15 Jan 25 History&Evolution of Anesthesia Flashcards
What is the definition of anesthesia?
A lack of feeling or sensation.
What is the primary goal of anesthesia for nurse anesthetists?
The primary goal of anesthesia for nurse anesthetists is to prevent negative outcomes in the performance of surgery or favorable procedures.
This involves ensuring that the patient does not feel pain and remains unconscious or insensible to pain stimuli during the procedure.
What is general anesthesia?
A drug-induced loss of consciousness where patients are not arousable with painful stimuli.
What is regional anesthesia?
Insensibility of pain stimuli in a particular region, such as spinal or epidural anesthetics.
What happens to the level of consciousness during regional anesthesia?
It remains unchanged unless sedation is delivered.
What is sedation and how is it categorized?
Sedation is a spectrum ranging from minimal sedation to deep sedation.
It has different effects on consciousness and respiratory functions
What are the three categories of sedation?
- Minimal sedation
- Moderate sedation
- Deep sedation
What does minimal sedation entail?
A slight decrease in anxiety without affecting responsiveness.
What characterizes moderate sedation?
Responsive to verbal commands and touch, with adequate spontaneous ventilation.
What is deep sedation?
Patients respond to painful stimulation but may need assistance maintaining their airway.
When was the documented use of anesthetics first noted?
As far back as 4000 BC.
What plants were historically used as anesthetics?
- Poppy
- Coca leaves
- Cannabis
Who is considered a key figure in the early development of anesthesia?
Hippocrates.
What was Hippocrates’ perspective on anesthesia?
He focused on the surgeon’s needs rather than the patient’s comfort.
What significant contribution did Dioscorides make to anesthesia?
He categorized plants with medical properties, including the use of mandrake.
What was the first true inhalation anesthetic developed?
Diethyl ether.
Who discovered nitrous oxide?
Joseph Priestley.
What challenges were associated with using ether?
- Flammability
- Prolonged emergence
- Vomiting
Who popularized the use of chloroform in obstetrics?
Sir James Simpson and Dr. John Snow.
What modern anesthetics were introduced in contemporary practice?
- Propane
- Halothane
- Isoflurane
- Sevoflurane
What is balanced anesthesia?
The targeting of amnesia, analgesia, and muscle relaxation.
What are the stages of anesthesia?
- Induction
- Maintenance
- Emergence
- Recovery
Why is it important to understand the patient’s stage of anesthesia?
For safe and effective care.
What is the significance of maintaining homeostasis in modern anesthesia?
To ensure cardiovascular and GI motility.
True or False: The level of consciousness is always affected by regional anesthesia.
False.
Fill in the blank: The first inhalation anesthetic was _______.
[diethyl ether]
What is the humorous implication about God in relation to anesthesia?
That God was the first anesthetist during the creation of Eve.
What magical properties were believed to be associated with the mandrake?
Hallucination and magical properties
The mandrake was thought to have some hallucinogenic effects.
What inhalation methods were used during the Middle Ages?
Sponges, soaps, medications mixed with opium and hemlock
These substances were used in inhalation approaches for their anesthetic effects.
What was the purpose of inhaling vinegar in historical anesthetic practices?
To reverse unconsciousness
This method was used when patients became too deep or unconscious.
Who is credited with the creation of ether, and what was it derived from?
Cortis; made from sulfuric acid and ethyl alcohol
Cortis was a physician and botanist.
First inhaled anesthetic
What is the Greek word for ‘ignite’
Ether
Ether is highly flammable.
What animals were commonly used for testing anesthetic drugs historically?
Chickens and dogs
These animals were used before testing on humans.
Why did volatile anesthetics develop before IV anesthetics?
Lack of IV technology
IV needles and tubing were not available initially.
What invention did Christopher van and Robert Boyle create in the 1650s?
IV needle from a goose quill
They also used a bladder for the IV bag.
What is nitrous oxide commonly known as?
Laughing gas
It has been used for surgical pain control.
Who first discovered nitrous oxide?
Joseph Priestley
He was also credited with discovering oxygen.
What did Horace Wells do in relation to nitrous oxide?
Self-administered nitrous for dental work
He attempted to demonstrate its use for anesthesia in surgery.
What was the significant issue with using nitrous oxide in anesthesia?
Hypoxia due to lack of oxygen
It was unclear whether hypoxia was caused by nitrous or insufficient oxygen.
Who was one of the first to administer nitrous with oxygen?
Andrews, a surgeon
This method helped reduce hypoxia during procedures.
What was one of the main drawbacks of ether as an anesthetic?
Very prolonged emergence and high incidence of vomiting
Ether was known for its sweet smell but caused nausea.
Who was the first to widely use chloroform as an anesthetic?
Sir James Simpson (OB)
His work faced religious opposition regarding its use in childbirth.
What did Sir James Simpson believe about the pain of childbirth?
It could cause actual or potential tissue damage
This belief supported the use of anesthesia during childbirth.
Who was Dr. John Snow, and what was he famous for?
An obstetrician known for using chloroform and discovering the cholera outbreak source
He was associated with Queen Victoria’s childbirth.
