Dr. Michael Gropper appointed 5th Chair
Dr. Michael Gropper, having served as Director of Critical Care Medicine at UCSF, assumed roles as acting chair in 2013, interim chair in 2014, and was appointed chair of the Department of Anesthesia and Perioperative Care in 2015 following an international search. Under his leadership, the department has upheld its legacy of excellence in patient care, education, and research amid substantial health system growth.
Dr. Charlene Blake, member of first all-woman team to perform a heart transplant
On a normal clinical day in December 2022, Dr. Charlene Blake, a cardiac anesthesiologist, was assigned to manage a heart transplant case. It was only after the 5-hour case had ended that Dr. Blake, surgeon Amy Fiedler, perfusionist Ashley Risso, and other members of the OR team realized there were no men present in the room. This was the first heart transplant performed by an all-woman team at UCSF – and possibly anywhere. The story was featured in the SF Chronicle, CBS News, Today, and Good Morning America.
Brain signals for chronic pain
Dr. Prasad Shirvalkar and team find an objective marker of chronic pain. Read more in the New York Times, Wall Street Journal, New Scientist, the Guardian, Live Science, the Conversation, or MIT Tech Review.
UCSF-Led study suggests treatment combination that may increase chances for survival
In a study published May 22, 2023 in NEJM: Evidence, an international team of researchers from UCSF, Raymond Poincaré AP-HP Hospital, Versailles SQY University, Paris-Saclay University and Inserm, and the George Institute for Global Health in Sydney, studied the role of hydrocortisone in the management of adult patients with septic shock. They found that while the effect of hydrocortisone was modest in terms of overall survival, it was associated with a decrease in the need for blood pressure-raising drugs (vasopressors) and improvement in survival when used in combination with other corticosteroids. The study was coordinated by first authors Romain Pirracchio, MD, MPH, PhD, chief of Anesthesia at ZSFG and the Ronald D. Miller distinguished professor at UCSF, Djillali Annane, MD, PhD, and senior author Anthony Delaney, MBBS, MSc, PhD.
Dr. Alex Perez, Anesthesia Resident, member of groundbreaking "cancer shredding" research team
Dr. Michael Gropper serves as editor-in-chief for the 10th edition of Miller's Anesthesia
Originally published in 1981, Miller’s Anesthesia remains the definitive text on anesthesia practice. In the 10th edition expert editors and authors address timely topics alongside basic science for an in-depth and comprehensive understanding of the field.
Dr. Mary E. Botsford awarded 1st faculty position in anesthesia at UCSF
In 1910, Dr. Mary Botsford (1865-1939) was appointed "assistant in surgery" and "anesthetist" at UCSF medical school and hospital, the first faculty position in anesthesia here.
Anesthesia at UCSF in the 1920s
In the 1920s and 1930s, hospital-employed physicians provided anesthesia services. Botsford led anesthesia within the Department of Surgery, which grew to include five women physicians by 1921. By 1925, Drs. Mary Botsford, Ethel Righetti, Mary Kavanagh, and Dorothy Wood were key in providing anesthesia at UCSF. This photo shows a surgery in UC Hospital in 1924.
UCSF Anesthesia and UCSF Pharmacology
Dr. Chauncey Leake (1896-1978) was Professor and Chair of Pharmacology at UCSF from 1928 to 1942 (Professor Emeritus). Dr. Leake conducted pioneering investigative work on anesthetic agents. He is pictured here with Edward Leong Way, PhD, whose work centered on the development of physical dependence and tolerance of opiates, and who was a professor and graduate of UCSF.
Arthur Guedel collaborating with UCSF
Arthur Guedel, MD (1883-1956), was an early anesthesiologist who made many important contributions to the development of anesthesiology. Guedel would travel from Los Angeles to UCSF for various research projects at UCSF in collaboration with Chauncey Leake and Mary Botsford. Explore the Arthur E. Guedel Anesthesia Collection, UCSF Archives and Special Collections.
Dr. Mary Botsford appointed Clinical Professor of Anesthesiology
In 1932, Botsford was appointed clinical professor of anesthesiology, UC's first professor of anesthesia.
Procurement of curare paste from Ecuador
In 1938, Richard Gill brought curare to the United States after learning about its use from an indigenous tribe in Ecuador, returning with about 25 pounds of the poisonous paste.
