Introduction: Anesthesia in Bangladesh is now enjoying its 41st birth anniversary.  long anaesthesia history of this land is described by different authors. It starts from undivided India and Pakistan. We can not forget those persons and events whose contribution in producing Anaesthetic services familiar to physicians and its improvement to make them  as a milestone in Bangladesh. Attempts to relieve pain due to trauma or surgical procedures have been noted since the ancient days. First recorded anaesthetized surgery was that in which Adam was put into a sleep to “give birth” to Eve.

History of anaesthesia in SAARC Region reveals that in 2000 BC, Sushratha used to perform plastic surgery of cut nose with the use of Opium, Indian hemp and Wine to keep the patient sedated. In the Buddhist Era, in BC 247, laparotomy was described using alcohol to obtund pain. In 427 AD, an herbal drug “Sammohini” had been described. Laparotomy with patients standing and tied to a pillar was described by King Raja Bhoj in his writing Bhoj Probhand.In 1843 Easdale reported surgical operation under mesmeric anaesthesia in Hoogly Hospital in West Bengal. Ether anaesthesia was used in India only six months after its official demonstration on October 16, 1846 in Massachusetts General Hospital, USA.
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Creation of Bangladesh: In 1947, British India was divided into India and Pakistan. Pakistan had two parts East and West. Bangladesh won independent from Pakistan in 1971 after a blood bath. The medical facilities available in this land  in undivided India and  the  East Pakistan at the time of independence  included  one medical college hospital, few Medical Schools under a medical faculty, which used to confer Licentiate of Medical Faculty(LMF).Mitford Medical School, Dhaka; Liton Medical School, Mymensingh; Medical School, Chittagong; Medical School, Sylhet; Medical School, Rajshahi; etc. Surgeons used to perform operations using local anaesthetic themselves. During East Pakistan  seven medical colleges , one post graduate institute and research, few district hospitals and rural health centers were developed. Upto sixties most of the hospitals have no recognized anaesthetist  to deliver anaesthesia and sometimes it was given by nondoctors under the supervision of surgeon.

Anaesthesia development In Bangladesh: Dhaka Medical College was established during the British period in the undivided India on the 1st July 1946. The first Principal was Major W.J.Virgin, IMS. Dhaka Medical College Hospital started to function on the 16th July 1947 one month before the independence. The order was as follows:Ref: Govt of Bengal Order No. Meld. (MPO) 21-S-2/46 dt. 14.03.47. The hospital opened on November the 1st. 1946 as an emergency relief hospital in order to supplement the hospital facilities available at the Mitford Hospital, Dhaka City. It was located in the old secretariat building, Ramna, recently taken over from the University of Dhaka for the purpose of establishing a Medical College (100 students per year) and a hospital of 500 beds. By the order of Major Virgin, IMS Principal cum Superintendent dated 16.6.1947.Dhaka Medical College & Hospital steps were taken to close the emergency relief hospital and to replace it by the permanent establishment of the Medical College Hospital on June 15, 1947. The number of patients on that day was 86 only.
                                                 
Dhaka Medical College Hospital: The doctors and other staffs of the emergency relief hospital were absorbed as the staffs of the Medical College Hospital in separate orders. Dr. Prithi Bhusan Dutta and Dr. Subratha Sen Gupta – two Junior House Surgeons and Dr. Hira Lal Dey – one Junior House Physician were the doctors on the first day. Their pay scale was Rs.50/- per month + 10/- adhoc relief and DA. 22/- per month .Gradually, hospital departments were developed which included Medicine, Surgery, Midwifery, Ophthalmology and ENT.
            For operative procedures, Local anaesthesia and regional blocks were in use and practiced by the Surgeons themselves. General anaesthesia was used under supervision of the surgeons and used to be administered by the house surgeons of the respective departments. However, Dr. Beni Madhab Basak a house surgeon was mostly responsible to administer general anaesthesia till December, 1948.

Dr. S.M.Mukhlesur Rahman, MB was the first physician appointed as an  Anaesthetist, Dhaka Medical College Hospital vide Govt. order NO.3354/Medl. dt. 21st December 1948. DMCH order No.1993 of 1949 confirmed the posting of Dr. Beni Madhab Basak to work as regular Anaesthetist.
            The two pioneers of Anaesthesia of DMCH i.e. of Bangladesh left the specialty soon they could manage. Dr. Beni Madhab Basak left the country on 7.3.50 and did not return. Dr. S.M.Mukhlesur Rahman handed over the charge of Anaesthetist on 14.3.50 and joined a post in Midwifery and retd. as Professor of Midwifery.There was no complete record could be available about the anaesthetists who worked in Dhaka medical college Hospital during that period. However, the other anaesthetists who worked in early days were Dr. Md. Yusuf Ali, retd as Professor of Medicine; Dr.T.C.Nandi left the job, was a renowned general practitioner and then left the country. Late Dr. Abdul Mannan retd as Professor of Anatomy and Dr. K.A.S.M.A.Quader retd as Professor of Anaesthesiology.

