Anesthesia History Flashcards
What barriers where found to surgical intervention in the early years of the profession?
Pain, Infection & Blood Loss
What did ancient practices of anesthesia include?
Administration of opium poppy, cocoa leaves, mandrake root, alcohol, and phlebotomy.
How did a Greek philosopher in the 1st century A.D. defined “anesthesia”?
as a narcotic like effect caused by the mandrogara root
What was the definition of anesthesia in 1721 England?
“anesthesia” was defined as a “defect of sensation”
When was ether first introduced?
1540: Chemical structure of Ether introduced
When was nitrous oxide discovered? Who discovered nitrous oxide?
1773: N2O discovered by Joseph Priestly
N2O and O2 isolated
CO2 was the first isolated gas
Who was consider the “pioneer of chemistry”?
Joseph Priestly
Who discovered the analgesic properties of nitrous oxide? When?
1800: Humphrey Davies discovers analgesic properties of N2O
What impact did Humphrey Davies have to early anesthesia?
-Davies a student of Priestly’s
-Coined “laughing gas”
-Published the chemistry of N2O – first paragraph about decreasing pain with surgery
(Missed opportunity?)
Who is William E. Clark (Jan. 1842)?
Chemist, One obscure note in a medical journal that lacked corroboration
Who is Crawford Long (March 30, 1842)?
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
What important anesthesia history occurred in December 10, 1844?
Wells and his spouse attended a demonstration of the unique effects of N2O given by Quincy Colton.
What unique effects did Wells observe about nitrous oxide?
- 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
Wells takes on _______as a student (both dentists)
William Morton
What important anesthesia history occurred in January 1845 with Wells and Morton?
Wells (with Morton) attempted public demonstration of a tooth extraction with N20
-Patient groaned and Morton and Wells publically ridiculed
Who identified “Letheon”?
Morton contacted surgeon John Collin Warren to say he had “Letheon” for sleep and wanted to demonstrate its merits
What did Morton plan to use Letheon for?
An operation on patient Edward Gilbert Abbott at Mass General Hospital. Successful demonstration of Letheon October 16, 1846. Applied for a patent
When was successful demonstration of letheon completed?
October 16, 1846
What is the Ether Dome?
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
Where is the ether monument located?
The Ether Monument (1868) in the Boston Public Garden, foot of Malborough & Charles Streets.
What important anesthesia history occurred in November 4, 1847?
James Simpson, obstetrician, uses chloroform
Who was another important individual to the field of anesthesia that also used General anesthesia?
Oliver Wendell Holmes, Inhalation parties rise in popularity
What are the characteristics of chloroform (trichloromethane) (5)?
Chlorination of methane gas (sweet smelling, colorless, nonflammable): halogenated hydrocarbon
When was chloroform first prepared?
in 1831 by the American chemist Dr. Samuel Guthrie, who combined whiskey with chlorinated lime in an attempt to produce a cheap pesticide
What was chloroforms use during war time (3)?
Crimea and Spanish-American Wars and exclusively in the American Civil War
When did more physicians begin using chloroform?
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)
What is the term sudden sniffer’s death refer to?
When administered improperly, chloroform can cause cardiac arrest leading to sudden death
What led to the decrease in popularity of chloroform?
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
What was ethers first used for?
Before used as an anesthetic was used as treatment for ailments such as scurvy or pulmonary inflammation
What are the characteristics of ether (3)?
Pleasant-smelling, colorless yet highly flammable liquid (explosive).
Ether was vaporized into a gas that ________ but left patients conscious
numbed pain
What is the organic make up of ether?
Organic compound containing carbon, hydrogen and oxygen
Why was ether considered safer to use (titrate) then chloroform?
Chloroform continued in British system of medicine - deemed too dangerous to be given by anyone than a physician; Ether/N2O predominated in the US
What is consider the basis of modern inhaled anesthetics?
Ether, Became the basis of modern inhaled anesthetics - halogenated ethers (halogenation produced less toxicity and flammability)
Who was John Snow (1813-1858) (2)?
- 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
Who was James Thomas Clover (1825 – 1882)?
First to follow vital signs (pulse), developed jaw thrust and cricothyrotomy
Who was Sir Fredrick Hewitt (1857-1916)?
