How did anesthesiology evolve? To your surprise, the history of anesthesia is very old. But the real evolution of the discipline began in the mid-19th century and was not really fully established until about 60 years ago. The use of cannabis and mandrake flowers for dental and surgical pain has been documented since Babylonian, ancient Greek and Egyptian times. They were even used for surgical procedures by methods such as bleeding and making the patient lose consciousness. Regional anesthesia in ancient times was accomplished by compressing the nerve trunk (nerve ischemia) or by using freezing (cryo-pain relief). Ancient Incan surgeons achieved local anesthesia by chewing cocoa leaves and spitting saliva (thought to contain cocaine) into the surgical wound. The vast majority of surgical procedures were limited to fractures, traumatic injuries, amputations and bladder extraction. In ancient times, there were no anesthesiologists, so the main criterion for evaluating a surgeon’s success was the speed of surgery. In China, during the Spring and Autumn Period and the Warring States Period, the “Nei Jing” recorded the treatment of headache, toothache, earache, lumbago, joint pain and stomach pain by acupuncture, and Bian Ji was a famous doctor of this era. In the 2nd century A.D., the Shennong Ben Cao Jing contained 365 kinds of drugs including scopoletin, marijuana, ocimum sanctum, sophora, pepper and other drugs with analgesic or anesthetic effects. Hua Tuo (141-203) of the Later Han Dynasty (141-203) used marijuana to perform a caesarean operation after general anesthesia by taking marijuana with wine. Tang Dynasty (618-907) and Song Dynasty (960-1279) era often used warm wine to mix the fine powder of Da Cao Wu as a whole bone anesthetic. The early Song Dynasty widely used Yang Jinhua (mandrake flower), the Yuan Dynasty (1279-1368) application of Cao Wu San for blood to cause coma to anesthesia, of course, this is very dangerous. The history of modern anesthesiology began in 1846, when only a fairly small number of operations could be performed, and diseases that seem very easy to treat now, such as appendicitis, were fatal at that time. The operation could only be performed if the patient was securely tied to the bed or held down by several people, as the patient might struggle desperately because of the severe pain. A number of distinguished medical men worked tirelessly to pioneer anesthesia. On October 16, 1846, Dr. Morton of the United States gave the first public demonstration of general anesthesia using ether in Boston, with great success, thus causing the surgeon to declare to a skeptical audience, “It’s not a trick!” In 1847, the first use of chloroform for labor analgesia was performed by Sir Spurgeon, which became the beginning of modern history of labor analgesia. aether ruled anesthesia for 110 years from 1846 to 1956, but it was soon discovered that aether, an inhalation anesthetic, had three disadvantages: 1. easy combustion and explosion. 2. toxic effects. 3. respiratory and circulatory depressant effects. Therefore, ether and chloroform have long been eliminated. And in the last decade, isoflurane, desflurane, and sevoflurane have been introduced one after another, making fast induction of anesthesia, rapid awakening, and increased safety, and becoming the commonly used inhalation anesthetic drugs in clinical anesthesia today. Therefore, the progress of anesthesia technology first originated from inhalation anesthesia, followed by local anesthesia, and finally developed to intravenous anesthesia. The beginning of modern local anesthesia is attributed to an ophthalmologist named Kakol, who demonstrated in 1884 that cocaine could be used for surface anesthesia in ophthalmic surgery. Cocaine was isolated from coca leaves in 1885 and further purified and synthesized. The beginning of regional block anesthesia was in 1898, and the first spinal anesthesia was performed by Oglespine using cocaine injected intrathecally. sacral epidural anesthesia was introduced in 1901. Subsequently, the clinical use of local anesthetics procaine (1904), bupivacaine (1932), lidocaine (1947), and bupivacaine (1963) were introduced and are still commonly used in clinical anesthesia. For a long time the most commonly used general anesthesia induction drug – thiopental sodium, was first used in the clinic in 1934. 1959 synthetic Valium, 1976 synthetic imipramine as preoperative drugs, induction drugs, anesthetic adjuncts and intravenous sedation drugs are widely used in the clinic today. Ketamine was synthesized in 1962, and propofol was introduced in 1989 and became a major advance in anesthesia for outpatient procedures (e.g., painless abortions) because of its short duration of action. The use of arrow poison by Guilfoyth and Joulsen in 1942 was a milestone in the development of anesthesiology. The use of arrow poison greatly facilitated the operation of tracheal intubation and provided good abdominal muscle relaxation for surgical procedures. Succinylcholine was introduced in 1951, and to this day no other muscle relaxant is comparable for its rapid onset of action and good muscle relaxation. The representative of opioids, morphine, was isolated from opium in 1805, and the synthesis of dulcolax (pethidine) in 1939 led to renewed interest in the use of opioids in anesthesia. In fact, surgical development was very slow until the 1840s. The problems of surgical pain, wound infection, hemostasis and blood transfusion were not well addressed, resulting in high patient mortality. With the improvement of anesthesia, the invention of antibiotics and the solution of blood transfusion problems, surgery was able to develop by leaps and bounds. In short, in the medical writings of the world over the ages, there are rich records on anesthesia for pain relief and resuscitation and first aid, and the experience is valuable, which shows that anesthesia has great achievements and contributions in the history of medical development.