UCSF Division of Anesthesia established
In 1941, the Department of Surgery established a Division of Anesthesia and a residency program with 4 faculty members and 10 positions.
Dr. Frank Murphy appointed Chief of the Division of Anesthesia
Frank J. Murphy, M.D., C.M. (1900–1972), was UCSF's chief of Anesthesia from 1946 to 1958, known for inventing the "Murphy Eye" endotracheal tube. Before UCSF, he was Chief of Anesthesia at Pearl Harbor Naval Hospital (1944-45).
First 3-function blood gas analyzer
Dr. John Severinghaus unveiled the first Po2 and Pco2 blood gas analyzer at the 1957 ASA meeting. The pH probe was added in 1959. Read more in Gadgeteering for Health Care, the inaugural John W. Severinghaus Lecture on Translational Science.
UCSF Anesthesia Department founded
The Department of Anesthesia and Perioperative Care at UCSF was established in 1958 by Stuart Cullen, MD, who came from the University of Iowa. He accepted the chair on the condition that Anesthesia became independent of Surgery. Cullen and his faculty expanded the residency program to include obstetric anesthesia, ICU, and training at San Francisco General Hospital.
Dr. Stuart Cullen appointed Chair of Anesthesia
Cullen prioritized education for residents, including daily preoperative rounds, Saturday Grand Rounds, and Wednesday evening lectures. He believed anesthesia care should integrate knowledge from basic sciences like physiology, pharmacology, anatomy, and biochemistry
Discovery of central chemoreceptor
Robert Mitchell, MD, an internist, joined Dr. John Severinghaus' lab in 1958. Alongside Dr. Hans Loeschke, Mitchell discovered the medullary area regulating blood PCO2, maintaining spinal fluid pH. Mitchell's work remains critical today, particularly in understanding abnormal CO2 levels in conditions like COPD through his chemoreceptor research.
Dr. John Severinghaus, respiratory control and high altitude
Dr. Severinghaus had grown curious about how breathing and brain blood flow were regulated during acclimatization to the hypoxia of high altitude. Studies were performed on human volunteers after rapid ascent from sea level to the Barcroft laboratory at 12,470 feet in the White Mountains near Bishop, California, gifting John a near-disabling headache after spinal puncture to measure the pH of his cerebrospinal fluid. Read more. Watch a video of Severinghaus explaining these studies.
Minimum Alveolar Concentration (MAC)
In collaboration with colleagues Merkel, Saidman and Severinghaus, Dr. Edmond Eger coined the concept of Minimum Alveolar Concentration (MAC).
Dr. Morley Singer appointed first Director of the UCSF ICU
Dr. Morley Singer, pictured here lecturing to department members, became the first director of the UCSF Moffitt Hospital ICU.
Dr. Sol Shnider, anesthetic effects in a fetal lamb model
Shnider was a captivating lecturer, researcher and physiologist, who pioneered research to understand the effects of anesthetics in fetal lamb models.
Dr. William K. Hamilton appointed 2nd Chair
During his 16 years as chair of the Department of Anesthesia, Dr. Bill Hamilton enhanced operating room coverage, negotiated a balanced departmental agreement benefiting clinicians and researchers, and forged a strong partnership with the Department of Obstetrics alongside Sol Shnider. His charisma, influential leadership, and remarkable intellect attracted top talent and facilitated groundbreaking collaborations, leading to significant research advancements during his leadership tenure.
Dr. Joe Lee appointed first Director of the ICU at SFGH
He is pictured here in the department group photo from 1967, second from left in the third row, behind Drs. Sol Shnider and John Severinghaus.
Dr. Edmund "Ted" Eger II publishes 1st edition of Anesthetic Uptake and Action
Dr. George Gregory, CPAP for neonatal respiratory distress syndrome
Working in part from findings by a group in Boston about oxygen toxicity, Gregory - whose commitment to pediatric anesthesia is legendary - confirmed that oxygen toxicity was real and soon discovered that if you increased airway pressure with 30 percent oxygen, you could keep the airways open without harming the lungs. The result was Continuous Positive Airway Pressure (CPAP), which has saved the lives of countless children in respiratory distress.