The first post-graduate anaesthetist is Dr. K.A.S.M.A Quader, DA (Lond). By the Order of Superintendent, Dhaka Medical College Hospital, memo. No. 458 dt. February 17, 1951 Dr. Abdul Quader, MB, DA (London) has been In Charge, Deptt. Of Anaesthesia of the Medical College Hospital, Dhaka. Henceforth, anaesthetists will work under him. Dr. Quader joined the post of lecturer of anaesthesiology in October, 1951; Chief Anaesthetist cum Lecturer of Anaesthesiology in 1958 and promoted as the   Professor of Anaesthesiology in July 1965. He was also awarded the FFARCS by the Royal College of Surgeons of England, FCPS by the Bangladesh College of Physicians & Surgeons.  He was also the first president of the society of Anaesthesiologist of Pakistan and Bangladesh. In his honour “Quader Lecture Gallery” is established   in the department Of Anaesthesiology in Dhaka Medical College & Hospital.
            

 Name of the Other  Anaesthetists  in Early  Days :The other anaesthetists worked in fifties were Dr. Shah Fazlul Haque Choudhury, Dr. Md.Sirajul Islam, Dr. Ziaul Hasan Khan, Dr. Anwarullah Choudhury, Dr. Quazi Obaidul Haque Siddiqui, Dr. Shamsuddin Ahmad, Dr. R.K.Khandhakar, Dr.M.A.Khaleque, Dr. Md.Serajuddin, Dr. Afsaruzzaman, Dr. A.Gani Gazi, Dr. Mir Mohiuddin, Dr. Anwar Hossain Azmi, Dr. A.K.M.Ruhul Amin, & others.

Anaesthetic Drugs and Techniques used : Infiltration analgesia, field blocks, regional blocks were popular amongst the surgeons in those days. Spinal block was popular for surgery of lower abdomen, pelvis and lower limbs. Procaine was the drug used for local analgesia. Heavy Cinchocaine (Nupercaine) was in use for spinal analgesia.

Chloroform, mixture of chloroform and ether, ether and ethyl chloride were the volatile anaesthetics used for general anaesthesia. Open-drop method was used for the purpose. Younker’s Face Mask, Schimmelbusch Face Mask, Junker’s Inhaler were equipments available for anaesthetic procedures. Tongue Holding Forceps, Philips Oro-pharyngeal airways, Guedal’s Oro-pharyngeal airways, Mouth Gag were the supporting equipments. In the later period Boyle’s Davis Mouth Gag and Insufflations Method was in practice for ENT operation.

Open drop method was in use in the early days. Those were replaced by draw over machine in many centres. Gradually, modern anaesthetic machines replaced these in most centres and in all of the educational institutes. Artificial ventilators were introduced in some teaching & private hospitals. Monitors for different parameters were introduced in few hospitals – both Public & Private.

The first anaesthetic machine was the Boyle’s apparatus (Produced by the British Oxygen Co. Ltd. No. 329) available since 1949 at DMCH. But it could not be used till return of Dr. Quader from UK in January 1951. That machine had type 7 cylinders of oxygen, nitrous oxide, cyclopropane and carbon dioxide (without pin index) and ether and trichloroethylene vaporizers.

Thiopentone sodium was introduced in 1952-53. Gallamine tri-ethiodide (Flaxidil) was introduced in mid-fifties. Chloroform disappeared from practice in early fifties. Ether continued to be in use in open-drop method and in Boyle’s Anaesthetic Machines. Halothane was introduced in late fifties. In course of time, Halothane replaced other volatile anaesthetics. Trichloroethylene was available in limited quantity.

Suxamethonium was introduced in early sixties. Tubocurarine chloride was available in limited quantity. Pancuronium Bromide was introduced in mid-eighties. Atracurium was introduced in late eighties. Vecuronium was introduced in early nineties.
Pipecuronium was introduced in late nineties.

Artificial ventilators were introduced in late sixties and in early seventies. Spinal anesthesia was re-introduced and very popularly used in most of the hospitals.
Epidural blocks are getting popularity in the recent days.
            Piped Medical Gases & Vacuum was introduced in DMCH on the 19th February 1985 and are extended in many hospitals.

Anaesthesia Service outside DMCH: Anaesthesia service was recorded with a very short of trained manpower in Chittagong Medical College & Hospital in 1956.In this way anaesthetics services were started gradually in other  Govt Medical College  and Hospitals and limited District Hospitals. Great evolution and expansion of anaesthesia services were recorded after establishment of institute of postgraduate medical and research in 1964,  latter on  Bangubandhu Sheikh Mujib Medical University(BSMMU) in 1998. Now  this  services are  rationally  recognized and establishment  of well equipped  Department  extended in all govt. medical college hospitals , Specialized Hospitals or Institutes, private medical college hospitals , District Hospitals and up to upazilla health complexes still with a  very short of trained manpower.

