Introduction to Anesthesia Flashcards
Anesthesia definition
Artificially induced loss of ability to feel pain
General anesthesia definition
a drug induced loss of consciousness
Are patients under general anesthesia arousable by painful stimulation?
no
What is regional anesthesia?
Insensibility cause by interrupting the sensory nerve conduction of a particular region
Does regional anesthesia affect LOC or airway?
No
Name three types of regional anesthesia.
Peripheral, spinal, epidural
What are three levels of sedation we can do?
Minimal, Moderate, deep
Minimal sedation
Responsiveness, airway, ventilation, CV function?
Responsive to verbal commands, everything else unaffected
Moderate
Responsiveness, airway, ventilation, CV function?
Responsiveness: to verbal/touch
airway assistance not needed
Spontaneous ventilation is adequate
CV function is maintained
Deep sedation
Responsiveness, airway, ventilation, CV function?
Responsive after repeated painful stimuli
airway assistance may be required
Spontaneous ventilation possibly inadequate
CV function usually maintained
Who wrote the Materia Medica and how many volumes of it were there? How many medical properties?
Dioscorides (surgeon in nero’s army)
5 volumes
360 medical properties
anesthesia during the days of Hippocrates
Accommodate the surgeon, avoid sinking down and turning away
Madragora (mandrake) and wine
Had hallucinogenic properties, interestingly human shaped and thought to have magical properties
What is it called when a substance is put on a sponge and then inhaled?
soporific
What was a reversal to soporific mentioned in lecture?
Vinegar
What was the first true inhalant agent that we know of? what was it made of?
Diethyl ether
made of sulfuric acid and ethyl alcohol
Who discovered diethyl ether?
Valerius Cordus, a german botanist
Diethyl ether became a recreational drug, why?
Whiskey was expensive d/t tax
What was an interesting property of diethyl ether?
it explodes
Why did inhalation agents start before IV?
Because IV’s had not been discovered!
Who created the first IV? and what was it made out of? Who did they test it on?
Christopher Wren and Robert Boyle
made of goose quill and bladder, gave alcohol to a dog
Who discovered oxygen and nitrous oxide? he also discovered photosynthesis
Joseph Priestly
Who discovered electrolytes and suggested NO be used for surgical pain relief? Why wasn’t his discovery appreciated?
Humphry David, not apprecieated because it didn’t stop movement
What was the name of the dentist who realized people under the influence of Nitrous Oxide had no recall of pain/injury?
Horace Wells
Why was it an issue that NO was just administered with just air?
Were they just becoming hypoxic or was it true anesthesia
Who was the first person to routinely give nitrous oxide with oxygen?
Andrews in chicago
Who developed the first anesthesia machine where we could give nitrous and oxygen together?
Hewitt
What surgeon used ether on a patient with two vascular neck tumors?
Crawford Long
A dentist that used Ether as the anesthesia for denture fittings
William Morton
What happened in 1846 that was significant?
The first successful demonstration with ether. Within 60 days it was used in England
Who developed the process for purifying Ether?
Dr. Robinson Squibb, he founded Squibb pharmaceuticals and became the leading manufacturer
What are the disadvantages of ether?
Flammable
Prolonged induction
unpleasant persistent odor
High incidence of N/V
This obstetrician from Scotland defined pain and used Chloroform.
How did he define pain?
Sir James Simpson
Actual or potential tissue damage
Who advocated for chloroform use in obstetrics and also used Genesis 2:21 to back up his work against religious organizations?
Sir James Simpson
Who gave Queen Victoria chloroform for the births of both of her children?
Dr. John Snow
What did 1888 Hyderabad commission say about chloroform and deaths of healthy people? What about in 1891?
They felt it was due to poor skills on the part of the anesthetists in 1888.
In 1891 they realized it could be the drug causing respiratory and cardiac arrest
Who realized that chloroform was causing delayed chloroform hepatotoxicity in children?
Gunthrie
Who found that light chloroform anesthesia and the increase in adrenaline was fatal in animals?
Levy
What Viennese ophthamologist used Cocaine for eye surgery?
Dr. Koller
Who did the 1st regional nerve block with cocaine on a mandible?
Dr. Halsted
Who did the first spinal Anesthetic with cocaine and what procedure did he develop?
Dr. August Bier, he developed the Bier Block
Who was the first nurse Anesthetist?
