Achille Mario Dogliotti was a surgeon–scientist whose work bridged anesthesia, analgesia, general and cardiac surgery, with a focus on integrating neuraxial anesthesia into operative care. He developed segmental epidural (peridural) anesthesia in the early 1930s, injecting local anesthetic into the epidural space to produce targeted, segmental blockade while avoiding many spinal anesthesia risks. He described the loss-of-resistance technique to identify the epidural space and emphasized a tactile sign of correct needle placement, arguing that epidural anesthesia acts extradurally on spinal nerves and dorsal roots with minimal cerebrospinal fluid spread. This work helped convert epidural anesthesia from experimental to standardized practice. Dogliotti also contributed to pain therapy by pioneering chemical neurolysis, including alcoholisation of posterior nerve roots, cranial ganglia, and peripheral nerves for refractory neuralgia. In the late 1940s, he led a cardiothoracic program in Turin and, on August 7, 1951, reported a successful short-term extracorporeal circulation-assisted operation during thoracic tumor resection, illustrating partial, time-limited extracorporeal circulation as a lifesaving measure in acute surgical crises. He promoted a broader, modernized view of epidural anesthesia and integrated surgical physiology with clinical innovation.
Dogliotti was a versatile surgeon-scientist whose work spanned anaesthesia, pain therapy, general and cardiac surgery. Trained as a surgeon, he approached anaesthesia and analgesia as integral components of operative care rather than separate disciplines.
Dogliotti made contributions to neuraxial blockade, particularly through his development of segmental epidural (peridural) anaesthesia in the early 1930s. He demonstrated that controlled, regional blockade could be achieved by injecting local anaesthetic into the epidural space at lumbar or thoracic levels, avoiding many of the haemodynamic and meningeal complications of spinal anaesthesia. His description of the loss-of-resistance technique for identifying the epidural space (“ Dogliotti’s principle ”) transformed epidural anaesthesia into a reproducible and widely adoptable procedure.
Dogliotti was a pioneer of pain therapy, employing chemical neurolysis and alcoholisation of posterior nerve roots and cranial ganglia for refractory neuralgia. From the late 1940s he also emerged as a leader in Italian cardiac surgery, founding a dedicated centre in Turin and, on August 7, 1951, reporting one of the earliest successful human operations using total extracorporeal blood circulation.
Dogliotti was central to the modernisation and international adoption of epidural anaesthesia, transforming it from a variably effective procedure into a reproducible, anatomically grounded technique. His work in the early 1930s consolidated epidural blockade as a distinct neuraxial modality, capable of producing controlled, segmental anaesthesia without entering the subarachnoid space.
Dogliotti described segmental peridural anaesthesia with the injection of local anaesthetic into the epidural space so that it could act on spinal nerves along their course “between the dura mater and the intervertebral canals” . He determined this method would be “an intermediate position between the Corning–Bier method of spinal anesthesia and paravertebral anesthesia” , allowing safe and targeted blockade of selected spinal segments.
With this method one can anesthetize a series of spinal nerves… without danger of diffusion of the anesthetic toward the bulb, of serious fall of blood pressure and without the occurrence of meningeal irritation.
Dogliotti described his method of identifying the epidural space by the loss of resistance encountered as the needle passes through the ligamentum flavum into the epidural space. By applying constant pressure to the syringe plunger during needle advancement, the sudden decrease in resistance provided a reliable physiological sign of correct needle placement. This simple but powerful concept dramatically improved the safety, accuracy, and reproducibility of epidural anaesthesia.
Quando la punta dell’ago supera i legamenti gialli l’iniezione non incontra più alcuna resistenza e dà l’impressione di versarsi nel vuoto.
In his 1933 English-language synthesis, he reiterated the use of the simple tactile sign
As soon as the needle pierces the ligaments and arrives in the peridural space, all resistance is at once removed and the liquid enters with every facility
Through anatomical dissection, cadaveric injection studies, radiological imaging, and clinical observation, Dogliotti demonstrated that epidural anaesthesia acts primarily on the spinal nerves and ganglia extradurally, with “only a very small quantity” of anaesthetic passing into the cerebrospinal fluid. His contributions assisted in the transition of epidural anaesthesia from experimental innovation to standard clinical practice.
From the late 1940s, Dogliotti emerged as a pioneer of cardiothoracic and cardiovascular surgery in Italy. At the University of Turin he established a surgical programme that combined experimental physiology with clinical innovation, particularly in situations of acute cardiopulmonary failure. Unlike many contemporaries pursuing complete cardiac replacement, Dogliotti conceptualised extracorporeal circulation primarily as a form of temporary circulatory assistance, analogous to assisted ventilation rather than total organ substitution.
August 7, 1951 – Dogliotti and Antonio Costantini performed the first documented successful human use of an apparatus for extracorporeal blood circulation . The patient was a 57-year-old man from Turin undergoing thoracotomy for a large mediastinal connective-tissue tumour causing severe compression of the great veins and right heart
After abrupt intraoperative deterioration (profound venous stasis, cyanosis, hypotension and impending cardiopulmonary arrest), they cannulated the left axillary vein (advancing a long cannula toward the superior vena cava) for venous drainage and returned oxygenated blood via the brachial artery, using systemic anticoagulation. Circulatory assistance was maintained for approximately 20 minutes , during which the patient stabilised sufficiently to allow tumour resection. Postoperatively, recovery was uncomplicated, with no biochemical or renal evidence of blood trauma.
Appena iniziata la circolazione artificiale, rapidamente assistemmo ad un rialzo della pressione arteriosa che raggiunse i 110 mm di Hg… la stasi venosa e la cianosi si risolsero rapidamente… le condizioni del malato si stabilizzarono in modo così soddisfacente che ci fu consentita senza altri incidenti l’asportazione di gran parte della massa tumorale. La circolazione artificiale fu mantenuta per circa 20. Dogliotti 1951
As soon as artificial circulation was initiated, we rapidly observed a rise in arterial pressure to 110 mmHg… venous stasis and cyanosis resolved quickly… the patient’s condition stabilised so satisfactorily that removal of the greater part of the tumour could be completed without further incident. Artificial circulation was maintained for approximately 20 minutes. Dogliotti 1951
Dogliotti published this operation as proof that partial, time-limited extracorporeal circulation could be lifesaving in acute surgical crises. He proposed the term “ circolazione assistita ” (assisted circulation) and suggested future applications in pulmonary embolism, acute pulmonary oedema, asphyxia, and acute cardiac failure.
Dogliotti helped formalise pain therapy as a surgical and neuro-anatomical discipline. He pioneered and critically evaluated techniques of chemical neurolysis , including alcoholisation of posterior spinal roots, cranial ganglia, and peripheral nerves in patients with refractory neuralgia.