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2-General Anesthesia Exam 1 > Anesthesia History > Flashcards

Anesthesia History Flashcards

1
Q

What barriers where found to surgical intervention in the early years of the profession?

A

Pain, Infection & Blood Loss

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2
Q

What did ancient practices of anesthesia include?

A

Administration of opium poppy, cocoa leaves, mandrake root, alcohol, and phlebotomy.

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3
Q

How did a Greek philosopher in the 1st century A.D. defined “anesthesia”?

A

as a narcotic like effect caused by the mandrogara root

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4
Q

What was the definition of anesthesia in 1721 England?

A

“anesthesia” was defined as a “defect of sensation”

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5
Q

When was ether first introduced?

A

1540: Chemical structure of Ether introduced

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6
Q

When was nitrous oxide discovered? Who discovered nitrous oxide?

A

1773: N2O discovered by Joseph Priestly

N2O and O2 isolated
CO2 was the first isolated gas

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7
Q

Who was consider the “pioneer of chemistry”?

A

Joseph Priestly

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8
Q

Who discovered the analgesic properties of nitrous oxide? When?

A

1800: Humphrey Davies discovers analgesic properties of N2O

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9
Q

What impact did Humphrey Davies have to early anesthesia?

A

-Davies a student of Priestly’s
-Coined “laughing gas”
-Published the chemistry of N2O – first paragraph about decreasing pain with surgery
(Missed opportunity?)

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10
Q

Who is William E. Clark (Jan. 1842)?

A

Chemist, One obscure note in a medical journal that lacked corroboration

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11
Q

Who is Crawford Long (March 30, 1842)?

A

Surgeon/obstretician and pharmacist, Claimed to perform the first ether anesthetic, although his account was not published until 1848 in the Southern Medical and Surgical Journal

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12
Q

What important anesthesia history occurred in December 10, 1844?

A

Wells and his spouse attended a demonstration of the unique effects of N2O given by Quincy Colton.

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13
Q

What unique effects did Wells observe about nitrous oxide?

A
  • A volunteer sustained a leg laceration without perceiving pain
  • This phenomenon gave Wells the idea of painless dentistry
  • Later his peers claimed that Wells had already experimented with N2O several years previously
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14
Q

Wells takes on _______as a student (both dentists)

A

William Morton

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15
Q

What important anesthesia history occurred in January 1845 with Wells and Morton?

A

Wells (with Morton) attempted public demonstration of a tooth extraction with N20

-Patient groaned and Morton and Wells publically ridiculed

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16
Q

Who identified “Letheon”?

A

Morton contacted surgeon John Collin Warren to say he had “Letheon” for sleep and wanted to demonstrate its merits

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17
Q

What did Morton plan to use Letheon for?

A

An operation on patient Edward Gilbert Abbott at Mass General Hospital. Successful demonstration of Letheon October 16, 1846. Applied for a patent

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18
Q

When was successful demonstration of letheon completed?

A

October 16, 1846

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19
Q

What is the Ether Dome?

A

location of the first recorded public demonstration of ether anesthesia, October 16, 1846 in the Bulfinch Building of the Massachusetts General Hospital, Fruit Street, Boston, MA

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20
Q

Where is the ether monument located?

A

The Ether Monument (1868) in the Boston Public Garden, foot of Malborough & Charles Streets.

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21
Q

What important anesthesia history occurred in November 4, 1847?

A

James Simpson, obstetrician, uses chloroform

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22
Q

Who was another important individual to the field of anesthesia that also used General anesthesia?

A

Oliver Wendell Holmes, Inhalation parties rise in popularity

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23
Q

What are the characteristics of chloroform (trichloromethane) (5)?

A

Chlorination of methane gas (sweet smelling, colorless, nonflammable): halogenated hydrocarbon

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24
Q

When was chloroform first prepared?

A

in 1831 by the American chemist Dr. Samuel Guthrie, who combined whiskey with chlorinated lime in an attempt to produce a cheap pesticide

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25
Q

What was chloroforms use during war time (3)?

A

Crimea and Spanish-American Wars and exclusively in the American Civil War

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26
Q

When did more physicians begin using chloroform?

A

Physicians began using it in civilian practice in the late 1840s and 1850s (both ether and chloroform were being used but chloroform was considered faster and non-flammable)

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27
Q

What is the term sudden sniffer’s death refer to?

A

When administered improperly, chloroform can cause cardiac arrest leading to sudden death

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28
Q

What led to the decrease in popularity of chloroform?

A

Given the concept of rendering someone unconscious was new (and “scary” for most) - the published deaths in medical journals and newspaper led to its decreased popularity in the US

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29
Q

What was ethers first used for?

A

Before used as an anesthetic was used as treatment for ailments such as scurvy or pulmonary inflammation

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30
Q

What are the characteristics of ether (3)?