Who was Dr. John Snow?
An anesthetist known for using chloroform and for his work in epidemiology, particularly during a cholera outbreak.
He is famous for discovering that cholera was caused by contaminated water.
What anesthetic method was used for Queen Victoria’s childbirth?
Chloroform.
It was administered by Dr. John Snow.
What were some of the issues associated with chloroform in the late 1800s?
Deaths from healthy individuals, fear of anesthetics, and cardiac arrests during administration.
Some patients were more afraid of chloroform than the surgery itself.
What did the commission created in Hyderabad in 1888 investigate?
The safety and implications of chloroform use in anesthesia.
They reviewed cases to determine the risks associated with chloroform.
What was a key finding from the investigations into chloroform use?
Chloroform was safe if administered correctly and monitored properly.
They analyzed numerous cases to conclude that proper ventilation and attention were crucial.
What is a Bier block?
A regional anesthetic procedure involving a tourniquet and lidocaine injection into the arm.
It is used for procedures like carpal tunnel surgery.
Who is considered the first nurse anesthetist?
Sister Mary Bernard in 1877.
Nurses became prominent in anesthesia due to lower costs and a focus on patient care.
What major contribution did Alice Magaw make to anesthesia?
She performed about 14,000 open ether cases without a single death.
She is often referred to as the mother of anesthesia.
What is curare, and why is it significant in anesthesia?
*When was it discovered?
A muscle relaxant discovered from South American hunting practices, used to decrease the amount of anesthetic needed.
*1942
It was purified and adapted for medical use.
What does the triad of anesthesia consist of?
*Actually it’s 4 things
Amnesia, analgesia, and muscle relaxation.
*Homeostasis is 4th component
Modern anesthesia aims to achieve a balance among these three components.
What are some modern concerns in anesthesia practice?
Homeostasis, sympathetic nervous system balance, and immunosuppression.
These concerns have emerged from recent studies on anesthetic effects.
When was isoflurane introduced, and what are its benefits?
Introduced in 1981, it has a quicker onset than halothane and fewer side effects.
Isoflurane is still widely used in modern anesthesia.
True or False: Halothane was used until the late 1990s without any concerns.
False.
Halothane was associated with side effects, such as hepatitis, which led to its decline in use.
Fill in the blank: The anesthetic _______ was developed in 1934 but was quickly withdrawn from the market due to safety concerns.
Cyclopropane.
What is desflurane, and when was it introduced?
A volatile anesthetic introduced in 1995, known for its rapid onset and offset.
It is less irritating to the airway compared to other volatile anesthetics.
What role do opioids play in modern anesthesia?
They provide analgesia but require careful management to avoid overdose and side effects.
Their use has evolved over time to balance benefits and risks.
What is the significance of the term ‘balanced anesthetic’?
It refers to the practice of providing amnesia, analgesia, and muscle relaxation in a controlled manner.
This approach is aimed at improving patient outcomes during surgery.
What is the maximum recommended duration for surgical cases according to Dr. Liston?
20 minutes
Dr. Liston believed that surgeries lasting longer than this had a much higher mortality rate.
What incident is Dr. Liston infamously known for?
Killing three people in the same operation
This occurred due to his extremely fast amputation technique, resulting in fatalities from blood loss and infection. Death occured for the patient and two of Dr. Liston’s assistants.
What technique did Dr. Kreil advocate for in surgery?
Local infiltration of anesthetic
He recognized the benefits of preemptively inhibiting pain reflexes.
What was Dr. Cushing known for in the field of anesthesia?
Data collection
He emphasized the importance of documenting vital signs like blood pressure and heart rate.
What is neurolept anesthesia?
An anesthetic that used predominantly antipsychotics and opioids
It aimed to block the autonomic response to stress but led to problematic side effects.
What shift in anesthesia techniques occurred over the last 20 years?
Focus on multimodal techniques and reduced opioid use
This change was driven by concerns over addiction and side effects from high doses of opioids.
What are the stages of anesthesia?
Three main stages: induction, maintenance, emergence
These stages are altered by pharmacology and individual patient needs.
What characterizes stage one of anesthesia?
Beginning of induction to loss of consciousness
This stage includes the administration of amnestic and analgesic agents.
What happens during stage two of anesthesia?
Loss of consciousness to automatic breathing onset
This stage is characterized by irregular respiration and potential for patient agitation.
What is the primary focus during stage three of anesthesia?
Onset of automatic respiration to respiratory paralysis
This is the surgical plane where the patient is ready for surgery.
What is stage four of anesthesia?
Intercostal paralysis and diaphragmatic paralysis
This stage is too deep and can lead to apnea and death.
Fill in the blank: The first plane of stage one anesthesia is characterized by _______.
analgesia and partial amnesia
True or False: The third stage of anesthesia is where surgery begins.
True
What are the risks associated with stage two of anesthesia?
Aspiration and irregular respirations
Patients may struggle or fight against the mask, leading to complications.
What type of drugs are discussed in relation to the preoperative phase?
Benzodiazepines, H2 blockers, bronchodilators
These medications are used to prepare patients for anesthesia.
