Exam 1: Introduction Flashcards
What is anesthesia
Lack of feeling/sensation.
Artificially induced loss of ability to feel pain.
What is general anesthesia
Drug-induced loss of consciousness
Patients are not arousable even to painful stimulation with this type of anesthetic
General anesthesia
What is regional anesthesia
Insensibility caused by interrupting the sensory nerve conduction of a particular region of the body.
List the different types of Regional blocks
Peripheral
Spinal
Epidural
How do spinal and epidural blocks differ
Spinal is within the intrathecal space, giving medication where the CSF is.
Epidural is not in the CSF, it is outside the Dura in a potential space
How does regional anesthesia effect the ventilation and level of consciousness
Level of consciousness is unchanged (unless sedatives are used) and ventilators/airway protection maintained
Who wrote Materia Medica
Dioscorides (a general in Nero’s army)
Describe the Mandragora aka mandrake
Hallucinogen, human shaped, magical properties
Who invented IV access and what did they use?
Sir Christopher Wren and Robert Boyle. They used a goose quill to access a dogs vein.
What is the reversal for soporifics
Vinegar. Vinegar is similar to modern day smelling salts.
Diethyl ether “ignite” in Greek was utilized by
Valerius Cordus German botanist.
Ingredients of diethyl ether
Sulfuric acid and ethyl alcohol
Why was diethyl ether used recreationally
It was used recreationally due to whiskey tax of the time.
Who discovered oxygen and nitrous oxide as well as photosynthesis
Joseph Priestly an English chemist
Who suggested NO for surgical pain control
Humphry Davy
Who noticed pt under N2O had no recall of pain/injury
Horace Wells
What is Humphry Davy know to have discovered
Elements such as potassium, calcium, sodium and magnesium
Horace Wells arranged a demonstration of nitrous oxide administration for an amputation. Why was this demonstration unsuccessful
He wanted to show that nitrous oxide was useful for general anesthesia. The observers did not believe it was effective due to the patient being able to move and be aware of events.
What was nitrous originally given with and how did this alter its effects
Nitrous was given with air up until about 1868. It is believed that some of the general anesthetic effect was related to hypoxia
What is Andrews know for
Andrews, a Chicago surgeon, was the first to mix nitrous with oxygen. This led to anesthesia without cyanosis
Hewitt is know for what
Hewitt is know for making the first anesthesia machine with nitrous/oxygen
Crawford Long is known for what
Delivering ether for a patient with 2 vascular neck tumors.
What was the limitation of Crawford Long’s procedure
He used whiskey as well. Difficult to determine if whiskey or ether provides anesthetic effect
Who held 1st public demonstration of ether
William Morton
After the ether demonstration in 1846 how long did it take for ether to be in widespread use in England
60 days
Who developed pure ether
Dr Robinson Squibb
Disadvantage of ether
Flammable, odor, N/V, prolonged induction
Which country discovered chloroform
It was discovered independently in USA, German, Great Britain and France
Sir James Simpson is known for
Defining pain as something that is either causing actual potential tissue damage
Dr John Snow discovered what
Epidemiology by tracing cholera outbreak to water source
Why was chloroform controversial
Chloroform was controversial d/t deaths in healthy patients
What did Hyderabad commissions determine
They determined that hypoxia is was led to apnea
Levy found that light chloroform use led to
Increased adrenaline via SNS stimulation which led to fatal VF in animals.
Dr Koller used what anesthetic for eye surgery
Cocaine
Dr Halsted is known for
Being the 1st to use cocaine for a regional block
Dr August Bier is best known for
Being the first to use cocaine for spinal anesthesia. He also invented the Bier block
First nurse anesthetist
Sister Mary Bernard
Mother of anesthesia
Alice Magaw
Who opened the first nurse anesthesia school and also founded the AANA
Alice Hodgins
Cyclopropane
Violently explosive. Not beneficial to ether.
Halothane drawbacks and upside
Cons: Hepatitis, slow onset.
Pros: caused decent bronchodilation.
Isoflurane was a huge advancement in the field. Why was it so substantial
It is relatively safe/stable. Less N/V. Also has a quicker onset than halothane. Volatile of choice for hearts
Pros of desflurane
Rapid onset/offset
Cons of desflurane
High vapor pressure. Large quantities to achieve anesthesia
Sevoflurane
Intermediate action between iso and desflurane. Unstable in soda lime.
What is included in the triad
Amnesia, don’t want to remember surgery.
Analgesia, don’t want to feel surgery.
Muscle relaxation, ease of doctor to operate.
What is stimulated and inhibited with amnesia
Stimulated: acetylcholine
Inhibit: GABA
Todays analgesics
Narcotics (opioids), COX Inhibitors, Gabapentin (pregabalin), Tylenol, peripheral nerve blocks.
Why was morphine not initially in favor
High death rate d/t resp depression
What is meant by balanced or stress free anesthesia
Homeostasis is included with triad. Decrease stress on body ex. Prevent increases in HR/BP with incision
Who had 3 deaths in one case
Dr Liston
Who used preemptive analgesia in the form of local administration of procaine
George Crile
Who utilized regional blocks prior to emergence from ether?
Harvey Cushing
Besides the timing of his regional blocks what was Dr Harvey Cushing known for
Keeping anesthetic records, BP/HR measurements
What is neurolept anesthesia
Altered brain via opioids, antipsychotics (Haldol, droperidol), nitrous. Blocked autonomic and endocrine response to stress.
Downside to neurolept anesthesia
High incidence of awareness, extrapyramidal movement, dysphoria
Surgical stimulation produced what signs despite lack of movement
Tachycardia, HTN
Meds during preop
BZD, H1/H2 blockers, bronchodilators
Induction meds
Etomidate, ketamine, prop, narcs
Maintenance of anesthesia drugs include
Inhalation drugs, NMB, pressors or blockers
Emergence drugs
NMB reversal, local anesthetics
How many Stages of anesthesia
Ideally 3. Stage 1,2,3. Stage 4 is untoward.
What is defined as stage 1 of anesthesia
Beginning of induction of general anesthesia to LOC
List and describe the three planes of Stage 1
1st plane: no amnesia/analgesia
2nd plane: amnestic but only partially analgesic
3rd plane: complete analgesia and amnesia
Describe stage 2 of anesthesia
Loss of consciousness to onset of automatic breathing
What things might be witnessed in stage 2
Eyelash reflex disappears
Coughing, vomiting, struggling may occur
Irregular respirations with breath holding.
Describe stage 3 of anesthesia
Onset of automatic respiration to respiratory paralysis (surgical plane)
Describe Plane 1 of Stage 3
1st plane: automatic respiration to cessation of eyeball movement.
Describe Plane 2 of Stage 3
2nd plane: cessation of eyeball movement to beginning of intercostal muscle paralysis; secretions of tears increases.
Describe Plane 3 of Stage 3
3rd plane: beginning to completion of intercostal muscle paralysis; pupils dilate; desired plane prior to muscle relaxants.
Describe Plane 4 of Stage 3
4th Plane: complete intercostal paralysis to diaphragmatic paralysis (apnea)
What is Stage 4 of anesthesia
Stoppage of respiration till death