A

Pleasant-smelling, colorless yet highly flammable liquid (explosive).

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31
Q

Ether was vaporized into a gas that ________ but left patients conscious

A

numbed pain

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32
Q

What is the organic make up of ether?

A

Organic compound containing carbon, hydrogen and oxygen

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33
Q

Why was ether considered safer to use (titrate) then chloroform?

A

Chloroform continued in British system of medicine - deemed too dangerous to be given by anyone than a physician; Ether/N2O predominated in the US

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34
Q

What is consider the basis of modern inhaled anesthetics?

A

Ether, Became the basis of modern inhaled anesthetics - halogenated ethers (halogenation produced less toxicity and flammability)

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35
Q

Who was John Snow (1813-1858) (2)?

A
  • First to describe the states of anesthesia, created the inhaler mask and identified monitored anesthesia care (MAC)
  • Popularizes obstetric anesthesia by chloroform to Queen Victoria for the birth of Prince Leopold (1853) and Princess Beatrice (1857
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36
Q

Who was James Thomas Clover (1825 – 1882)?

A

First to follow vital signs (pulse), developed jaw thrust and cricothyrotomy

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37
Q

Who was Sir Fredrick Hewitt (1857-1916)?

A

Created the airway restorer which secured the upper airway

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38
Q

Who was William Halstead (1852 – 1922)?

A
  • Helped bring aseptic technique to the operating room
  • Sprayed formaldehyde-like substance around to keep the surgery tent clean - caustic
  • Went to Goodyear rubber company to make rubber gloves
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39
Q

History of Regional Block: What influential development was made in 1884 by Carl Koller?

A

Carl Koller, ophthalmologist, uses topical cocaine to localize the eye

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40
Q

History of Regional Block: What influential development was made in 1884 by William Halsted ?

A

administered first nerve block with injectable cocaine

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41
Q

History of Regional Block: What influential development was made in 1898?

A

August Bier administered first spinal (0.5% cocaine, 3ml)

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42
Q

History of Regional Block: What influential development was made in 1908?

A

Caudal block & Bier block developed

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43
Q

History of Regional Block: What influential development was made in 1921?

A

Lumbar epidural performed by Fidel Pages

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44
Q

History of IV agents: What influential development was made in 1805?

A

Morphine isolated (High mortality because of large doses)

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45
Q

What is morphine associated with in early periods of use?

A

High mortality because of large doses

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46
Q

History of IV agents: What influential development was made in 1903?

A

Barbiturates synthesized by Fischer and Von Mering

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47
Q

History of IV agents: What influential development was made in 1932?

A

Pentothal and Demerol synthesized

48
Q

History of IV agents: What influential development was made in 1942?

A

Curare used for intubations and relaxation of abdominal muscles by Griffith and Johnson

49
Q

History of IV agents: What influential development was made in 1949?

A

Succinylcholine used by Bovet

50
Q

History of IV agents: What influential development was made in 1957?

A

Benzodiazepines (E.g. valium)

51
Q

History of IV agents: What influential development was made in 1962?

A

Ketamine

52
Q

History of IV agents: What influential development was made in 1969?

A

Balanced technique of anesthesia

53
Q

History of IV agents: What influential development was made in 1976?

A

Versed

54
Q

What was Oliver Wendell Holmes Sr. definition of anesthesia?

A

to describe the process of making a patient unconscious in order to free them of surgical pain; he based it on the Greek word “anaisthesis,” which means insensibility or loss of sensation

55
Q

Who was anesthesia first delegated to?

A

medical students and residents

56
Q

What did surgeons being to recognize regarding anesthesia in the lat 1800s?

A

high morbidity and mortality related to anesthesia (as much as 50%)

“The surgery was a success, but the patient died.”

57
Q

Who was anesthesia transitioned to and why?

A
  • Surgeons saw nurses as professionals being able to give undivided attention to monitoring the patient
  • Residents more interested in the surgery (how they would make money)
58
Q

Who was Mrs. Harris (Civil War 1861-1865)?

A

Unclear if she was a nurse): administered chloroform and stimulants at Battle of Gettysburg

59
Q

Who was private budlinger (Civil War 1861-1865)?

A

administered chloroform, reapplied by nurses in attendance

60
Q

Who was Catherine S. Lawrence (Civil War 1861-1865)?

A

administered sedatives and chloroform at a hospital outside D.C. during and after the Second Battle of the Bull Run (1863)

61
Q

Who was Sister Mary Bernard? What influential did she have in the history of nurse anesthesia?

A
  • Considered to be the first formally recognized nurse anesthetist
  • Earliest existing records (1877) documenting the anesthetic care of patients by nurses
62
Q

Where was Sister Mary Bernard a nurse anesthetist at?

