Edmond I. “Ted” Eger II, the anesthesiologist and scientist who pioneered development of modern inhaled anesthetics, died peacefully at his home in Tiburon, California, on August 26, 2017, one week shy of his 87th birthday. Dr Eger’s research is the basis for the safe use of modern inhaled anesthetics administered to more than 300 million patients every year. His death was due to pancreatic cancer.
Edmond I Eger II was born September 3, 1930, in Chicago, the son of an advertising executive. The young Ted Eger received ether anesthesia at ages 6 and 10, experiences that would haunt him and guide him into a career to improve anesthesia care. In both cases, he felt restrained, suffocated, and drawn into a black vortex as consciousness disappeared.
Eger graduated from Hyde Park High School at the age of 15, having led his school checker team to 2 consecutive victories in the All-Chicago Checker Championship. He graduated in the lower 20 percent of the class, however, and after his first (and only) day of selling women’s shoes, he resolved to improve his study habits. He enrolled in Roosevelt College and was able to transfer to the University of Illinois 1 year later, from which he graduated Phi Beta Kappa with a major in chemistry and a minor in mathematics. Later that year, he enrolled in Northwestern Medical School, from which he graduated in 1955. He had expected to pursue a career as a general internist, when an epiphany during an externship directed him to a career in anesthesia instead: assisting with the care of a patient receiving the anesthetic thiopental by infusion, the patient’s breathing gradually slowed and finally stopped, whereupon Eger discovered that he could move air in and out of the patient’s lungs by squeezing the anesthesia circuit, thus keeping him alive. This power of controlling a person’s breathing, coupled with the haunting memory of his own sense of suffocation during anesthesia, inspired him to embark on a career in anesthesiology. He was determined to improve on what he had experienced as a child.
Following a 1-year internship at St Luke’s Hospital in Chicago, Dr Eger began residency training at the University of Iowa with a new baby and wife, Dollie Ross Eger, in tow (after 25 years of marriage, they divorced in 1983). Under the leadership of Iowa’s Dr Stuart Cullen, Dr Eger began publishing his first research papers and also began working with another anesthesia resident, Dr John Severinghaus, who successfully challenged Dr Eger’s initial notions about the physiology of uptake and distribution. Dr Eger followed him to UCSF to work as his research fellow and spent the next 50 years applying precise mathematical detail to answer the questions that Dr Severinghaus had posed while they were residents.
Working at the University of California, San Francisco, Dr Eger methodically characterized the effects of drugs used in anesthetic practice. This work began with halothane and methoxyflurane in the 1960s and extended to enflurane and isoflurane in the 1970s, and to desflurane in the 1990s. Early in his career, Eger (and Lawrence Saidman) were challenged by Severinghaus to develop a standard measure of anesthetic potency. Severinghaus handed Eger a bottle of something called halopropane. “He asked me to find out if it was any good,” says Eger. “And when I asked him how, exactly, he shrugged and told me I would figure it out.” That bottle of halopropane would prove useless as an anesthetic, but it was the perfect vehicle for Eger to learn how to compare one anesthetic to another. Their studies introduced the concept of “MAC” for the “minimum alveolar concentration” of anesthetic required to prevent movement in response to surgical stimulation. Eger also characterized the processes governing the onset, uptake, and distribution of inhaled anesthetics into the lungs and body tissues, including the brain, and how quickly anesthetics are removed at the end of anesthesia. This provided precise guidance on how to administer inhaled anesthetics safely and effectively during surgery. Dr Eger developed these concepts for the anesthetics available in the 1960s, and then used these concepts to identify new drugs meriting commercial development: isoflurane, sevoflurane, and desflurane.
Eger’s research, with numerous collaborators, led to more than 500 peer-reviewed publications, including 9 of the 100 most frequently cited anesthesia-related publications. His research trainees include the editors-in-chief of Anesthesiology and Anesthesia & Analgesia; 2 medical school deans; 4 recipients of the Distinguished Service Award from the American Society of Anesthesiologists; four recipients of the Excellence in Research Award from the American Society of Anesthesiologists; and 24 chairs of departments of Anesthesiology. Dr Eger has received numerous awards for his research and leadership roles in anesthesia, including the Distinguished Service Award (1991) and the Excellence in Research Award from the American Society of Anesthesiology, and is an Elected Fellow of the Royal College of Surgeons, London. In 2010, he gave the Second Annual John W. Severinghaus Lecture in Translational Science (“After You Please”).
Eger is the author, co-author, or co-editor of 7 books. The first, “Anesthetic Uptake and Action”, published in 1975, remains the definitive description of the principles of anesthetic pharmacology. The last, “The Wondrous Story of Anesthesia”, edited with Lawrence Saidman and Roderick Westhorpe, provides a definitive history. In 1990, Dr Eger was interviewed by former Chair of Anesthesia at UCSF, Dr William K. Hamilton, for the Wood Library’s John W. Pender Collection of the Living History of Anesthesiology. Fifty-five years ago, Eger founded and subsequently supported the Western Anesthesia Residents Conference, an annual meeting hosted by departments of anesthesia located in the western US inviting Anesthesia Residents to present results of their research. This Conference has thrived and grown over the years to a vibrant annual meeting well-attended by residents, department chairs, and anesthesia research faculty. The conference recently honored Eger by naming an annual lectureship after him.
Eger spent his final 2 decades as an investigator pursuing the mechanism of action of inhaled anesthetics, one of the oldest mysteries in pharmacology. He gave a legendary series of lectures on anesthetic uptake and distribution to the first-year anesthesia residents at UCSF. Eger discovered tantalizing clues about how fundamentally different various anesthetics are, while also proving that anesthetics have less person-to-person variability than do other drugs. He showed that modern inhaled anesthetics can anesthetize any animal at doses similar to those in humans, that plants and even the most primitive forms of life, blue-green algae, can be anesthetized. No other drug behaves like this. But despite these clues and decades of work, the puzzle of exactly how anesthetics work remains unsolved.
An avid lover of nature, Eger hiked throughout the Sierra Nevada and completed the entire John Muir Trail three times; one of his favorite places was Yosemite’s Half Dome, which he last climbed on his 75th birthday with his entire family. Dr Eger is survived by his wife of 21 years, Dr Lynn Spitler; 4 children, Cris Cadence Waste, Dr Doreen J. Eger, Edmond Eger III, and Dr Renee R. Eger; 2 step-children, Dr Diane Anderson and Paul Spitler; 7 grandchildren, 6 step-grandchildren, and a half-brother, Larry Eger.