History of Anesthesia Flashcards
Define anesthesia
Lack of feeling or sensation
Artificially induced loss of the ability to feel pain
To permit the performance of surgery or painful procedures
Define general anesthesia
A drug-induced loss of consciousness. Patients are not arousable; even by painful stimulation
T/F: The term General anesthesia insinuates intubation and mechanical ventilation is necessary
False
Considerations for general anesthesia
Maintain patent airway
Positive pressure ventilation
Cardiovascular support
Define regional anesthesia
Insensibility caused by interrupting the sensory nerve conduction of a particular region of the body (Peripheral, Spinal, Epidural)
Level of consciousness during regional anesthesia
unchanged; Ventilatory/airway protection is maintained
Define sedation
A spectrum of consciousness between “awake” and “unconscious”
Describe RASC during minimal sedation
responsiveness: to verbal commands
airway: unaffected
spontaneous vent: unaffected
Cardio fx: unaffected
Describe RASC during moderate sedation
responsiveness: to verbal/touch
airway: no assistance needed
spontaneous vent: adequate
Cardio fx: usually maintained
Describe RASC during deep sedation
responsiveness: after repeated touch/stimulation
airway: assistance may be required
spontaneous vent: poss inadequate
Cardio fx: usually maintained
First ever forms of anesthesia
Plants…poppy, coca leaves
Acupuncture
Ethylene fumes from geologic fault lines beneath Apollo’s temple
Cannabis vapor
Carotid compression
Beliefs of hippocrates
Accommodate the operator
Avoid sinking down and turning away
Who was Dioscorides?
Wrote the first pharmacology book; Materia Medica
Describe the Materia Medica
Authoritative for 15 centuries
5 volumes; plants, animal and mineral products
360 medical properties (antiseptic, anti-inflammatory)
Features of mandragora and wine
Hallucinogenic
Human shaped
Magical properties
What was used in the middle ages as an anesthetic? Reversal?
Soporifics….sponges
½ ounce opium
Juice of mandrake leaves
Juice of hemlock
3 ounces of hyposcyamus (L-isomer of atropine)
Sufficient water
Reversal: vinegar
Who discovered diethyl ether?
Valerius Cordus
Describe diethyl ether
Made from sulfuric acid and ethyl alcohol
Tested on chickens
What does ether mean?
greek for “ignite”
T/F: Ether was used recreactionally
true
Why were inhalation agents used as the first anesthetics?
No IV technology
Who were Sir Christopher Wren and Robert Boyle?
Created IV therapy using a goose quill
Administered alcohol into a dog’s vein
Who discovered NO? What was his occupation? Any other discoveries?
Joseph Priestly
English chemist; oxygen and photosynthesis
Who was Humphry Davy? occupation?
Chemist; Discovered potassium, sodium, calcium, magnesium….
He suggested NO for surgical pain control but it did not take off
Who first noticed amnesia properties of NO? occupation?
Horace Wells ; Dentist
Noticed that a man under the influence of N2O had no recall of pain/injury
Self administered for tooth extraction and uses on several dental patients
Why was use of NO for an amputation at Mass Gen in 1845 not impressive at the time?
The patient moved alot
Until what point was anesthesia administered with air? then it was administered with
1868; oxygen
Who was the first surgeon to administer NO without cyanosis?
Andrews
Who used the 1st anesthesia machine with nitrous/oxygen
Hewitt
Who was Crawford Long?
Delivered ether for a patient with 2 vascular neck tumors
Who was the dentist that used ether for a denture fitting?
William Morton
What year was the 1st successful public demonstration of ether? Where did it take place?
1846; Mass Gen Ether Dome
Why was the 1st successful public demonstration of ether considered “lucky”?
poor inhaler fit, no IV access, prolonged emergence, variable quality
What were Dr. Robinson Squibb’s contributions?
Developed process for pure ether (1856)
Founded Squibb pharmaceuticals….leading manufacturer
Disadvantages of ether
Flammable
Prolonged induction
Unpleasant, persistent odor
High incidence of nausea/vomiting
What year was choloform discovered?
1831
who Defined pain: “actual or potential tissue damage”?
Sir James Simpson
An OB that experimented with chloroform following a dinner party
Sir James Simpson
Who was Dr. John Snow?
Full time anesthetist; “discovered” epidemiology when he traced London cholera outbreak to water source; delivered Queen Victoria’s babies with choroform
Why was there controversy with chloroform?
cardiac deaths to. healthy individuals
The country Hyderabad studied almost 600 cases of what anesthetic and what did they conclude?
