Introduction

Question 1

Anesthesia

Answer 1

Artificially induced loss of the ability to feel pain

Question 2

General Anesthesia

Answer 2

A drug-induced loss of consciousness

Patients are not arousable; even by painful stimulation

Question 3

Regional Anesthesia

Answer 3

insensibility caused by interrupting the sensory nerve conduction of a particular region of the body
Peripheral
Spinal
Epidural

Question 4

Accommodate the operator
Avoid sinking down and turning away

Answer 4

Hippocrates

Question 5

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

Answer 5

Dioscorides

Question 6

German botanist, physician
Made from sulfuric acid and ethyl alcohol
Named ether: greek for ignite
Tested on chickens

Answer 6

Valerius Cordus

Question 7

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

Answer 7

Sir Christopher Wren and Robert Boyle

Question 8

English chemist
Discovers oxygen and nitrous oxide
Discovered photosynthesis

Answer 8

Joseph Priestly

Question 9

British chemist
Discovered potassium, sodium, calcium, magnesium….
Suggested its use (Nitrous) for surgical pain control

Answer 9

Humphry Davy

Question 10

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
1845 at Mass General….Arranged administration for amputation
“humbug”

Answer 10

Horace Wells

Question 11

Chicago surgeon….Nitrous/oxygen anesthesia without cyanosis

Answer 11

Andrews

Question 12

1st anesthesia machine with nitrous/oxygen
Common surgical anesthesia

Answer 12

Hewitt

Question 13

Delivered ether for a patient with 2 vascular neck tumors
Continued use of whiskey

Answer 13

Crawford Long

Question 14

Dentist
Needed anesthesia for denture fitting

Answer 14

William Morton

Question 15

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

Answer 15

Dr. Robinson Squibb

Question 16

Disadvantages of ether

Answer 16

Flammable

Prolonged induction

Unpleasant, persistent odor

High incidence of nausea/vomiting

Question 17

Obstetrician in Scotland
Experimented chloroform following dinner party
Defined pain: “actual or potential tissue damage”
Religious opposition

Answer 17

Sir James Simpson

Question 18

Full time anesthetist
Used chloroform for Queen Victoria’s childbrith….prince Leopold and princess Beatrice
“discovered” epidemiology when he traced London cholera outbreak to water source

Answer 18

Dr. John Snow

Question 19

Hyderabad commissions

Answer 19

Discussed the possibility of Respiratory arrest vs cardiac paralysis from Chloroform

Question 20

Found delayed chloroform hepatotoxicity in children

Answer 20

Guthrie

Question 21

Light chloroform anesthesia and adrenaline….fatal vf in animals

Answer 21

Levy

Question 22

Viennese ophthalmologist (colleague of Sigmund Freud)
Used Cocaine for Anesthetic for eye surgery

Answer 22

Dr. Koller

Question 23

1st regional (mandibular) nerve block with cocaine

Answer 23

Dr. Halsted

Question 24

1st spinal anesthetic with cocaine

Answer 24

Dr. August Bier
Developed Bier block

Question 25

1st nurse anesthetist Low pay Intelligent Focused on patient instead of surgery

Answer 25

Sister Mary Bernard

Question 26

“mother of anesthesia” 14,000 open drop ether cases without death

Answer 26

Alice Magaw

Question 27

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

Answer 27

Agatha Hodgins

Question 28

Cyclopropane

Answer 28

Violently explosive

Question 29

Halothane

Answer 29

Hepatitis Slow onset

Question 30

Isoflurane

Answer 30

Relatively safe, still used today Less nausea and vomiting Quicker onset than halothane

Question 31

Desflurane

Answer 31

Rapid uptake and distribution! (most rapid onset and offset), so used for outpatient procedures High vapor pressure Large quantity to achieve anesthesia

Question 32

End-tidal concentration correlated to movement….MAC (Minimal alveolar concentration/dose of volatile anesthetic) Also experimented a lot in Desflurane

Answer 32

Edmund Egar

Question 33

Sevoflurane

Answer 33

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

Question 34

The “triad”

Answer 34

Amnesia, Analgesia and Muscle Relaxation

Question 35

Amnesia cause by Stimulating inhibitory transmissions of

Answer 35

Acetylcholine

Question 36

Amnesia caused by Inhibiting stimulatory transmissions of

Answer 36

GABA

Question 37

Curare

Answer 37

Natural Muscle relaxants used by south American tribes

Question 38

Discovered Surgical cases > 20 minutes…death 3 deaths from 1 operation

Answer 38

Dr. Liston

Question 39

Cleveland clinic Light nitrous/oxygen anesthesia Local infiltration of procaine

Answer 39

George Crile

Question 40

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

Answer 40

Harvey Cushing

Question 41

1959 Opioids, antipsychotics (Haldol, droperidol), nitrous Blocked autonomic and endocrine response to stress High incidence of awareness, dysphoria, extrapyramidal movements

Answer 41

neurolept anesthesia

Question 42

Phases of Anesthesia

Answer 42

Preoperative period BZD, H1 and H2 blockers, bronchodilators Induction of anesthesia Etomidate, ketamine, propofol, narcotics Maintenance of anesthesia Inhalation drugs, neuromuscular blockers, pressors, blockers Emergence from anesthesia NMB reversal, local anesthetics Postoperative period

Question 43

Stage I of Anesthesia

Answer 43

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

Question 44

Stage 2 of Anesthesia

Answer 44

loss of consciousness to onset of automatic breathing eyelash reflex disappears coughing, vomiting, struggling may occur irregular respirations with breath-holding

Question 45

Stage 3 of Anesthesia

Answer 45

onset of automatic respiration to respiratory paralysis (surgical plane) 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)

Question 46

Stage 4 of Anesthesia

Answer 46

stoppage of respiration till death