Dr. Ronald D. Miller, complications and coagulation defects associated with massive blood transfusion
While on tour as a battlefield physician in Da Nang, Vietnam, Dr. Ronald D. Miller began his seminal work on blood transfusion. Read more about Coagulation defects associated with massive blood transfusions
Dr. Ronald D. Miller, pharmacology of neuromuscular blockade and reversal
After returning from Vietnam, Ron Miller collaborated with Ted Eger, initially monitoring neuromuscular function in volunteers studying isoflurane's effects. This led to three decades of research with talented residents, advancing knowledge of volatile anesthetics and muscle relaxants, crucial for safe anesthesia practice.
Drs. Peter Suter, H. Barrie Fairley, and Michael Isenberg: Optimum PEEP in acute pulmonary failure
In 1975, Dr. Barrie Fairley, then Chief of Anesthesia at San Francisco General Hospital, led several seminal research studies that provided the foundation for contemporary lung protective ventilation strategies.
Read about Optimum End-Expiratory Airway Pressure in Patients with Acute Pulmonary Failure
SFGH opens new facility
In 1967, when Dick Barber arrived in San Francisco, the anesthesia faculty at San Francisco General Hospital (SFGH) consisted of just three members: Earnest P. Guy, Robert Hudson Smith, and himself. Operating rooms lacked piped gases and vacuum, relying on large cylinders of nitrous oxide and oxygen mounted on anesthesia machines. Despite the challenges, SFGH served as the city's sole level one trauma center, requiring round-the-clock coverage from anesthesia and surgical specialties. Over time, increased staffing, updated equipment, and city support culminated in the mid '70s with the opening of a new, state-of-the-art hospital. The new hospital facilitated Barber and his colleagues' ongoing crucial work for an underserved population.
Mass spectrometry for multi-patient end-tidal gas monitoring in the OR
Gerald Ozanne, MD, technician Bill Young, and John Severinghaus, MD, developed a mass spectrometry system for use in the UCSF Moffitt Hospital’s 10–operating room suite. A single central mass spectrometer sequentially analyzed, through long sampling catheters, the inspired and expired gases from each of the operating rooms, providing the anesthesiologists with minute-by-minute analyses. For more, read, Gadgeteering for Health Care: The John W. Severinghaus Lecture on Translational Science.
1st Edition of Anesthesia for Obstetrics Published
Sol Shnider, a charismatic figure, leveraged his engaging showmanship to elevate a critical sub-specialty. While renowned for his pioneering studies on anesthesia's fetal impact in humans and animals, Shnider's greatest legacy lies in education. He authored the foundational textbook Anesthesia for Obstetrics, originally conceived as a resident refresher course.
Development of combined transcutaneous PCO2 and PO2 blood-gas electrode
Read about the development of the combined transcutaneous PCO2 and PO2 blood gas electrode in Gadgeteering for Health Care.
A combined transcutaneous PO2-PCO2electrode with electrochemical HCO3-stabilization
1st Edition of Anesthesia published
Since its original publication in 1981, Miller's Anesthesia has been the definitive textbook on anesthesia practice. The textbook is now in its 10th edition.
Transesophageal echocardiography (TEE) introduced into clinical practice
"We slipped the scope down and suddenly, in real time, saw a moving image of all four chambers of the heart. My jaw hit the ground and I knew right away this was a fundamentally better way to monitor patients." - Michael Cahalan, MD
1st Edition of Pediatric Anesthesia published
Since its original publication in 1983, Pediatric Anesthesia has been recognized as the definitive text on pediatric anesthesia and pediatric intensive care.
Dr. Ronald D. Miller, appointed 3rd Chair
After an extensive international search, Dr. Ronald D. Miller succeeded Dr. Bill Hamilton and interim chair Dr. Sol Shnider in 1984. Implementing a comprehensive strategy, Miller ensured the department remained a leader amid growing regulation and competition. Under his leadership, the department expanded and upheld its legacy of excellence, becoming globally renowned and among the largest in the field.
Ambulatory Surgery Center opens at UCSF Parnassus
The Outpatient Surgery Center at Parnassus provides same-day surgeries in a wide variety of specialties for patients 18 and older. Patients are scheduled through referring practices in endocrinology, general surgery, hepatology, neurosurgery, ophthalmology, otolaryngology – head and neck surgery, and urology.
