History (angela's) Flashcards
What is the definition of anesthesia?
Artificially induced loss of the ability to feel pain (lack of feeling and sensation)
What is general anesthesia?
Drug induced loss of consciousness
Not arousable by painful stimuli
What are the different types/ common areas of regional anesthesia?
Peripheral
Spinal (intrathecal)
Epidural
What is the goal of regional anesthesia?
Insensibility caused by interrupting the sensory nerve conduction of a particular region of the body
What are the 3 depths of sedation?
Minimal
Moderate
Deep
What is expected with minimal sedation?
Anxiolysis
Respond to verbal commands
Airway/ventilation and CV function are unaffected
What is expected with moderate sedation?
Responds to touch or verbal
No airways assistance needed/ spontaneous ventilation is adequate
CV usually maintained
What is expected with deep sedation?
Responds after repeated/painful stimuli
Airway assistance may be needed
Spontaneous ventilation might not be adequate
CV usually maintained
What were some common plants used as early anesthetics?
poppy, coca leaves
What are some of the earliest forms of anesthesia?
Acupuncture
Plants
Cannabis vapor
Ethylene fumes (under apollos temple)
Carotid compression
How was carotid compression used as “anesthesia”?
Interruption of blood supply to brain for temporary forgetfulness of painful stimuli (not very safe)
Which early philosopher valued accommodating the surgeon?
Hippocrates
Who wrote the first pharmacology textbook?
Dioscorides (40-90 AD)
What is the name of the first pharmacology text book and how many volumes was it?
Materia Medica- 5 volumes
How many medical properties did the materia medica contain?
360 medical properties–broken into categories (antiseptic, anti-inflammatory)
Who was responsible for mixing mandragora with wine and what was the outcome?
Dioscorides–mandragora shaped like a human and believed to have hallucinogenic/magical properties
What was used in the middle ages for anesthetic delivery?
Sponges soaked in solutions for inhalation
What elements were mixed to create the solution to soak the sponges?
.5oz opium
Juice of mandrake leaves
Juice of hemlock
3oz hyposcyamus
Water
What role did Hyposcyamus play in the inhalation mixture?
L-isomer of atropine (prevent bradycardia)
What reversal was used if too much solution was inhaled from the sponge?
Vinegar inhalation (similar to ammonia)
What was the first true inhalation anesthetic?
Diethyl ether
Which physician first synthesized Diethyl Ether?
Valerius Cordus in 1540–German botanist and physician
What is ether synthesized from?
sulfuric acid and ethyl alcohol
How did ether get its name?
Ether is greek for “ignite”
highly flammable
Why did volatile anesthetics take off before IV anesthetics?
There wasn’t IV technology at the time of volatile anesthetic development
What were common disadvantages with the use of Ether?
Flammable
Prolonged induction and emergence
Unpleasant odor
High incidence of N/V
Who were the 2 men that discovered means for IV therapy?
Sir Christopher Wren
Robert Boyle
(1650s)
What were the first IV supplies created from?
IV needle–goose quill
IV bag–goose bladder
How did the discussion of drug metabolism start to come about?
Animal testing IV injection of alcohol and discovering that the animal pees it out shortly after
Showed that drugs can infuse into the venous system with effect but dont last forever (metabolism)
Who discovered nitrous oxide?
Joseph Priestly (1773) an English chemist
Who discovered photosynthesis?
Joseph Priestly
Which English chemist discovered potassium, sodium, calcium, and magnesium?
Humphry Davy
Who discovered that a man under the influence of N2O has no recall of pain/injury?
Horace Wells–dentist
What happened in 1845 during an arranged administration of N2O for amputation?
It was thought the N2O wasnt working because the patient was moving
even though it was doing what it was suppose to by giving pain relief and not meant for preventing movement
What was N2O administered with early on in its discovery (up until 1868)?
Air
What issues occurred with giving N2O in combination with air?
Lots of issues with N2O use associated with hypoxia
Who was the first person to give N2O with O2 instead of air?
Andrews–Chicago surgeon
improvement in oxygenation/ no cyanosis
After 1869 _________ was commonly used on the anesthesia machine with any other volatile anesthetic.
Oxygen
First anesthesia machine with nitrous/oxygen:
Hewitt
Why was it hard to prove Ether not successful?
In most studies they were still using whiskey as well
Which dentist preferred using ether for denture fittings?
William Morton
Which physician used Ether (as well as whiskey) for a patient with 2 vascular neck tumors?
Crawford long
When was the first successful public display of ether?
1846
How did the first public demonstration of ether affect its use?
Within 60 days it was in use all over England and America
Where was the successful ether demonstration conducted?
Mass general in an area now called the “ether dome”
Even after the successful demonstration, what was a big issue with ether administration?
Poor inhaler fit with lots of leakage–no good way to see quantity of what is being inhaled or exhaled
prolonged emergence and variable quality
What made ether dosing inconsistent?
Would decide on more or less ether administration by palpating the patients pulse
Who developed a process for pure ether and why was it an upgrade from prior ether?
Dr. Robinson Squibb
Pure ether has the same concentration–consistent every time
Who was the Scottish obstetrician that defined pain as “actual or potential tissue damage”?