Created the airway restorer which secured the upper airway
Who was William Halstead (1852 – 1922)?
- 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
History of Regional Block: What influential development was made in 1884 by Carl Koller?
Carl Koller, ophthalmologist, uses topical cocaine to localize the eye
History of Regional Block: What influential development was made in 1884 by William Halsted ?
administered first nerve block with injectable cocaine
History of Regional Block: What influential development was made in 1898?
August Bier administered first spinal (0.5% cocaine, 3ml)
History of Regional Block: What influential development was made in 1908?
Caudal block & Bier block developed
History of Regional Block: What influential development was made in 1921?
Lumbar epidural performed by Fidel Pages
History of IV agents: What influential development was made in 1805?
Morphine isolated (High mortality because of large doses)
What is morphine associated with in early periods of use?
High mortality because of large doses
History of IV agents: What influential development was made in 1903?
Barbiturates synthesized by Fischer and Von Mering
History of IV agents: What influential development was made in 1932?
Pentothal and Demerol synthesized
History of IV agents: What influential development was made in 1942?
Curare used for intubations and relaxation of abdominal muscles by Griffith and Johnson
History of IV agents: What influential development was made in 1949?
Succinylcholine used by Bovet
History of IV agents: What influential development was made in 1957?
Benzodiazepines (E.g. valium)
History of IV agents: What influential development was made in 1962?
Ketamine
History of IV agents: What influential development was made in 1969?
Balanced technique of anesthesia
History of IV agents: What influential development was made in 1976?
Versed
What was Oliver Wendell Holmes Sr. definition of anesthesia?
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
Who was anesthesia first delegated to?
medical students and residents
What did surgeons being to recognize regarding anesthesia in the lat 1800s?
high morbidity and mortality related to anesthesia (as much as 50%)
“The surgery was a success, but the patient died.”
Who was anesthesia transitioned to and why?
- 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)
Who was Mrs. Harris (Civil War 1861-1865)?
Unclear if she was a nurse): administered chloroform and stimulants at Battle of Gettysburg
Who was private budlinger (Civil War 1861-1865)?
administered chloroform, reapplied by nurses in attendance
Who was Catherine S. Lawrence (Civil War 1861-1865)?
administered sedatives and chloroform at a hospital outside D.C. during and after the Second Battle of the Bull Run (1863)
Who was Sister Mary Bernard? What influential did she have in the history of nurse anesthesia?
- Considered to be the first formally recognized nurse anesthetist
- Earliest existing records (1877) documenting the anesthetic care of patients by nurses
Where was Sister Mary Bernard a nurse anesthetist at?
Nurse anesthetist at St. Vincent’s Hospital in Erie, PA
Who was Alice Magaw?
In 1889 Alice Magaw administered anesthesia for Dr. William Mayo at St. Mary’s Hospital in Rochester, MN
What was Alice Magaws nickname? Why did she earn the nickname?
Dr. Mayo bestowed upon Magaw the title “Mother of Anesthesia” for her mastery of open drop ether
What did Alice Magaw perfect?
Perfected the drop/titration method= Credited for her vigilance
What impact did Alice Magaw have on the education of anesthesia?
Trained doctors and nurses from around the world to administer anesthesia
In 1906, a report was published for alice magaw that stated on ______ anesthetics without any complications related to anesthesia.
14,000
What was the training for anesthetists in 1920?
was a one month History of Nurse Anesthetists course in Ohio conducted by E. I. McKesson
Who are some nurse anesthetists appointed to medical schools for training of medical students in anesthesia?
Agnes McGee & Alice Hunt
Who is Agnes McGee?
taught 3rd year medical school students at the University of Oregon
Who is Alice Hunt?
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
Who was agatha hodgins?
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
In 1908 Agatha Hodgins became first anesthetist at University Hospital of Cleveland after being appointed by _________-
Dr. George Crile
Who founded the present day AANA?
Agatha Hodgins
What impact did agatha hodgins have in WWI?
- 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
What did Agatha Hodgins establish? When?
In 1915, Agatha Hodgins established the Lakeside Hospital School of Anesthesia in Cleveland, Ohio
What was the criteria for the Lakeside Hospital School of Anesthesia (5)?
