ACE mixture

ACE mixture is an historical anaesthetic agent for general anaesthesia. It was first suggested by George Harley[1] and first used in England around 1860. In 1864 it was recommended for use by the Royal Medical and Surgical Society's Chloroform Committee. It was rarely used after the 19th century, except in Germany, where it was used for slightly longer.[2]

It was a mixture of alcohol, chloroform and ether[1][3] which gives the mixture its name. Its effects were said to be between that of chloroform and ether and it was used when ether alone was contraindicated.[1] Its boiling point was given as 48°C.[4] Its actual safety margin over its components alone was marginal.[5][6]

Usage

ACE 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 chloroform in the ACE mixture was believed to reduce this.[2] However, some did question this experimentally at the time.[7]

Many anaesthetists favoured ACE mixture and one author in 1887 in the British Medical Journal considers the ACE mixture, at the time, the best anesthesia 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, fewer deaths from ACE mixture were reported than deaths from chloroform or ether.[6][10]

Other preparations

After widespread use of ACE mixture, anaesthetists would try different mixtures for different patients and different procedures. CE mixture omitted the alcohol and AC mixture omitted the ether.[1] One doctor described using equal parts alcohol and chloroform in minor operations, but chloroform with Eau de Cologne (which has a high alcohol content) in dental procedures for a more pleasant experience.[11]

Other mixtures were:[1]

Preparation Nameas written in sourceReduced ratio of AlcoholReduced Ratio of ChloroformReduced Ratio of Ether
Common mixture1 part alcohol, 2 parts chloroform, and 3 parts ether123
Richardson's mixture20 parts alcohol, 12 chloroform and 8 ether532
Vienna mixture0 parts alcohol, 31 parts chloroform and 23 parts ether03123
Billroth's mixture1 part alcohol, 3 part chloroform and 1 part ether131
Linhart's Mixture20% alcohol with chloroform140
Methylene ("Bichloride of methylene")30% methylic alcohol and 70% chloroform370

Not included in table as they include petroleum ether in addition to diethyl (sulphuric) ether:

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

ACE mixture was also used to anaesthetise animals, including in preparation for vivisection.[12]

Method of administration

ACE 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 Gwathmey modified his idea and created a practical apparatus. Tyrrell created a similar idea called the 'Tyrrell's double-bottle method'.[1]

References
  1. 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. 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. "Deaths under chloroform And A.C.E. mixture". The British Medical Journal. 2 (1663): 1072–1073. 1892-11-12. JSTOR 20222445.
  6. "Death Under Chloroform". The British Medical Journal. 2 (1698): 143. 1893-07-15. doi:10.1136/bmj.2.1698.152. JSTOR 20225168. S2CID 1432522.
  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. S2CID 12472582.
  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. S2CID 73074361.
  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. PMC 2344476.
  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. S2CID 220195762.
  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. S2CID 34144846.
  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. S2CID 220149652.
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