Arthur E. Guedel Memorial Anesthesia Center

The Importance of the Guedel Chart By Clyde W. Jones, M.D., F.A.C.A.

ne of the pivotal bits of information that I learned as a beginning Oresident in anesthesiology in 1963 was the Guedel Chart (originally published in 1937), outlining the assessment of anesthetic depth. Some of my teachers who saw to it that I was trained in the fundamentals of ether administration allowed me to see in graphic outline the utility of this masterpiece of the measure of anesthetic depth. This chart is still imprinted on my brain and became not only useful in the operating room, but was used as a reference whenever I was called to treat an unconscious patient in the emergency room or other areas. By quickly mentally placing the patient on the Guedel Chart, I was afforded a brisk method of assessing the degree of respiratory and cardiovascular intervention necessary. This fundamental acquaintance with the Guedel Chart has been of inestimable value to my understanding of our specialty.

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Newer drugs and anesthetic agents forced us to seek other means of assessing anesthetic depth because, unlike ether, they often traversed the Guedel Stages with lightning-like rapidity. Philip Woodbridge presented an alternate way of looking at anesthetic depth, one which reflected the newer agents in 1957.

Figure 2. The Woodbridge Classification

Figure 3. J. Snow’s Five Stages of Ether. It is to be remembered that Arthur Guedel was not the first to offer the Stages of Anesthesia, though he no doubt refined it. John Snow of England, the first full-time anesthesiologist, offered such a system in 1847. Now we are in the era of the processed EEG and its many implications. Thus, we march ever forward to finer and finer techniques of mensuration in a dynamic and sophis- ticated area of medical specialization. References Figure 1: Guedel, Arthur E. Inhalation Anesthesia—A Fundamental Guide. 1937. Figure 2: Woodbridge, Philip D. Changing Concepts Concerning Depth of Anesthesia. Anesthesiology, Vol. 18, #4, pp. 536-550, Jul-Aug 1957. Figure 3: Snow, John. On the Inhalation of the Vapor of Ether. 1847.

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Guedel (cont’d) Guedel Contributors for 2005-2006 Virgil M. Airola George G. Doykos George P. Herr Augusto C. Alarcon Christine A. Doyle Mark Hilberman Paterno A. Almendral Varner E. Dudley III Paul F. Hoar Glenn W. Alper Samir Dzankic Richard W. Horrigan Clarita G. Amurao John C. Eckels Leland R. House Jr. Eduardo E. Anguizola Steven A. Ecoff Samuel C. Hughes Merrill P. Bacon Peter K. Ely Patrick C. Humphreys, Jr. Timothy E. Baldwin Richard C. Engel Eric J. Hunt Sanjoy Banerjee Paul Englund Kha K. Huynh Steven E. Bansbach Paul G. Epler Shale F. Imeson William H. Barbee Aubrey G. Eyer George G. Izmirian Jonathan F. Barrow Mark R. Fahey Russell T. Jackson Edwin E. Batte Carl W. Fisher Stephen H. Jackson Kevin P. Becker Richard P. Fogdall James R. Jaworski John I. Benet Wayne A. Foran Robert A. Jelinek Dean B. Berkus Mary J. Ford William Jenkins Ronald S. Bierma Brandt A. Foreman Paul W. Johnson John B. Bornstein Wendy W. Forrest Clyde W. Jones Harriet B. Branick Peter E. Frasco Hasmukh G. Joshi Terrance W. Breen Kenneth T. Furukawa Robert W. Kalayjian Heinrich A. Brinks Jeffrey D. Galland Patricia A. Kapur Romualdas V. Brizgys Donald J. Galligan Eva M. Kavan D. Robert Buechel Robert C. Garbak Kaye H. Kelley Ralph B. Busch, Jr. Laurens N. Garlington Robert T. Keszler Rick R. Bushnell J. Kent Garman Sung-Hwan Kim Selma H. Calmes Robert M. Gasway Kenneth Y. Kimura James W. Carlin Steven J. Gerschultz Gilbert E. Kinyon Paul D. Carlton John W. Gibbs Jr. Arthur C. Klein Ian Chait John C. Glina Irv Klein Anthony H. Chang Adamson G. Go Wayne M. Kleinman Calvin Chang Paul Goehner Sandra W. Kluwe Chun T. Chen Steven D. Goldfien Brian N. Kopeikin Yong S. Chen Alex L. Goodman Harold S. Korduner Gerald Y. Choi Randall L. Goskowicz Caroline J. Labrie Gerald Y. Choi L. Richard Greenstein Michael J. Laflin Sungkey L. Chong George A. Gregory Michael Lam Jon W. Churnin Philip A. Greider George H. Lampe Richard W. Clark Hans J. Gritsch Laurence A. Lang Rodney D. Clark Nita N. Grover Nathaniel C. Law Jonathan T. Clarke Gary T. Guglielmino Edwin R. Lee Daniel M. Cosca Edward F. Gunz George I. Lee Harry J. Cozen Galust G. Halajyan Hee Y. Lee Thomas H. Cromwell Klane L. Hales In Soo Lee James L. Crook Jr. Brian P. Harney Kee Y. Lee Brandt R. Culver Richard E. Harris Gary A. Leopold Gary L. Cutter Fredrick E. Harrison Yvonne I. Leramo Patricia A. Dailey John S. Hattox Norman Levin Martha Y. Daly Richard D. Hauch Kuang C. Liao Maria A. De Castro Quin R. Hauss Teresa H. Liao Robert P. DeVoe John M. Haworth Michael J. Lillie John O. Dimowo William L. Hazard Frederick A. Lodge John W. Ditzler Thomas D. Heiman Ann S. Lofsky Robert F. Dong Eva H. Henriksen James F. Lourim Donald B. Dose Michael G. Hernandez Shawn W. Lucas

