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Eric Anesthesia Pharm 2025 > History of Anesthesia > Flashcards

History of Anesthesia Flashcards

1
Q

Define anesthesia

A

Lack of feeling or sensation
Artificially induced loss of the ability to feel pain
To permit the performance of surgery or painful procedures

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2
Q

Define general anesthesia

A

A drug-induced loss of consciousness. Patients are not arousable; even by painful stimulation

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3
Q

T/F: The term General anesthesia insinuates intubation and mechanical ventilation is necessary

A

False

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4
Q

Considerations for general anesthesia

A

Maintain patent airway
Positive pressure ventilation
Cardiovascular support

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5
Q

Define regional anesthesia

A

Insensibility caused by interrupting the sensory nerve conduction of a particular region of the body (Peripheral, Spinal, Epidural)

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6
Q

Level of consciousness during regional anesthesia

A

unchanged; Ventilatory/airway protection is maintained

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7
Q

Define sedation

A

A spectrum of consciousness between “awake” and “unconscious”

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8
Q

Describe RASC during minimal sedation

A

responsiveness: to verbal commands
airway: unaffected
spontaneous vent: unaffected
Cardio fx: unaffected

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9
Q

Describe RASC during moderate sedation

A

responsiveness: to verbal/touch
airway: no assistance needed
spontaneous vent: adequate
Cardio fx: usually maintained

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10
Q

Describe RASC during deep sedation

A

responsiveness: after repeated touch/stimulation
airway: assistance may be required
spontaneous vent: poss inadequate
Cardio fx: usually maintained

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11
Q

First ever forms of anesthesia

A

Plants…poppy, coca leaves
Acupuncture
Ethylene fumes from geologic fault lines beneath Apollo’s temple
Cannabis vapor
Carotid compression

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12
Q

Beliefs of hippocrates

A

Accommodate the operator
Avoid sinking down and turning away

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13
Q

Who was Dioscorides?

A

Wrote the first pharmacology book; Materia Medica

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14
Q

Describe the Materia Medica

A

Authoritative for 15 centuries
5 volumes; plants, animal and mineral products
360 medical properties (antiseptic, anti-inflammatory)

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15
Q

Features of mandragora and wine

A

Hallucinogenic
Human shaped
Magical properties

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16
Q

What was used in the middle ages as an anesthetic? Reversal?

A

Soporifics….sponges
½ ounce opium
Juice of mandrake leaves
Juice of hemlock
3 ounces of hyposcyamus (L-isomer of atropine)
Sufficient water

Reversal: vinegar

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17
Q

Who discovered diethyl ether?

A

Valerius Cordus

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18
Q

Describe diethyl ether

A

Made from sulfuric acid and ethyl alcohol
Tested on chickens

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19
Q

What does ether mean?

A

greek for “ignite”

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20
Q

T/F: Ether was used recreactionally

A

true

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21
Q

Why were inhalation agents used as the first anesthetics?

A

No IV technology

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22
Q

Who were Sir Christopher Wren and Robert Boyle?

A

Created IV therapy using a goose quill
Administered alcohol into a dog’s vein

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23
Q

Who discovered NO? What was his occupation? Any other discoveries?

A

Joseph Priestly
English chemist; oxygen and photosynthesis

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24
Q

Who was Humphry Davy? occupation?

A

Chemist; Discovered potassium, sodium, calcium, magnesium….
He suggested NO for surgical pain control but it did not take off

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25
Q

Who first noticed amnesia properties of NO? occupation?

A

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

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26
Q

Why was use of NO for an amputation at Mass Gen in 1845 not impressive at the time?

A

The patient moved alot

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27
Q

Until what point was anesthesia administered with air? then it was administered with

A

1868; oxygen

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28
Q

Who was the first surgeon to administer NO without cyanosis?

A

Andrews

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29
Q

Who used the 1st anesthesia machine with nitrous/oxygen

A

Hewitt

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30
Q

Who was Crawford Long?

A

Delivered ether for a patient with 2 vascular neck tumors

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31
Q

Who was the dentist that used ether for a denture fitting?

A

William Morton

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32
Q

What year was the 1st successful public demonstration of ether? Where did it take place?

A

1846; Mass Gen Ether Dome

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33
Q

Why was the 1st successful public demonstration of ether considered “lucky”?

A

poor inhaler fit, no IV access, prolonged emergence, variable quality

34
Q

What were Dr. Robinson Squibb’s contributions?

A

Developed process for pure ether (1856)
Founded Squibb pharmaceuticals….leading manufacturer

35
Q

Disadvantages of ether

A

Flammable
Prolonged induction
Unpleasant, persistent odor
High incidence of nausea/vomiting

36
Q

What year was choloform discovered?

A

1831

37
Q

who Defined pain: “actual or potential tissue damage”?

A

Sir James Simpson

38
Q

An OB that experimented with chloroform following a dinner party

A

Sir James Simpson

39
Q

Who was Dr. John Snow?

A

Full time anesthetist; “discovered” epidemiology when he traced London cholera outbreak to water source; delivered Queen Victoria’s babies with choroform

40
Q

Why was there controversy with chloroform?