LMA first used at UCSF
Dr. Martin Bogetz was the first anesthesiologist to utilize a laryngeal mask airway at UCSF.
Pharmacokinetic and pharmacodynamic research on intravenous anesthetics
Nearly four decades ago, Dennis Fisher and Steve Shafer independently encountered remarkable people changing the course of pharmacokinetic and pharmacodynamic modeling. Read more in The Wondrous Story of Anesthesia.
UCSF acquisition of Mount Zion Hospital
Read about the history and importance of UCSF Medical Center at Mount Zion.
Perioperative Thermoregulation - the importance of being normothermic
Dr. Daniel Sessler, starting from his residency at UCLA and continuing through his tenure at UCSF Anesthesia, conducted extensive research with his Outcomes Research Consortium. Their findings demonstrated that even slight hypothermia, common in unwarmed surgical patients, triples the risk of surgical wound infection, increases blood loss and transfusion needs, delays recovery, and prolongs hospital stays. It is now standard of care to keep surgical patients normothermic.
Management of pulmonary pseudomonas infection
"Dr. Wiener-Kronish has devoted much of her academic career to investigating the mechanism of acute lung injury produced by Pseudomonas aeruginosa, a gram negative bacterium that can infect patients in the intensive care unit." Read more about her investigations.
Dr. Kenneth Drasner, spinal neurotoxicity of local anesthetics
The most feared complication associated with the administration of local anesthetics is the profound and potentially lethal effect that these agents can have on cardiac conduction and function. Read Drasner's American Society of Regional Anesthesia (ASRA) practice advisory on local anesthetic systemic toxicity.
Dr. Philip Bickler, neuroprotection from hypoxia
Since 1958 when the legendary John Severinghaus, MD, founded the UCSF Hypoxia Research Laboratory, faculty, fellows and residents from the department have been journeying to the University of California’s White Mountain Research Station – a multi-campus research unit – to study the effects of hypoxia on humans. Learn more about Dr. Phil Bickler's work exploring the effects of hypoxia on human neurons.
Ambulatory Surgery Center opens at SF VAMC
Dr. Art Wallace was instrumental in its development.
Discovery of non-immobilizer
Read about Polyhalogenated and perfluorinated compounds that disobey the Meyer-Overton hypothesis.
Beta blockade to reduce perioperative mortality
Researchers at the San Francisco Veterans Affairs Hospital, led by Dennis Mangano with Martin London and Art Wallace (dubbed McSPI), conducted an epidemiological study revealing poor surgical outcomes in older, sick patients. Seeking modifiable risk factors, they aimed to achieve hemodynamic stability without inducing unconsciousness. In a major clinical trial, they tested 17 drugs, including beta blockers, Alpha 2 agonists, and various anesthetic agents. In a landmark piece of research they published in the New England Journal of Medicine, McSPI found that the generic beta blocker atenolol was the most effective at reducing the risk of both myocardial ischemia and mortality. More than a hundred hospitals across the country adopted the McSPI protocols. Perioperative beta blockade in select patients became a level one standard of care.
Cloning of capsaicin receptor
Read about The capsaicin receptor: a heat-activated ion channel in the pain pathway.
Dr. David Julius was the recipient of the 2021 Nobel Prize for this work.
Dr. James Marks, monoclonal antibody for treatment of botulinum neurotoxins
In 1993, Dr. Jim Marks initiated a search for a safer botulism antidote, as existing treatments derived from exposed hospital workers and horses had serious side effects. His team developed a novel combination of monoclonal antibodies targeting type A, B, and E Botulinum neurotoxins (BoNTs), with ongoing research progress.
Dr. Arthur Wallace, developer of endotracheal cardiac output monitor
The endotracheal cardiac output monitor (ECOM) is a device that uses an endotracheal tube with multiple electrodes to measure cardiac output (CO). It measures the changes in electrical impedance caused by pulsatile blood flow in the aorta. Read more: Endotracheal Cardiac Output Monitor
Dr. Mervyn Maze appointed 4th Chair
After overseeing the department's 50th anniversary celebration, Dr. Ronald D. Miller retired as chair. Dr. Mervyn Maze succeeded him, celebrated for his groundbreaking research on general anesthetics and co-invention of dexmedetomidine, a widely used sedative in perioperative and critical care settings. His pioneering work has garnered prestigious awards, including the American Society of Anesthesiology's Excellence in Research award.
