Intro the Anesthesia

Question 1

Early days:

Hippocrates

Answer 1

Hippocrates 460-377 BC
“Accomodate the operator”

Question 2

Early days:

Materia Medica

Answer 2

5 volumes; plants, animal, and mineral products

360 medical properties

Question 3

Mandragora and wine
What are the properties?

Answer 3

Hallucinogenic
Human shaped
Magical properties :)

Question 4

Valerius Cordus

What did this guy make? What are the components of what he made?

Answer 4

Diethyl ether= Sulfuric Acid + Ethyl Alcohol

Ether: “greek for ignite”; tested on chickens

Question 5

Sir Christopher Wren
and
Robert Boyle

What did they create??

Answer 5

IV access using a GOOSE QUILL

Tested by giving alcohol into a dog’s vein

Question 6

Joseph Priestly

What did he discover?
3 Things

Answer 6

Discovered:
1.) Oxygen
2.) NITROUS OXIDE
3.) Photosynthesis

Question 7

Humphry Davy

What did he discover?

Answer 7

Electrolytes!
Potassium, Na, Ca, Mg
“Suggested use for surgical pain control”

Question 8

Horace Wells

Answer 8

DENTIST GUY!
Used nitrous for dental pt/ tooth extraction

Noticed with the use of nitrous -> No recall of pain

Question 9

Andrews… Chicago surgeon..

what did he do?

Answer 9

Admin nitrous/oxygen anesthesia without cyanosis :D

Question 10

Hewitt

Answer 10

1st anesthesia machine with nitrous/oxygen

Question 11

Crawford Long

What did he discover?? or do?

Answer 11

First to discover Ether

Delievered ether for a patient with 2 vascular neck tumors

Question 12

William Morton

Answer 12

Dentist,
Needed anesthesia for denture fitting (Ether)

Question 13

Dr. Robinson Squibb

What did he develop?
What is he the founder of?

Answer 13

-Developed process for PURE ETHER
-Founded Squibb pharmaceuticals– the leading manufacturer

Question 14

Disadvantages of Ether:
1.)
2.)
3.)
4.)

Answer 14

1.) Flammable
2.) Prolonged induction— long onset
3.) Unpleasant, persistent oder— smelly
4.) N/V

Question 15

Sir James Simpson

What did he define?
What are his viewpoints?

Answer 15

Defined pain: “actual or potential tissue damage”.

Religious opposition.
Used the idea that god liked anesthesia and that women did not deserve pain for childbirth.

Obstetrician

Think: CHLOROFORM + CHILDBIRTH

Question 16

Dr. John Snow

What did he discover

Answer 16

Full time anesthetist

“Discovered epidemiology” when he traced London cholera outbreak to water source

Treated Queen victoria + princesses

chloroform?

Question 17

What was controversy with chloroform?

Why is chloroform bad??

Answer 17

1.) Delayed chloroform hepatoxicity in children
2.) Adrenaline/ ANS stimulation -> V-fib in animals
3.) Respiratory arrest vs cardiac paralysis

DEATH WITH CHLOROFORM.
Drug vs provider ignorance

Question 18

Dr. Koller

what did he use anesthetic for?

Answer 18

Ophthalmologist

Anesthetic for eye surgery

Question 19

Dr. Halsted

First person to do what?

Answer 19

1st regional (mandibular) nerve block with cocaine

Question 20

Dr. August Bier

what did he develop?
First spinal anesthetic with ___?

Answer 20

1st spinal anesthetic with cocaine

Developed Bier block

Question 21

Sister Mary Bernard

Alice Magaw

Answer 21

Nuns were the first nurse anesthesist!

“Mother of Anesthesia”
14k surgery cases without death

Question 22

Agatha Hodgins

What did she open and develop?

What was founded by her?

Answer 22

Opened first nurse anesthesia school– taught in France

Developed nitrous/oxygen technique

Founded AANA

Question 23

Recent Anesthetics:

Cyclopropane
Halothane
Isoflurane

why were they not used anymore?
Why do we still use isoflurane

Answer 23

Cyclopropane: VIOLENT EXPLOSIVE. no more use

Halothane: Slow onset, Hepatitis

Isoflurane:
SAFE, less N/V, quicker onset than halothane

Question 24

Desflurane

Answer 24

-Most rapid onset and offset
-High vapor pressure
-Large quantity to achieve anesthesia

Question 25

Edmund Egar

Answer 25

End-tidal concentration correlated to movement… MAC

Question 26

Sevoflurane

Answer 26

-Intermediate action between isofluane and desflurane
-Toxic degradation product concerns
-NO new inhaled anesthetics since :)

Question 27

Triad of Anesthesia

What are the 3 things?

Answer 27

Amnesia
Analgesia
Muscle Relaxation

Question 28

Amnesia

Stimulate ___?
Inhibit ___?

Answer 28

Stimulate inhibitory transmission: GABA

Inhibit stimulatory transmissions: Acetacholine

Question 29

Today’s analgesics?

Answer 29

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

Question 30

Dr. Liston

Answer 30

Surgical case < 20 mins… death

he killed 3 people in 1 operation

Question 31

George Crile

Answer 31

-Light nitrous/oxygen anesthesia
-Local infiltration of procaine

Question 32

Harvey Cushing

Answer 32

-Regional blocks prior to emergence from ether
-Anesthetic records!!!
BP/HR measurements
-Crushings Triad

Question 33

Phases of Anesthesia:
1.)
2.)
3.)
4.)
5.)

Answer 33

1.) Pre-operative pd
2.) Induction of anesthesia
3.) Maintenance of anesthesia
4.) Emergence from anesthesia
5.) Post-operative period

Question 34

1.) Pre-operative pd
2.) Induction of anesthesia
3.) Maintenance of anesthesia
4.) Emergence from anesthesia
5.) Post-operative period

what kind of meds do you use for each phase?

Answer 34

1.) Pre- op
Benzos, H1/H2 blockers, bronchodilators

2.) Induction
Etomidate, ketamine, prop, narcotics

3.) Maintenance
Inhalation drugs, neuromuscular blockers, pressors, blockers

4.) Emergence
NMB reversal, local anesthetics

5.) Post-op
whatever you need LOL