A

cardiac deaths to. healthy individuals

41
Q

The country Hyderabad studied almost 600 cases of what anesthetic and what did they conclude?

A

Chloroform; that its safe if given correctly, in smaller doses and if the patient is monitored for changes

42
Q

When did chloroform fall out of favor and why?

A

about 1900; delayed hepatotoxicity in children and discovery of fatal vf in animals

43
Q

3 physicians that used cocaine as an anesthetic?

A

Dr. Koller (eye surgery)
Dr. Halsted (regional mandibular nerve block)
Dr. August Bier (spinal anesthetic)

44
Q

1st nurse anesthetist

A

Sister Mary Bernard

45
Q

Why were nurses ideal as anesthetists?

A

Low pay
Intelligent
Focus

46
Q

Who was the mother of anesthesia? what was she known for?

A

Alice Magaw; 14,000 open drop ether cases without death

47
Q

Who was Agatha Hodgins ?

A

Opened one of 1st nurse anesthesia schools
Taught in France
Developed nitrous/oxygen techniques
Founded AANA

48
Q

Name and years of “recent” anesthetics?

A

cyclopropane 1934
halothane 1956
isoflurane 1981
desflurane 1992
sevoflurane 1995

49
Q

issue with cyclopropane?

A

Violently explosive

50
Q

issues with halothane

A

Hepatitis
Slow onset

51
Q

Discovery of isoflurane benefits?

A

Relatively safe
Less nausea and vomiting
Quicker onset than halothane

52
Q

Describe desflurane

A

Rapid uptake and distribution! (most rapid onset and offset)
High vapor pressure
Large quantity to achieve anesthesia

53
Q

What did Edmund Egar discover?

A

End-tidal concentration correlated to movement….MAC

54
Q

Describe sevoflurane

A

Intermediate action between isoflurane and desflurane
Unstable in soda lime; toxic degradation product concerns
No new inhaled anesthetics since

55
Q

What is the triad of anesthesia?

A

amnesia
analgesia
muscle relaxation

56
Q

What causes amnesia?

A

Either Stimulation of inhibitory transmissions or Inhibiton of stimulatory transmissions
(usally Ach and GABA)

57
Q

What year was morphine first used

A

1805 from opium

58
Q

Why were opiates initially not in favor?

A

high death rate

59
Q

Today’s analgesics?

A

Narcotics (opioids)
Cyclooxygenase inhibitors
Gabapentin (pregabalin)
Acetaminophen
Peripheral nerve blocks

60
Q

First muscle relaxant

A

Curare in 1942

61
Q

Why was there decreased mortality with use of muscle relaxants?

A

Decreased amount of anesthesia due to relaxation

62
Q

Balanced anesthesia components?

A

amnesia
analgesia
muscle relaxation
homeostasis

63
Q

Who was Dr. Liston?

A

Believed surgical cases needed to be 20 min and less.
Had 3 deaths from one amputation operation

64
Q

Who was George Crile?

A

Cleveland clinic
Light nitrous/oxygen anesthesia
Local infiltration of procaine

65
Q

Who was Harvey Cushing?

A

Regional blocks prior to emergence from ether
Anesthetic records, BP/HR measurements

66
Q

What was neurolept anesthesia in 1959 and what were the issues?

A

Opioids, antipsychotics (Haldol, droperidol), nitrous
Blocked autonomic and endocrine response to stress
High incidence of awareness, dysphoria, extrapyramidal movements

67
Q

Describe anesthesia in the 1980s

A
  • surgical stimulation produced despite lack of movement
  • Tachycardia
  • Hypertension
  • Insignificant? Except with CAD…. beta blockade
  • High dose opioid technique
68
Q

What is the problem with the high dose opiod technique?

A

Pt takes a long time to wake up

69
Q

What changes to anesthesia in the 2000s?

A

Opioid sparing techniques
“multi modal” techniques

70
Q

What are the phases of anesthesia?

A
  • Preop period
  • Induction of anesthesia
  • Maintenance of anesthesia
  • Emergence from anesthesia
  • Post op period
71
Q

Meds given during preop period

A

BZD, H1 and H2 blockers, bronchodilators

72
Q

Meds given during induction period

A

Etomidate, ketamine, propofol, narcotics

73
Q

Meds given during maintenance phase

A

Inhalation drugs, neuromuscular blockers, pressors, blockers

74
Q

Meds given during emergence phase

A

NMB reversal, local anesthetics

75
Q

What is stage 1 of anesthesia? Planes?

A

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

76
Q

What is Stage II of anesthesia? characteristics? Patient is at high risk of what during this stage?

A

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

77
Q

What stage should the patient move quickest in and out of?

A

stage II

78
Q

What is stage III of anesthesia? Planes?

A

onset of automatic respiration to respiratory paralysis (surgical plane)

79
Q

4 planes of Stage III of anesthesia?

A

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)

80
Q

What is stage 4 of anesthesia?

A

stoppage of respiration till death

Eric Anesthesia Pharm 2025 (3 decks)

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