- 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
What impact did nurse anesthetists have during WWI?
- 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
This was the first time, _____, the U.S. military started training nurse anesthetists for service
WWI (It is speculated that nurse anesthetist were among the first Americans to serve during WWI)
What is the role of CRNAs is many military treatment facilities?
CRNAs function as the only licensed independent anesthesia practitioners at many military treatment facilities, including Navy ships at sea
_________ are the leading provider of anesthesia for
Veterans Affairs and Public Health medical facilities
Nurse anesthetists
What is the impact that CRNAs have during wartime?
- 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
CRNAs have provided the majority of anesthesia services in every _________
U.S. war during the 20th century
Who is Mildred Clark?
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)
What change to the CRNA field occurred the 1960s?
U.S. Army begins increasing their number of male CRNAs
When did the first all male nurse anesthetist class graduate? From where?
Walter Reed General Hospital, Washington, D.C., in May 1961
What is the Ethernauts?
The first all male nurse anesthetist class graduated from Walter Reed General Hospital
What continued the trend of man entering into the military as CRNA?
- 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.
How many nurse anesthetists lost their lives in Vietnam?
First Lieutenant Kenneth Shoemaker, Jr., CRNA
First Lieutenant Jerome Olmsted, CRNA
Both were assigned to 67th Evacuation Hospital in Qui Nhon
Since WWI nurse anesthetists have been the ________ in combat areas of every war in which the United States has been engaged
principal anesthesia providers
During the Panama action, only _________were sent with the fighting forces
nurse anesthetists
What have military nurse anesthetists been awarded with?
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
Where was the first school of nurse anesthesia formed?
in 1909 at St. Vincent Hospital, Portland, Oregon
Who established the first school of nurse anesthesia?
Established by Agnes McGee
What were the characteristics of the first school of nurse anesthesia?
Six months in length, Included courses on anatomy and physiology, pharmacology, and administration of common anesthetic agents
What happened after the first school of nurse anesthesia?
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
What occurred in June 17, 1931?
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)
Who organized the first meeting of the American Association of Nurse Anesthetist?
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.
What was the two main objectives of the first meeting of the American Association of Nurse Anesthetist?
- Establish a national qualifying exam
- Establish an accreditation program for nurse anesthesia schools
What is a national qualifying exam?
The first national certification exam was held on June 4, 1945, with 90 candidates sitting for the exam
What is an accreditation program for nurse anesthesia?
On January 19, 1952, a program for the accreditation of nurse anesthesia schools went into effect
What was the end decision of Frank V South: 1917 ?
Kentucky Court of Appeals rules nurse anesthetists were not practicing medicine
What was the end decision of Chalmers & Francis V Nelson: 1934?
California Supreme Court affirms the legality of nurse anesthesia practice
AANA History: What occurred to the organization in 1944?
AANA admits female African American members
AANA History: What occurred to the organization in 1945?
AANA establishes certification exam
AANA History: What occurred to the organization in 1947?
AANA admits males as members
AANA History: What occurred to the organization in 1952?
- 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
What was the end decision of Bahn V NME Hospital: 1985?
- 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
What influential impact to the field of nurse anesthetist in 1986?
- 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
What influential impact to the field of nurse anesthetist in 1989?
International Federation of Nurse Anesthetists formed in Switzerland
What influential impact to the field of nurse anesthetist in 1989 regarding financing?
Health Care Financing Administration (CMS) proposed legislation to defer to states on physician supervision ruling
What influential impact to the field of nurse anesthetist in 1998?
Council on Accreditation mandates nurse anesthesia programs offer graduate level (Masters) education
What influential impact to the field of nurse anesthetist in 2001?
Supervision rule published in the final days of the Clinton administration
What impact did the Bush administration have on the supervision rule?
Bush administration postpones this action and in Nov 2001 mandates physician supervision but states/Governors may “opt out”
Who became the first state to opt out of physician supervision? When?
Dec 12, 2001: Iowa becomes first state to opt out
What states shortly followed to opt out of physician supervision (5)?
2002: Nebraska, Idaho, Minnesota, New Mexico, and New Hampshire opt out
What has research showed regarding mortality and anesthesia provider?
2003: Research released showing no association between surgical mortality and type of anesthesia provider
