Exam 1 - History of Anesthesia Flashcards
What is the definition of anesthesia?
Lack of feeling or sensation
Artifically induced loss of the ability to feel pain
What is general anesthesia?
Drug-induced loss of conciousness
Patients are not arousable even to painful stimulation
Typically impairs independent ventilatory function requiring support
What is regional anesthesia?
Insensibility caused by interruption of sensory nerve conduction in a region of the body (peripheral, spinal, erpidural)
LOC and venilation are unaffected
What is sedation?
A spectrum of conciousness between “awake” and “unconcious”
Describe the three depths of sedation?
When do some believe was the first anesthetic given?
In the Garden of Eden when God made a deep sleep fall of upon adam when he made Eve from his rib.
What are thought to be some of the earliest forms of anesthesia?
- Plants like poppy and coca leaves
- Ethylene fumes beneathe Apollo’s temple
- Cannabis vapor
- Carotid compression (just made people unconcious temporarily)
What was Hippocrates known for?
Stated it was the patient’s responsibilty to help the operator (keep still)
Who was Diascorides and what was he known for?
- A surgeon in Nero’s army who created the Materia Medica that consisted of 5 volumes of information on medical properties of plants, animal, and mineral products
- Used mandragora (mandrake) and wine to anesthetize. Caused hallucinations and was thought to have magical properties.
What anesthetic was used in the middle ages?
Soporifics: sponges soaked in opium, mandrake, hemlock, and hyposcyamus (isomer of atropine)
Reversed with vinegar (ammonia vapors)
What is the first inhaled anesthetic?
Who discovered it?
- Diethyl ether
- Valerius Cordus, a german botanist and physician, made it from sulfuric acid and ethyl alcohol
Who created IV therapy?
How?
- Sir Christopher Wren and Robert Boyle
- Used a goose quill for a needle and bladder for a IV bag
- They injected alcohol into a dog and described how it made them pee a lot
Who discovered nitrous oxide?
Joseph Priestly
Who discovered many important metals and suggested nitrous for surgical pain control?
Humphry Davy
What is Horace Wells known for?
- He was a dentist who noticed nitrous caused amnesia and analgesia
- He self adminstered nitrous and used it at Mass General during an amputation, but they didn’t like that the patient was still moving.
Who first gave nitrous with oxygen?
Andrews
Who made the first anesthesia machine with oxygen/nitrous?
Hewitt
Who used ether and whisky to remove 2 vascular neck tumors?
Crawford Long
Who used ether for anesthesia during denture fittings?
William Morton
When was the first successful public demonstration of ether?
1846, spread rapidly to England afterwards
Developed the process for pure ether and has a pharmaceutical company named after them?
Dr. Robinson Squibb
What are the disadvantages of using ether?
- Flammable
- Prolonged induction and emergence
- Unpleasant odor
- High incidence of nausea and vomiting
Who discovered chloroform?
Sir James Simpson, obstetrician
What is Dr. John Snow known for?
- He was a full time anesthetist who administered chloroform to queen victoria during birth of her two children.
- Traced London cholera outbreak to a water source
What 2 reasons made chloroform controversial?
- Healthy individuals would die under chloroform
- Religious people of the time believed pain during childbirth should not relieved because it was a consequence of Eve disobeying God in the Garden of Eden
What are the Hyderabad commissions?
Council that deemed chloroform safe as long as respirations were maintained.
Who discovered chloroform caused hepatotoxicity in children?
Guthrie
Who discovered that too light of chloroform released adrenaline and cause fatal VF in animals?
Levy
Who used cocaine as an anesthetic for eye surgery?
Dr. Koller
Who completed the first regional nerve block with cocaine?
Dr. Halsted
Who did the first spinal with cocaine?
Dr. August Bier
Technique called “Bier Block”
Who is the first nurse anesthetist?
Sister Mary Bernard
Who is the mother of anesthesia?
What is she credited for?
- Alice Magaw
- Delivered 14,000 open drop ether cases without death
What is Agatha Hodgins known for?
- Opened one of the first nurse anesthesia schools
- Developed oxygen/nitrous techniques
- Founded the AANA
Describe the inhaled anesthetics cyclopropane, halothane, and isoflurane?
Cyclopropane: violently explosive
Halothane: Caused hepatitis and had slow onset/emergence
Isoflurane: safer, less N/V, quicker onset than halothane but slower that desflurane and sevoflurane
Describe Desflurane?
- Has the most rapid onset and offset
- Takes a large quantity to acheive anesthesia ($$$)
Who correlated EtCO2 to movement and described MAC?
- Edmund Egar
Describe Sevoflurane?
- Intermediate action between isoflurane and desflurane
- Last new inhaled anesthetic
- Non-irritating to airways
What is the anesthesia triad?
Amnesia, Analgesia, and Muscle Relaxation
How is amnesia acheived?
Stimulating inhibitory transmission or Inhibiting stimulatory transmissions via GABA and ACh
What is the first musle relaxant?
How did it affect anesthesia?
Curare
Decreased the amount of anesthetic needed and decreased mortality
What is balanced or stress free anesthesia?
- Muscle relaxation
- Amnesia
- Homeostasis
- Analgesia
Who is known for killing 3 people from one operation?
Dr. Liston
Who attempted anesthetic balance by using light nitrous and oxygen and using local infilatration of procaine?
George Crile
Who placed regional blocks prior to emergence from ether and kept detailed scientific anesthetic records?
Harvey Cushing
What are the phases of anesthesia?
Preop
Induction
Maintenance
Emergence
Postop
What is neuroplept anesthesia?
Using opioids, antipsychotics, and nitrous to induce anesthesia
Caused high incidence of awareness and dysphoria
What is stage I of anesthesia and the 3 planes?
Beginning of induction of anesthesia to loss of conciousness
* 1st plane: no amnesia or analgesia
* 2nd plane: amnestic but only partially analgesic (versed/fentanyl)
* 3rd plane: complete analgesia and amnesia
What is stage II of anesthesia?
What is this stage dangerous?
Loss of conciousness to onset of automatic breathing (ANS takes over)
* Eyelash reflex disappears
* Coughing, vomiting, and struggling may occur (risk of aspiration, bradycardia, and bronchospasm)
*Need to get through this stage as quickly as possible
What is stage 3 of anestheisa and the 4 planes?
What plane is desired prior to administering NMB?
Onset of automatic breathing to respiratory paralysis (surgical plane)
* 1st plane: automatic respiration to cessation of eyeball movements
* 2nd plane: cessation of eyeball movements to beginning of intercostal muscle paralysis; secretion of tears increases
* 3rd plane: beginning to completion of intercostal muscle paralysis; pupils dilate; desired plane prior to muscle paralysis (think 3 and 3)
* 4th plane: comple intercostal muscle paralysis to diphragmatic paralysis (apnea)
What is stage 4 of anesthesia?
Apnea until death… not desirable obviously