Sir James Simpson
Why was there religious opposition with the use of chloroform/anesthetics during childbirth?
Some religious people felt like the pain of childbirth was Gods consequence for Adam/Eves actions
Who discovered epidemiology by tracing London cholera outbreak to water source?
Dr. John Snow (anesthetist in obstetrician care)
Why was there controversy with the use of chloroform?
Reported deaths of healthy patients
What caused chloroform to go out of favor?
Gutherie–discovered delayed hepatotoxicity in kids
Levy–light chloroform anesthesia stimulating adrenaline causing fatal vfib in animal
Who completed the first regional mandibular nerve block with cocaine?
Dr. Halsted
Who developed the Bier Block and what is it?
Dr. August Bier: regional anesthetic by applying tourniquet around the arm then injecting lidocaine to numb just the arm
Who was the first recognized nurse anesthetist?
Sister Mary Bernard 1877
Who is known as the mother of anesthesia?
Alice Magaw
Who founded AANA, opened 1st nurse anesthesia school, taught in France in WWI, and developed N2O techniques?
Agatha Hodgins
Why were nurses the ones to become the first anesthetists?
Low cost
Intelligent
Focus (not like the med students who were more interested in the surgery)
What is the goal when trying to find a newer/better volatile anesthetic?
Fewer side effects
Faster onset
Faster emergence
What are 2 volatile anesthetics that were used before isoflurane?
Cyclopropane
Halothane
What volatile anesthetic replaced halothane?
Isoflurane 1981
safe, not explosive like the others before
less N/V
quicker onset than halothane
Which volatile anesthetic has the most rapid uptake and distribution?
Desflurane (1992)
What is a downside to the use of Desflurane?
Takes a large quantity to achieve anesthesia–expensive
Who discovered end tidal concentration and correlation to movement and also coined the term MAC? What does it stand for?
Edmund Egar
Minimal Alveolar Concentration
Why is Sevoflurane used almost exclusively in kids?
It doesn’t irritate the airway like other volatile anesthetics–good for inhalation induction
What is the most recent inhaled anesthetic discovered?
Sevoflurane–1995 (no new inhaled anesthetics since)
What is the action of Sevoflurane?
Intermediate–between isoflurane and desflurane
What is “the triad” for anesthetics?
Analgesia
Amnesia
Muscle relaxation
want a balanced anesthetic to affect all 3 of these
How is amnesia achieved?
Stimulate inhibitory transmissions
Inhibit stimulatory transmissions
What are the primary neurotransmitters being affected when trying to achieve amnesia?
Acetylcholine (excitatory)
GABA (inhibitory)
What is the main way of achieving analgesia today?
Balance of opioid and non-opioid drugs
(Narcotics, COX inhibs, Gabapentin, tylenol, nerve blocks)
Why were opioids not in favor when they first came out?
High death rate from respiratory depression–initially not a part of the anesthetic plan d/t this
Why are muscle relaxants beneficial to use in anesthesia?
Muscle relaxants decrease amount of anesthesia used and decrease mortality
What is the 4th aspect to balanced anesthesia with amnesia, analgesia, and muscle relaxation?
Homeostasis
Which physician believed that the faster the surgery is done, the better (<20min) and ended up with 3 deaths in one case?
Dr. Liston
What was Harvey Cushing known for?
Regional block to prevent pain response and was big on data collection and documentation of BP and HR
Who practiced local infiltration of procaine to preemptively inhibit pain reflexes?
George Crile
What is neurolept anesthesia?
Using antipsychotics, opioids, nitrous
Block autonomic and endocrine response to stress
high incidence of awareness, dysphoria, extrapyramidal movements
What are the phases of anesthesia?
Preoperative period
Induction of anesthesia
Maintenance of anesthesia
Emergence from anesthesia
Post op period
How many stages of anesthesia are there?
3
What is stage 1 of anesthesia and the 3 planes of this stage?
Beginning of induction of general anesthesia to loss of consciousness–starts with seeing patient in preop
plane 1: no amnesia or analgesia
plane 2: amnestic but only partial analgesic (preop anxiolytic)
plane 3: complete analgesia and amnesia–LOC
What is stage 2 of anesthesia?
Loss of consciousness to onset of automatic breathing
Eyelash reflex disappears Coughing, vomiting, struggling may occur
Irregular respirations with breath holding (risk fo bronchospasm)–want to be quiet and calm
Goal to get through stage 2 as quickly as possible (for going down and emergence)
What is stage 3 of anesthesia and the 4 planes of this stage?
Onset of automatic respiration to respiratory paralysis
plane 1: Automatic respiration to cessation of eyeball movements
plane 2: Cessation of eyeball movements to beginning of intercostal muscle paralysis; secretion of tears increases
plane 3: Beginning of completion of intercostal muscle paralysis, pupils dilate, desired plane prior to muscle relaxants
plane 4: complete intercostal paralysis to diaphragmatic paralysis (apnea)
What stage of anesthesia can surgery begin?
Stage 3
Why do we want to avoid stage 4 anesthesia?
sedation is too deep and could cause death
Which physician did the first spinal anesthetic with cocaine?
Dr. August Bier
Who used cocaine as anesthetic for eye surgery?
Dr. Koller