A

Nurse anesthetist at St. Vincent’s Hospital in Erie, PA

63
Q

Who was Alice Magaw?

A

In 1889 Alice Magaw administered anesthesia for Dr. William Mayo at St. Mary’s Hospital in Rochester, MN

64
Q

What was Alice Magaws nickname? Why did she earn the nickname?

A

Dr. Mayo bestowed upon Magaw the title “Mother of Anesthesia” for her mastery of open drop ether

65
Q

What did Alice Magaw perfect?

A

Perfected the drop/titration method= Credited for her vigilance

66
Q

What impact did Alice Magaw have on the education of anesthesia?

A

Trained doctors and nurses from around the world to administer anesthesia

67
Q

In 1906, a report was published for alice magaw that stated on ______ anesthetics without any complications related to anesthesia.

A

14,000

68
Q

What was the training for anesthetists in 1920?

A

was a one month History of Nurse Anesthetists course in Ohio conducted by E. I. McKesson

69
Q

Who are some nurse anesthetists appointed to medical schools for training of medical students in anesthesia?

A

Agnes McGee & Alice Hunt

70
Q

Who is Agnes McGee?

A

taught 3rd year medical school students at the University of Oregon

71
Q

Who is Alice Hunt?

A

Alice Hunt was appointed instructor in anesthesia at the Yale University School of Medicine in 1922

  • She held this position for over 25 years
  • She authored the 1949 book Anesthesia, Principles and Practice
72
Q

Who was agatha hodgins?

A

Under Crile’s direction she became an expert in the administration of anesthesia and administered 575 anesthetics by 1909

-Perfected nitrous oxide and oxygen anesthetic

73
Q

In 1908 Agatha Hodgins became first anesthetist at University Hospital of Cleveland after being appointed by _________-

A

Dr. George Crile

74
Q

Who founded the present day AANA?

A

Agatha Hodgins

75
Q

What impact did agatha hodgins have in WWI?

A
  • Served in WW I, teaching nurses and doctors to administer anesthesia on the battlefields of France
  • Hodgins served in France from 1914 to 1915, two years prior to America entering the war
76
Q

What did Agatha Hodgins establish? When?

A

In 1915, Agatha Hodgins established the Lakeside Hospital School of Anesthesia in Cleveland, Ohio

77
Q

What was the criteria for the Lakeside Hospital School of Anesthesia (5)?

A
  • Open to graduate nurses, physicians, and dentists
  • Training was 6 months; tuition was $50.00
  • Diploma awarded on completion
  • In its first year it graduated 6 physicians, 2 dentists, and 11 nurses
  • In 1918 a system of clinical affiliations with other Cleveland hospitals was established
78
Q

What impact did nurse anesthetists have during WWI?

A
  • America’s nurse anesthetists were the major providers of care to the troops in France
  • Helped train French and British nurses and physicians in anesthesia care
79
Q

This was the first time, _____, the U.S. military started training nurse anesthetists for service

A

WWI (It is speculated that nurse anesthetist were among the first Americans to serve during WWI)

80
Q

What is the role of CRNAs is many military treatment facilities?

A

CRNAs function as the only licensed independent anesthesia practitioners at many military treatment facilities, including Navy ships at sea

81
Q

_________ are the leading provider of anesthesia for

Veterans Affairs and Public Health medical facilities

A

Nurse anesthetists

82
Q

What is the impact that CRNAs have during wartime?

A
  • During wartime, they are often the primary anesthesia provider at forward positioned medical treatment facilities (like MASH units)
  • Play a key role in the education and training of nurses and technicians in the care of trauma patients
83
Q

CRNAs have provided the majority of anesthesia services in every _________

A

U.S. war during the 20th century

84
Q

Who is Mildred Clark?

A

Second Lieutenant Mildred Clark, who would later become the first nurse anesthetist to serve as Chief of the Army Nurse Corps, provided anesthesia for the wounded in WWII (1941-1945)

85
Q

What change to the CRNA field occurred the 1960s?

A

U.S. Army begins increasing their number of male CRNAs

86
Q

When did the first all male nurse anesthetist class graduate? From where?

A

Walter Reed General Hospital, Washington, D.C., in May 1961

87
Q

What is the Ethernauts?

A

The first all male nurse anesthetist class graduated from Walter Reed General Hospital

88
Q

What continued the trend of man entering into the military as CRNA?

A
  • This trend continued in order to fulfill an overall military need in the escalating Vietnam conflict
  • In 1966 there was a specific military order to draft male nurses to serve in Vietnam.
89
Q

How many nurse anesthetists lost their lives in Vietnam?

