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History (Test 1) Flashcards

1
Q

What is the definition of anesthesia?

A

Artificially induced loss of the ability to feel pain (lack of feeling and sensation)

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2
Q

What is general anesthesia?

A

Drug induced loss of consciousness

Not arousable by painful stimuli

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3
Q

What are the different types/ common areas of regional anesthesia?

A

Peripheral
Spinal (intrathecal)
Epidural

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4
Q

What is the goal of regional anesthesia?

A

Insensibility caused by interrupting the sensory nerve conduction of a particular region of the body

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5
Q

What are the 3 depths of sedation?

A

Minimal
Moderate
Deep

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6
Q

What is expected with minimal sedation?

A

Anxiolysis

Respond to verbal commands

Airway/ventilation and CV function are unaffected

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7
Q

What is expected with moderate sedation?

A

Responds to touch or verbal

No airways assistance needed/ spontaneous ventilation is adequate

CV usually maintained

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8
Q

What is expected with deep sedation?

A

Responds after repeated/painful stimuli

Airway assistance may be needed

Spontaneous ventilation might not be adequate

CV usually maintained

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9
Q

What were some common plants used as early anesthetics?

A

poppy, coca leaves

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10
Q

What are some of the earliest forms of anesthesia?

A

Acupuncture
Plants
Cannabis vapor
Ethylene fumes (under apollos temple)
Carotid compression

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11
Q

How was carotid compression used as “anesthesia”?

A

Interruption of blood supply to brain for temporary forgetfulness of painful stimuli (not very safe)

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12
Q

Which early philosopher valued accommodating the surgeon?

A

Hippocrates

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13
Q

Who wrote the first pharmacology textbook?

A

Dioscorides (40-90 AD)

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14
Q

What is the name of the first pharmacology text book and how many volumes was it?

A

Materia Medica- 5 volumes

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15
Q

How many medical properties did the materia medica contain?

A

360 medical properties–broken into categories (antiseptic, anti-inflammatory)

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16
Q

Who was responsible for mixing mandragora with wine and what was the outcome?

A

Dioscorides–mandragora shaped like a human and believed to have hallucinogenic/magical properties

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17
Q

What was used in the middle ages for anesthetic delivery?

A

Sponges soaked in solutions for inhalation

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18
Q

What elements were mixed to create the solution to soak the sponges?

A

.5oz opium
Juice of mandrake leaves
Juice of hemlock
3oz hyposcyamus
Water

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19
Q

What role did Hyposcyamus play in the inhalation mixture?

A

L-isomer of atropine (prevent bradycardia)

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20
Q

What reversal was used if too much solution was inhaled from the sponge?

A

Vinegar inhalation (similar to ammonia)

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21
Q

What was the first true inhalation anesthetic?

A

Diethyl ether

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22
Q

Which physician first synthesized Diethyl Ether?

A

Valerius Cordus in 1540–German botanist and physician

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23
Q

What is ether synthesized from?

A

sulfuric acid and ethyl alcohol

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24
Q

How did ether get its name?

A

Ether is greek for “ignite”