Chloroform; that its safe if given correctly, in smaller doses and if the patient is monitored for changes
When did chloroform fall out of favor and why?
about 1900; delayed hepatotoxicity in children and discovery of fatal vf in animals
3 physicians that used cocaine as an anesthetic?
Dr. Koller (eye surgery)
Dr. Halsted (regional mandibular nerve block)
Dr. August Bier (spinal anesthetic)
1st nurse anesthetist
Sister Mary Bernard
Why were nurses ideal as anesthetists?
Low pay
Intelligent
Focus
Who was the mother of anesthesia? what was she known for?
Alice Magaw; 14,000 open drop ether cases without death
Who was Agatha Hodgins ?
Opened one of 1st nurse anesthesia schools
Taught in France
Developed nitrous/oxygen techniques
Founded AANA
Name and years of “recent” anesthetics?
cyclopropane 1934
halothane 1956
isoflurane 1981
desflurane 1992
sevoflurane 1995
issue with cyclopropane?
Violently explosive
issues with halothane
Hepatitis
Slow onset
Discovery of isoflurane benefits?
Relatively safe
Less nausea and vomiting
Quicker onset than halothane
Describe desflurane
Rapid uptake and distribution! (most rapid onset and offset)
High vapor pressure
Large quantity to achieve anesthesia
What did Edmund Egar discover?
End-tidal concentration correlated to movement….MAC
Describe sevoflurane
Intermediate action between isoflurane and desflurane
Unstable in soda lime; toxic degradation product concerns
No new inhaled anesthetics since
What is the triad of anesthesia?
amnesia
analgesia
muscle relaxation
What causes amnesia?
Either Stimulation of inhibitory transmissions or Inhibiton of stimulatory transmissions
(usally Ach and GABA)
What year was morphine first used
1805 from opium
Why were opiates initially not in favor?
high death rate
Today’s analgesics?
Narcotics (opioids)
Cyclooxygenase inhibitors
Gabapentin (pregabalin)
Acetaminophen
Peripheral nerve blocks
First muscle relaxant
Curare in 1942
Why was there decreased mortality with use of muscle relaxants?
Decreased amount of anesthesia due to relaxation
Balanced anesthesia components?
amnesia
analgesia
muscle relaxation
homeostasis
Who was Dr. Liston?
Believed surgical cases needed to be 20 min and less.
Had 3 deaths from one amputation operation
Who was George Crile?
Cleveland clinic
Light nitrous/oxygen anesthesia
Local infiltration of procaine
Who was Harvey Cushing?
Regional blocks prior to emergence from ether
Anesthetic records, BP/HR measurements
What was neurolept anesthesia in 1959 and what were the issues?
Opioids, antipsychotics (Haldol, droperidol), nitrous
Blocked autonomic and endocrine response to stress
High incidence of awareness, dysphoria, extrapyramidal movements
Describe anesthesia in the 1980s
- surgical stimulation produced despite lack of movement
- Tachycardia
- Hypertension
- Insignificant? Except with CAD…. beta blockade
- High dose opioid technique
What is the problem with the high dose opiod technique?
Pt takes a long time to wake up
What changes to anesthesia in the 2000s?
Opioid sparing techniques
“multi modal” techniques
What are the phases of anesthesia?
- Preop period
- Induction of anesthesia
- Maintenance of anesthesia
- Emergence from anesthesia
- Post op period
Meds given during preop period
BZD, H1 and H2 blockers, bronchodilators
Meds given during induction period
Etomidate, ketamine, propofol, narcotics
Meds given during maintenance phase
Inhalation drugs, neuromuscular blockers, pressors, blockers
Meds given during emergence phase
NMB reversal, local anesthetics
What is stage 1 of anesthesia? Planes?
beginning of induction of general anesthesia to loss of consciousness
-1st plane: no amnesia or analgesia
-2nd plane: amnestic but only partially analgesic
-3rd plane: complete analgesia and amnesia
What is Stage II of anesthesia? characteristics? Patient is at high risk of what during this stage?
loss of consciousness to onset of automatic breathing
- eyelash reflex disappears
-coughing, vomiting, struggling may occur
-irregular respirations with breath-holding
High risk of aspiration
What stage should the patient move quickest in and out of?
stage II
What is stage III of anesthesia? Planes?
onset of automatic respiration to respiratory paralysis (surgical plane)
4 planes of Stage III of anesthesia?
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 relaxants
4th plane: complete intercostal paralysis to diaphragmatic paralysis (apnea)
What is stage 4 of anesthesia?
stoppage of respiration till death