Recent Milestones of Anaesthesia: Prof. S N Samad Chowdhury DA (London). FCPS (BD)( F F A R C S) who was the long time president of BSA and has great contribution for anaesthetic expansion in Bangladesh in the way of manpower development, post graduate courses and creation of Govt. Post for anaesthesiologist.He was also very popular in International Faculty of Anaesthesia for attending different national and international conferences and for his valuable opinion in developing anaesthesia. He is the one of the founder member of establishment of SACA and under his leadership Ist SACA Congress was held in Bangladesh very successfully.
In his honour “Samad Seminar Room” is established   in the department Of Anaesthesiology in Bangabandhu Sheikh Mujib Medical University.
Prof. K.M. Iqbal, Prof. M.Khalilur Raman, Prof Rashiduddin Ahmmed , Prof.Golam Rasul , Prof Afzalunnessa contribute  for the development  and expansion of modern anaesthesia in Bangladesh and  able to grow interest  to the juniors  become as anaesthetist.

Manpower development in Anaesthesia:  In 1947 there is no recognized trained anaesthesiologist ,in 1948 two self trained and one in1951,total three with one recognized .There after very slowly developed anaesthetic manpower up to 1971 with few postgraduate diploma from London. After 1971 few qualified anaesthesiologists with FFARCS and  DA(London) joined the  job and  tried to increase the qualified and trained manpower, also dignity of this services.Number Postgraduate anaesthesiologists increased after establishment of postgraduate course in Bangladesh. In 1981 gradually increased interest in this field due to national demand with improved some dignity but still slow.

   Table: I – Showing the  frequency of  of anaesthetic manpower developed in Bangladesh

Post graduation in Anaesthesia: In Bangladesh  basically two post graduate institute , BCPS (PCPS) gives the degree  of FCPS and MCPS   and BSMMU (IPGMR under Dhaka University) gives the degree  of DA and MD in Anaesthesiology. MD in Anaesthesiology course now is converted into  MD Residency course in BSMMU.
DA:  It was started in 1973. First two diplomats were Dr. FakhrunNissa and Dr. Dilip Kumar Das. Total diplomats are now more than 423.Now DA course is continuing in 11 medical colleges and institutes and admitted about 80 students per year.  
MCPS: It was introduced in Pakistan period. Dr. Md. Shafiqur Rasul was the first member. Total number is 151.First Bangladesh M C P S is Dr M Khalil ur Rahman 1976
FCPS: It was introduced in BCPS in1979. The first follow was Dr. Selim M Jahangir who was awarded Fellowships in 1983. Total number of follows is 120.
MD:  It was introduced in 1987. The first MD was Dr.Md. Abdul Hai. Total number of MD is 49. Now MD course is continuing in 3 medical colleges and institutes and admitted about 20 students per year.
MD. (Critical Care Medicine) : It was introduced in 2008  in BIRDEM and Dhaka Medical College. None could qualify till now.
MD. It is started in BSMMU very soon as a residency course.

PRESENTATATIONS IN HOME AND ABROAD: In anaesthesia, the first paper presented in a local medical conference by Dr. Anwarul Azim, an LMF doctor, posted in Civil Hospital, Sylhet and working in Sylhet Medical College Hospital in 1965. The title of the paper was “Anaesthetic Emergencies”. Later, he published that paper in a local Journal of Sylhet branch of Pakistan Medical Association (EZ). He also presented another paper in 1966 on “Some aspects of Anaesthesia”. Dr. S.N.Samad Choudhury presented a paper “Role of Anesthetists in the Management of Emergencies” in 1967.
Dr. S.N.Samad Choudhury also presented a paper titled “Practice of Anaesthesia at Sylhet Medical College Hospital” and Dr. Anwarul Azim presented another paper titled “Some Aspect of Anaesthesia (Balanced Soup or balanced intravenous anaesthesia)” in National Conference of Pakistan Medical Association held at Dhaka 1969. Dr. S.N.Samad Choudhury presented a paper at Karachi in 1969 at Jinnah Post-graduate Medical Institute titled “Hyperventilation in the management of Eclampsia”.

The first paper presented outside the country was “A method of Treating Eclampsia with IPPV” by Dr.S.N.Samad Choudhury in the III Asian Australasian Regional Congress of Anaesthesiology organized by the AARS of WFSA in 1970. He represented Pakistan Medical Association as one of the two invitees by the organizing committee of AARS.
Dr. K.M.Iqbal presented first paper on pain management titled “Scope of Pain Clinic” in 1983.