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Philip D. Lumb Robert E. Ploss Laura Slaughter Nelly K. Mac Jonathan J. Porter Eric T. Smith Thach D. Mai Marvin H. Primack Gary C. Smith Ann Marie Mallat Chunyuan Qiu John R. Spence Douglas K. Mandel Maria Concepcion G. Rabe John M. Stanec Gerard Manecke Saroja V. Rajashekara William R. Stevens Dennis T. Mangano Michele E. Raney Philip C. Stillman Guillermo T. Mantuano David Raybould Jeffrey S. Stuart Floyd F. Marchi John H. Redpath Daniel E. Sucha Steven R. Marcum Phillip C. Reed R. Lawrence Sullivan, Jr. Lewis S. Margolis Danielle M. Reicher Andrew D. Sun Bert W. Marks Roland D. Reinhart Frank A. Takacs Steven L. Marlowe Mark J. Richman David Y. Tang Rosemarie Marshall Johnson Francisco C. Rico Jeffrey C. Thue Linda J. Mason Miguel A. Rivera Richard E. Tirrell Thomas P. Mathews Beverly B. Roberson Narendra Trivedi William G. Maxwell H. Douglas Roberts Gerald E. Tull Michael D. McGehee Susanne C. Roessler Joseph A. Vasek Fred J. McKibben George G. Romero Christopher J. Vasil Stuart Melnick Lynn B. Rosenstock Jerrold A. Vest A. Duane Menefee David J. Ruderman Steven G. Vitcov Bernard S. Millman Laura A. Russell-Stringer Mark E. Vukalcic Iqbal Mirza Donal P. Ryan Gerald H. Wade Gayle R. Misle Kenneth R. Sacks Wayne T. Walker LeRoy Misuraca Stanley I. Samuels Michael A. Walter Avery C. Mittman Robert H. Sanborn Henry C. Walther Alan R. Mizutani Surinder Sandhu Brian W. Wamsley Daniel Y. Mochizuki Stanley J. Scheurman, Jr. Steven Wang Jack L. Moore Richard M. Schlobohm Eric A. Wardrip Patrick A. Moore William O. Schultz Walter L. Way Randall D. Morton Warren Schweitzer Paul M. Weidoff Suha Murad John W. Severinghaus Richard A. Weikel Steven Naleway David A. Shapiro Marc L. Weller Teri R. Namba James J. Shea Stephen Y. Wen Marco S. Navetta Susan S. Sheridan David P. Whalen Philippa Newfield Carla B. Shnier Jeffrey D. White Alan K. Nirady Karen S. Sibert Freddie A. Williams, Jr. Melvin S. Nunn Mark A. Singleton Marc D. Wolfsohn Nader S. Nwaisser Stephen J. Skahen Lillian S. Wong Aidan P. O’Brien Robert L. Worthington Helen T. O’Keeffe Stephen P. Yeagle Richard J. O’Leary, Jr. Ken Yew Alan F. Olson Nicole Yi Blanka A. Orloff Larry Yip Paul J. Pabst. Jr. Paul B. Yost Jeffrey D. Parks Vian Younan Robert S. Peck Anni Yue Constance H. Pinkerman Mark I. Zakowski Gail P. Pirie Eric J. Zeeb

Arthur E. Guedel Memorial Anesthesia Center, 2395 Sacramento Street, San Francisco, CA 94115 (415) 923-3240; http://www.cpmc.org/professionals/hslibrary/collections/guedel

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