highly flammable

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25
Why did volatile anesthetics take off before IV anesthetics?
There wasn't IV technology at the time of volatile anesthetic development
26
What were common disadvantages with the use of Ether?
Flammable Prolonged induction and emergence Unpleasant odor High incidence of N/V
27
Who were the 2 men that discovered means for IV therapy?
Sir Christopher Wren Robert Boyle (1650s)
28
What were the first IV supplies created from?
IV needle--goose quill IV bag--goose bladder
29
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)
30
Who discovered nitrous oxide?
Joseph Priestly (1773) an English chemist
31
Who discovered photosynthesis?
Joseph Priestly
32
Which English chemist discovered potassium, sodium, calcium, and magnesium?
Humphry Davy
33
Who discovered that a man under the influence of N2O has no recall of pain/injury?
Horace Wells--dentist
34
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
35
What was N2O administered with early on in its discovery (up until 1868)?
Air
36
What issues occurred with giving N2O in combination with air?
Lots of issues with N2O use associated with hypoxia
37
Who was the first person to give N2O with O2 instead of air?
Andrews--Chicago surgeon improvement in oxygenation/ no cyanosis
38
After 1869 _________ was commonly used on the anesthesia machine with any other volatile anesthetic.
Oxygen
39
First anesthesia machine with nitrous/oxygen:
Hewitt
40
Why was it hard to prove Ether not successful?
In most studies they were still using whiskey as well
41
Which dentist preferred using ether for denture fittings?
William Morton
42
Which physician used Ether (as well as whiskey) for a patient with 2 vascular neck tumors?
Crawford long
43
When was the first successful public display of ether?
1846
44
How did the first public demonstration of ether affect its use?
Within 60 days it was in use all over England and America
45
Where was the successful ether demonstration conducted?
Mass general in an area now called the "ether dome"
46
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
47
What made ether dosing inconsistent?
Would decide on more or less ether administration by palpating the patients pulse
48
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
49
Who was the Scottish obstetrician that defined pain as "actual or potential tissue damage"?
Sir James Simpson
50
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
51
Who discovered epidemiology by tracing London cholera outbreak to water source?
Dr. John Snow (anesthetist in obstetrician care)
52
Why was there controversy with the use of chloroform?
Reported deaths of healthy patients
53
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
54
Who completed the first regional mandibular nerve block with cocaine?
Dr. Halsted
55
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
56
Who was the first recognized nurse anesthetist?
Sister Mary Bernard 1877
57
Who is known as the mother of anesthesia?
Alice Magaw
58
Who founded AANA, opened 1st nurse anesthesia school, taught in France in WWI, and developed N2O techniques?
Agatha Hodgins
59
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)
60
What is the goal when trying to find a newer/better volatile anesthetic?
Fewer side effects Faster onset Faster emergence
61
What are 2 volatile anesthetics that were used before isoflurane?
Cyclopropane Halothane
62
What volatile anesthetic replaced halothane?
Isoflurane 1981 safe, not explosive like the others before less N/V quicker onset than halothane
63
Which volatile anesthetic has the most rapid uptake and distribution?
Desflurane (1992)
64
What is a downside to the use of Desflurane?
Takes a large quantity to achieve anesthesia--expensive
65
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
66
Why is Sevoflurane used almost exclusively in kids?
It doesn't irritate the airway like other volatile anesthetics--good for inhalation induction
67
What is the most recent inhaled anesthetic discovered?
Sevoflurane--1995 (no new inhaled anesthetics since)
68
What is the action of Sevoflurane?
Intermediate--between isoflurane and desflurane
69
What is "the triad" for anesthetics?
Analgesia Amnesia Muscle relaxation want a balanced anesthetic to affect all 3 of these
70
How is amnesia achieved?
Stimulate inhibitory transmissions Inhibit stimulatory transmissions
71
What are the primary neurotransmitters being affected when trying to achieve amnesia?
Acetylcholine (excitatory) GABA (inhibitory)
72
What is the main way of achieving analgesia today?
Balance of opioid and non-opioid drugs (Narcotics, COX inhibs, Gabapentin, tylenol, nerve blocks)
73
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
74
Why are muscle relaxants beneficial to use in anesthesia?
Muscle relaxants decrease amount of anesthesia used and decrease mortality
75
What is the 4th aspect to balanced anesthesia with amnesia, analgesia, and muscle relaxation?
Homeostasis
76
Which physician believed that the faster the surgery is done, the better (<20min) and ended up with 3 deaths in one case?
Dr. Liston
77
What was Harvey Cushing known for?
Regional block to prevent pain response and was big on data collection and documentation of BP and HR
78
Who practiced local infiltration of procaine to preemptively inhibit pain reflexes?
George Crile
79
What is neurolept anesthesia?
Using antipsychotics, opioids, nitrous Block autonomic and endocrine response to stress high incidence of awareness, dysphoria, extrapyramidal movements
80
What are the phases of anesthesia?
Preoperative period Induction of anesthesia Maintenance of anesthesia Emergence from anesthesia Post op period
81
How many stages of anesthesia are there?
3
82
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
83
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)
84
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)
85
What stage of anesthesia can surgery begin?
Stage 3
86
Why do we want to avoid stage 4 anesthesia?
sedation is too deep and could cause death
87
Which physician did the first spinal anesthetic with cocaine?
Dr. August Bier
88
Who used cocaine as anesthetic for eye surgery?
Dr. Koller

Anesthesia Pharm (A) (19 decks)

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