Society of Anaesthesiologists: Pakistan Society Of Anaesthesiology was formed in 1968 with Prof K.A.S.M. A. Quader as its first President having office located at Dhaka. Soon after separation of East Pakistan and formation of Bangladesh it died down spontaneously

Bangladesh Society of Anaesthesiologists
Foundation – Bangladesh Society of Anaesthesiologists (BSA) was formed in1974 with Prof. K.A.S.M.A.Quader and Dr.Md. Shafiqur Rasul as its President and Secretary respectively. Our journey began in 31 December in 1978 through first national conference held on the same year. Our society conducted 27 (Nineteen) National conferences until its inception. The society will pass its youth with the passage of time in 2011covering a period of 37 years. However, the long Journey was not very comfortable for it. The scope of the society has expanded by this time. As a result, the society has become member of the world Federation of the Societies of Anaesthesiologists in the year 1987. South Asian Confederation of Anaesthesiologists (SACA) was formed on 31 December 1991 in New Delhi & first Congress of SACA was held in Dhaka in October 27-29, 1993. There were only six postgraduate anaesthesiologists in the society during its inception. By this time, by the help of our society has produced about 750 different criteria of postgraduate anaesthesiologists engaged in their profession at home and abroad and acquired name and fame in their respective fields of work. The existing number of the members of the society is now about 750 including 425 life members.   Now there is  different  divisional and district  branches . 
Conferences- First National Conference was held in 1978 and the last 27th conference was held in 2011. It is always held in different attractive venue of whole of Bangladesh.  Many other conferences were organized that included Silver Jubilee, Anaesthesia Day with family get-together in every year. 1st SACA and International Congresses held in Dhaka in October 27-29, 1993. 5th SACA and International Congresses congress was held in Dhaka in 2003 organized be BSA and Society of Study of Pain.

SACA Re-named: 7th SACA congress was held at Katmandu, Nepal in 2007. In this SACA congress, SACA is re-named as “South Asian Association of Regional Cooperation – Association of Anaesthesia (SAARC-AA)” & to publish SAARC-Journal of Anaesthesia.The first SAARC-Journal of Anaesthesia contains 1. Background of SACA formation.2. Massage from President, BSA.3. Two articles from members of BSA.

Scientific activities -  In addition to conferences, monthly scientific meeting, workshops, joint meetings with other Societies are held regularly

Expansion of Anaesthesia Service: Anaesthesiologist are not limits their activities only in peri-operative anesthetic management and they also involved   in the organization and management of intensive care ,  pain clinic and palliative care. 

Intensive Care Unit was started in Dhaka Medical College Hospital in September 1985 with a six bed only .  Intensive Care Unit was  also started  IPGM&R(now BSMMU) in 1991 with five bed  by individual effort  and  donation.There after ICU was extended 20 bed in DMCH and 10 bed in IPGM&R by Govt. Now it is under great effort by the Govt. to established full pleased ICU in all Medical College and specialized institutions. In BSMMU ICU further extended into 40 bed.   Now there are 82 intensive care units around the country in both public & private sector. Bangladesh Society of Intensive Care  Medicine was formed in 2005 which was initiated by the anesthesiologists of BSA.  

Bangladesh Society of Study of Pain was formed in 1998 with members from multi-disciplines which was initiated by the anesthesiologists of BSA.. Initially Pain clinic was started as a  Outdoor basis in IPGM&R , later on BSMMU.Now it is full placed Pain clinic under Anaesthesiology Dept. served by qualified anaesthesiologist trained from Japan.

Palliative Care service  was started  with help of  Afzalunnessa foundation, Rotary Club of Bangladesh and Palliative care institute in Kerala, India. Now it is a recognized project  in BSMMU.

Conclusion

It can be said certainly with emphasis that the anesthesiologists of our country are not lagging behind in connection with safety and quality standard in comparison with those of the developed word. Now a days complicated surgical procedures like cardiac surgery, neurosurgery, thoracic surgery, kidney transplant, pain management and intensive care of patients have been possible due to improvement of Anaesthesiology. The aim of BSA is to provide peri-operative care of patients, pain management, intensive care of patient in ICU, manpower development through various courses like FCPS, MD, Diploma and MCPS and other academic activities like journal publication and conducting scientific seminars and symposium and encouraging the society members for participation in scientific sessions at home and abroad. There is no scope of complacency in this regard. Still we are lacking some basic infrastructural problems like proper placement and distribution of manpower, availability of equipments and drugs at all levels of health care delivery system, which is a pre-requisite for the beneficial, effective and fruitful surgical outcome. However, we are very much hopeful and awaiting a golden future.

Journals – The first journal of Bangladesh Society of Anaesthesiologists was published in 1987 with Dr. K.M.Iqbal as its Editor. Two issues of journals per year are published regularly. Now it’s volume 24, number 1 .