Sister Mary Bernard
Who is the mother of anesthesia and what significant accomplish did she make?
Alice Magaw, she did 14,000 open ether drop cases without a single death
What nurse anesthetist Opened one of the first nurse anesthesia schools, founded the AANA, and developed nitrous/ oxygen techniques?
Agatha Hodgins
What was a problem with cyclopropane?
It was violently explosive
Issues with halothane?
Hepatitis and slow onset
Benefits of isoflurane?
Relatively safe, less N/V, and quicker onset than halothane
But its not great for out patient surgery because of slow offset.
Which volatile anesthetic is the most rapid onset and offset?
Desflurane, it has rapid uptake and distribution
Which volatile anesthetic has a high vapor pressure?
Desflurane
Who is Edmund Egar?
He did a lot of experimentation with volatile anesthetics. He also came up with MAC (minimal alveolar concentration) which is the dose of volatile anesthetic that you give.
What is the name for the dose of a volatile anesthetic?
Minimal Alveolar Concentration (MAC)
Which volatile anesthetic requires A large quantity to achieve anesthesia? What does this mean about cost?
Desflurane, it requires a lot so have to buy more which means overall cost is higher
What is the intermediate acting volatile anesthetic?
Sevoflurane
Which volatile anesthetic is unstable in soda lime and causes toxic degradation products?
Sevoflurane
From oldest to newest name the volatile anesthetics.
cyclopropane
halothane
Isoflurane
Desflurane
Sevoflurane
What is the Anesthesia Triad?
Analgesia, amnesia, muscle relaxation
How do drugs cause amnesia?
By either stimulating inhibitory transmissions through acetylcholine or by inhibiting stimulatory transmissions by the us of GABA
What are todays common analgesics?
Narcotics
COX inhibitors
Gabapentin (pregabalin)
Acetaminophen
Peripheral nerve blocks
What was the original muscle relaxant?
Curare
What benefits do muscle relaxers have?
They decreased the amount of anesthesia used due to relaxation and also decreased mortality rates
What is the balanced anesthesia or “stress free” anesthesia model?
Muscle relaxation, amnesia, and analgesia to maintain HOMEOSTASIS of the body.
Who discovered that if the surgery took less than 20 minutes they had a better chance at survival
Dr. Liston
Who had 3 deaths from one operation?
Dr. Liston
Who was one of forerunners of preimptive anesthesia and was also known for light nitrous/oxygen anesthesia?
George Crile, preimptive anesthesia was giving lidocaine at the surgical site before making first incision.
Who was a person who did regional blocks prior to emergence from ether and also was credited with early anesthetic record development?
Harvey Cushing
What is neurolept anesthesia? And what were its problems?
Giving opioids, antipsychotics, and nitrous which blocked autonomic and endocrine response to stress.
Issue was that there was high incidence of awareness, dysphoria and extrapyramidal movements
What are the phases of anesthesia?
-preop period
-induction of anesthesia
-maintenance of anesthesia
- emergence from anesthesia
-Postop period
Who made a reference chart about how patients progressed through different stages of anesthesia?
Dr. Guedel
At what stage do you lose all occular movements?
Stage 3, plane 2
Stage 1 of anesthesia
Beginning of induction of general anesthesia to loss of conciousness
Stage 1, plane 1
no amnesia or analgesia
Stage 1 plane 2
Amnestic but only partially analgesic
stage 1 plane 3
complete analgesia and amnesia
stage 2
Loss of consciousness to onset of automatic breathing
What happens in stage two? what is significant about this?
eyelash reflex disappears, coughing vomiting struggling may occur, irregular respirations with breath holding.
DO NOT EXTUBATE DURING THIS STAGE! ASPIRATION RISK
Stage 3
Onset of automatic respiration to respiratory paralysis (surgical plane)
Stage 3 plane 1
automatic respiration to cessation of eyeball movements
stage 3 plane 2
cessation of eyeball movements to beginning of intercostal muscle paralysis; secretion of tears increases
Stage 3, plane 3
beginning to completion of intercostal muscle paralysis; pupils dilate; desired plane prior to muscle relaxants
Stage 3, plane 4
: beginning to completion of intercostal muscle paralysis; pupils dilate; desired plane prior to muscle relaxants
Stage 4
respirations stop til death