Dr. Michael Gropper appointed 5th Chair
Dr. Michael Gropper, having served as Director of Critical Care Medicine at UCSF, assumed roles as acting chair in 2013, interim chair in 2014, and was appointed chair of the Department of Anesthesia and Perioperative Care in 2015 following an international search. Under his leadership, the department has upheld its legacy of excellence in patient care, education, and research amid substantial health system growth.
Dr. Charlene Blake, member of first all-woman team to perform a heart transplant
On a normal clinical day in December 2022, Dr. Charlene Blake, a cardiac anesthesiologist, was assigned to manage a heart transplant case. It was only after the 5-hour case had ended that Dr. Blake, surgeon Amy Fiedler, perfusionist Ashley Risso, and other members of the OR team realized there were no men present in the room. This was the first heart transplant performed by an all-woman team at UCSF – and possibly anywhere. The story was featured in the SF Chronicle, CBS News, Today, and Good Morning America.
Brain signals for chronic pain
Dr. Prasad Shirvalkar and team find an objective marker of chronic pain. Read more in the New York Times, Wall Street Journal, New Scientist, the Guardian, Live Science, the Conversation, or MIT Tech Review.
UCSF-Led study suggests treatment combination that may increase chances for survival
In a study published May 22, 2023 in NEJM: Evidence, an international team of researchers from UCSF, Raymond Poincaré AP-HP Hospital, Versailles SQY University, Paris-Saclay University and Inserm, and the George Institute for Global Health in Sydney, studied the role of hydrocortisone in the management of adult patients with septic shock. They found that while the effect of hydrocortisone was modest in terms of overall survival, it was associated with a decrease in the need for blood pressure-raising drugs (vasopressors) and improvement in survival when used in combination with other corticosteroids. The study was coordinated by first authors Romain Pirracchio, MD, MPH, PhD, chief of Anesthesia at ZSFG and the Ronald D. Miller distinguished professor at UCSF, Djillali Annane, MD, PhD, and senior author Anthony Delaney, MBBS, MSc, PhD.
Dr. Alex Perez, Anesthesia Resident, member of groundbreaking "cancer shredding" research team
Dr. Michael Gropper serves as editor-in-chief for the 10th edition of Miller's Anesthesia
Originally published in 1981, Miller’s Anesthesia remains the definitive text on anesthesia practice. In the 10th edition expert editors and authors address timely topics alongside basic science for an in-depth and comprehensive understanding of the field.
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The history of our department
1910
Prior to 1900, anesthesia was primarily supervised and taught by faculty surgeons at both didactic and clinical levels. Dr. Mary Elizabeth Botsford, after graduating from UC San Francisco in 1896, began her anesthesia practice in 1897, making her one of the first physician anesthesiologists in the nation. In 1910, she became the first faculty anesthetist at UCSF.
Botsford played a key role in professionalizing anesthesia. She established the first section on anesthesia in a state medical society and advocated for legislation to include anesthesia in medical school curricula. By 1930, she was the third president of the Associated Anesthetists of the US and Canada.
In the 1920s and 1930s, hospital-employed physicians provided anesthesia as a service. Botsford led anesthesia services within the Department of Surgery, which had five women physicians by 1921. By 1925, Drs. Mary Botsford, Ethel Righetti, Mary Kavanagh, and Dorothy Wood were integral to providing anesthesia at UCSF.
Botsford was a dynamic teacher, offering lectures, demonstrations, and electives in anesthesia to medical students. Though no official anesthesia residencies existed, informal teaching was ongoing. During this period, Dr. Chauncey Leake conducted pioneering research on anesthetic agents in the Department of Pharmacology.
1932
In 1932, Botsford was appointed clinical professor of anesthesiology, UC's first professor of anesthesia.
1941
In 1941, a Division of Anesthesia was established within the Department of Surgery, coinciding with the launch of a formal residency program. Initially, the faculty comprised 4 members overseeing 10 residency positions. The department primarily focused on providing anesthesia for surgeries, with occasional consultations for intensive care and obstetric cases. Research was limited, and recruitment of residents was challenging due to World War II.