A

First Lieutenant Kenneth Shoemaker, Jr., CRNA
First Lieutenant Jerome Olmsted, CRNA

Both were assigned to 67th Evacuation Hospital in Qui Nhon

90
Q

Since WWI nurse anesthetists have been the ________ in combat areas of every war in which the United States has been engaged

A

principal anesthesia providers

91
Q

During the Panama action, only _________were sent with the fighting forces

A

nurse anesthetists

92
Q

What have military nurse anesthetists been awarded with?

A

have been honored and decorated by the U.S. and foreign governments for outstanding achievements, dedication to duty, and competence in treating the seriously wounded

93
Q

Where was the first school of nurse anesthesia formed?

A

in 1909 at St. Vincent Hospital, Portland, Oregon

94
Q

Who established the first school of nurse anesthesia?

A

Established by Agnes McGee

95
Q

What were the characteristics of the first school of nurse anesthesia?

A

Six months in length, Included courses on anatomy and physiology, pharmacology, and administration of common anesthetic agents

96
Q

What happened after the first school of nurse anesthesia?

A

Following this many schools formed

  • Between 1912 and 1920 approximately 19 schools opened
  • All consisted of post-graduate anesthesia training for nurses and were about 6 months in length
97
Q

What occurred in June 17, 1931?

A

The nurse anesthesia specialty was formally organized on June 17, 1931 when the American Association of Nurse Anesthetist held their first meeting

(Precursor was National Association of Nurse Anesthetists)

98
Q

Who organized the first meeting of the American Association of Nurse Anesthetist?

A

Agatha Hodgins organized the event, inviting members from the Alumnae Association of the Lakeside School of Anesthesia and also nurse anesthetist from across the U.S.

99
Q

What was the two main objectives of the first meeting of the American Association of Nurse Anesthetist?

A
  • Establish a national qualifying exam

- Establish an accreditation program for nurse anesthesia schools

100
Q

What is a national qualifying exam?

A

The first national certification exam was held on June 4, 1945, with 90 candidates sitting for the exam

101
Q

What is an accreditation program for nurse anesthesia?

A

On January 19, 1952, a program for the accreditation of nurse anesthesia schools went into effect

102
Q

What was the end decision of Frank V South: 1917 ?

A

Kentucky Court of Appeals rules nurse anesthetists were not practicing medicine

103
Q

What was the end decision of Chalmers & Francis V Nelson: 1934?

A

California Supreme Court affirms the legality of nurse anesthesia practice

104
Q

AANA History: What occurred to the organization in 1944?

A

AANA admits female African American members

105
Q

AANA History: What occurred to the organization in 1945?

A

AANA establishes certification exam

106
Q

AANA History: What occurred to the organization in 1947?

A

AANA admits males as members

107
Q

AANA History: What occurred to the organization in 1952?

A
  • AANA begins to accredit schools of nurse anesthesia and is recognized by the U.S. Department of Education
  • Transferred to Council on Accreditation in 1975 due to Office of Education criteria revisions
108
Q

What was the end decision of Bahn V NME Hospital: 1985?

A
  • U.S. Circuit Court of Appeals ruled CRNAs working with MDs other than Anesthesiologists (Surgeons, Dentists, Podiatrists) can compete with Anesthesiologists
  • Standing to bring about a federal anti–trust suit against hospitals and third party payers
109
Q

What influential impact to the field of nurse anesthetist in 1986?

A
  • Congress passes legislation to provide CRNAs with direct reimbursement from Medicare part B
  • Omnibus Budge Reconciliation Act (OBRA)
  • First non physician group to achieve this reimbursement status
110
Q

What influential impact to the field of nurse anesthetist in 1989?

A

International Federation of Nurse Anesthetists formed in Switzerland

111
Q

What influential impact to the field of nurse anesthetist in 1989 regarding financing?

A

Health Care Financing Administration (CMS) proposed legislation to defer to states on physician supervision ruling

112
Q

What influential impact to the field of nurse anesthetist in 1998?

A

Council on Accreditation mandates nurse anesthesia programs offer graduate level (Masters) education

113
Q

What influential impact to the field of nurse anesthetist in 2001?

A

Supervision rule published in the final days of the Clinton administration

114
Q

What impact did the Bush administration have on the supervision rule?

A

Bush administration postpones this action and in Nov 2001 mandates physician supervision but states/Governors may “opt out”

115
Q

Who became the first state to opt out of physician supervision? When?

A

Dec 12, 2001: Iowa becomes first state to opt out

116
Q

What states shortly followed to opt out of physician supervision (5)?

A

2002: Nebraska, Idaho, Minnesota, New Mexico, and New Hampshire opt out

117
Q

What has research showed regarding mortality and anesthesia provider?

A

2003: Research released showing no association between surgical mortality and type of anesthesia provider

2-General Anesthesia Exam 1 (7 decks)

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