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Guedel's classification
Guedel's classification is a means of assessing of depth of general anesthesia introduced by Arthur Ernest Guedel (1883-1956) in 1937.
==History==
Since general anesthesia first became widely used in late 1846, assessment of anesthetic depth was a problem. To determine the depth of anesthesia, the anesthetist relies on a series of physical signs of the patient. In 1847, John Snow (1813-1858)〔John Snow and Meyer Joubert. Five stages of narcotism; On the inhalation of ether in surgical operation, London, 1847〕 and Francis Plomley〔Plomley F. Lancet 1847,p. 134 (reprinted in classical file, Survey of Anesthesiology 1970, 14, 88)〕 attempted to describe various stages of general anesthesia, but Guedel in 1937 described a detailed system which was generally accepted.〔Lunn, J.N. (1982) Lecture Notes on Anaesthetics, 2nd edn. Blackwell Scientific Publications, Oxford.〕〔Guedel AE. Inhalation anesthesia, Ed 2, New York, 1951, Macmillan〕
This classification was designed for use of a sole inhalational anesthetic agent, diethyl ether (commonly referred to as simply "ether"), in patients who were usually premedicated with morphine and atropine. At that time, intravenous anesthetic agents were not yet in common use, and neuromuscular-blocking drugs were not used at all during general anesthesia. The introduction of neuromuscular blocking agents (such as succinylcholine and tubocurarine) changed the concept of general anesthesia as it could produce temporary paralysis (a desired feature for surgery) without deep anesthesia. Most of the signs of Guedel's classification depend upon the muscular movements (including respiratory muscles), and paralyzed patients' traditional clinical signs were no longer detectable when such drugs were used.
Since 1982, ether is not used in United States.〔Carlsson C, Karlsson JP, Daniels FB, Harwick RD. The end of ether anesthesia in the USA. In: Fink BR, Morris LE, Stephen CR, eds. Proceedings 3rd International Symposium on the history of Anesthesia. Atlanta, Georgia. Wood Library - Museum of anesthesiology, Illinois. 1992: 100–2.〕 Now, because of the use of intravenous induction agents with muscle relaxants and discontinuation of ether, Guedel’s classification is regarded as obsolete. Depth of general anesthesia can now be estimated using devices such as the BIS monitor,〔 however, the use of BIS monitoring remains controversial.
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