1957
On September 4, 1957, Julius Comroe arrived in Iowa City for a meeting of the American Physiologic Society. Comroe, the newly appointed director of UCSF’s planned Cardiovascular Research Institute (CVRI), was also focused on enhancing UCSF’s reputation and establishing the CVRI as a key resource for researchers. He believed the emerging field of anesthesia could contribute significantly to this goal.
Comroe met with Stuart Cullen, who had built an impressive academic department at Iowa. By the end of their meeting, Comroe asked Cullen to lead anesthesia at UCSF. Cullen was intrigued but insisted that anesthesia must have its own department, separate from surgery, before he would agree to join.
1958
Within hours, Comroe convinced UCSF to establish an independent Department of Anesthesia. In 1958, Dr. Stuart C. Cullen became its first chairman. Cullen recruited John Severinghaus, and together with faculty members Neri Guadagni, Frank DeBon, Earnest Guy (chief of anesthesia at San Francisco General Hospital), and new resident Walter "Skip" Way, they formed the core team.
Over the next 60+ years, the department played a pivotal role in the growth of modern anesthesia, significantly impacting surgical practice, critical care, and pain management. The department quickly gained a reputation for excellence in research, education, and clinical care, matching or surpassing any institution worldwide.
Dr. Cullen and his faculty expanded the residency program to include obstetric anesthesia, ICU, and training at San Francisco General Hospital. They also developed undergraduate teaching and a productive research unit. In June 1966, Cullen left the chairmanship to become Dean of the School of Medicine, during which time the department earned an international reputation for its research.
1967
Dr. William K. Hamilton (1922-2017) became chairman in 1967, continuing the department's growth. An anesthesia unit was established at the Veterans Administration Hospital, and the department took over the ICU at San Francisco General Hospital. Faculty began providing care in the pediatric and newborn ICUs at University Hospital, and the research base was significantly expanded in quality and depth.
1983
In 1983, Dr. Hamilton became vice dean and associate dean for Postdoctoral and Clinical Affairs. In 1984, as the department celebrated its 25th anniversary, Dr. Ronald D. Miller succeeded him as chair. The first edition of the “Miller’s Anesthesia” textbook was published in 1981, and now in its 10th edition, is a global standard.
Under Dr. Miller, the department expanded its clinical responsibilities, including preoperative evaluation, operating room, recovery, and critical care. It launched a model outpatient pain management program and assumed leadership roles at all UCSF-affiliated facilities.
The department became one of the largest and most prestigious academic anesthesia programs globally, pioneering simulation-based learning and flexible residencies in research and critical care. Dr. Miller foresaw the importance of molecular biology in medical research, modernizing the department's research program. The department has consistently been a top recipient of NIH funding.
2009
After leading the department through its 50th birthday celebration, Dr. Ronald D. Miller stepped down as chair. Dr. Mervyn Maze succeeded him, renowned for his pioneering studies on general anesthetics, notably co-inventing dexmedetomidine, widely used for sedation in perioperative and critical care. His innovative research earned him awards like the American Society of Anesthesiology's Excellence in Research award.
2015
Dr. Michael Gropper succeeded Dr. Maze in 2015, transitioning from his roles as chief of Critical Care Medicine at UCSF and as acting and interim chair. The Department of Anesthesia and Perioperative Care now boasts over 250 faculty members, 82 clinical residents, and over 20 research trainees and fellows. Active units are spread across various medical centers, including Zuckerberg San Francisco General Hospital, San Francisco Veterans Affairs Medical Center, Mount Zion Medical Center, UCSF Orthopaedic Institute, and several specialty hospitals in the Mission Bay neighborhood. Beyond operating rooms, the department plays crucial roles in ambulatory care, pain management, critical care, and preoperative evaluation.
Faculty members continue to influence the field nationally and internationally, participating in NIH study sections, securing funding, and serving on FDA and editorial boards. Graduates of the program hold prominent positions in academia and private practice, with many assuming leadership roles in hospitals and professional organizations. The department's contributions have shaped the evolution of anesthesiology since its establishment in 1958, with several faculty members recognized for innovative research.
