Introduction to Anesthesia Pharmacology (Exam I) Flashcards
Does general anesthesia, by definition, necessitate the use of an artificial airway or ventilator?
- No, it is just most often required.
How arousable would one be with the use of minimal sedation?
- Arousable to verbal commands.
How arousable would one be with the use of moderate sedation?
- Arousable to touch/loud verbal.
How arousable would one be with the use of deep sedation?
- Arousable to painful stimulation.
Who developed the Materia Medica?
What was the Materia Medica?
- Dioscorides
- Materia Medica was a large volume of what essentially predated pharmacology with medical properties of plants, animals, minerals, etc.
What was wine combined with in ancient days to elicit a hallucinogenic effect?
- Mandragora
What are soporifics?
What components made up a soporific?
What was the reversal?
- Sponges soaked with premodern “anesthetics”.
- opium, mandrake or hemlock juice, hyposcyamus
- Reversal = vinegar
What drug was the first inhalation agent?
Who discovered it?
What was its use?
- Diethyl Ether
- Valerius Cordus
- Recreational (replaced expensive whiskey)
Who invented IV access?
What material was used?
- Wren & Boyle
- Goose quill
Who first discovered oxygen and nitrous oxide?
Who suggested its use for surgical pain control and was laughed away?
- Joseph Priestly
- Humphry Davy
Which dentist used nitrous for extractions?
What was noted with these extractions?
- Horace Wells
- no recall of pain/injury
Which person mixed nitrous and oxygen?
- Andrews
Who first utilized an anesthesia machine with nitrous/oxygen?
- Hewitt
What was ether called when it was first commercialized?
Who ended up purifying ether?
- Letheon
- Dr. Robinson Squibb
What are the disadvantages of ether?
- Flammable
- Prolonged induction/emergence
- Bad odor
- PONV
Which person defined pain?
What was the definition?
- Sir James Simpson
- “Actual or potential tissue damage”
What was Dr. John Snow famous for?
- Full time anesthetist & “discovered” epidemiology by tracing London cholera outbreak.
What were the downsides of chloroform use?
- Hepatotoxicity in children (Guthrie)
- Chloroform + adrenaline = fatal vfib (at least in animal studies) (Levy)
What drug was used for the 1st spinal anesthetic?
Who used it and what else did they develop?
- Cocaine
- Dr. August Bier (Bier Block)
Who was the “mother of nurse anesthesia”?
What did she do?
- Alice Magaw
- 14,000 open drop ether cases with no deaths
What was Agatha Hodgins notable for?
- Opened 1st nurse anesthesia school
- Taught France in WWI
- Founded AANA
What was the issue with Cyclopropane use?
- Violently explosive
Why is halothane obsolete?
- Long induction/emergence
Contrast Isoflurane, Sevoflurane, and Desflurane.
- Isoflurane: longer onset/emergence
- Sevoflurane: intermediate onset/emergence
- Desflurane: rapid onset/emergence
Which volatile anesthetic has the highest vapor pressure? What does this mean?
- Desflurane
- High vapor pressure means it evaporates very quickly.
Which volatile anesthetic is unstable in soda lime? What does soda lime do?
- Sevoflurane
- Soda Lime is a CO₂ absorbent.
What benefits does Sevoflurane offer compared to other volatile anesthetics?
- Less airway irritation
What is the “Triad” of anesthesia?
- Amnesia, Analgesia, & Muscle Relaxation
Regarding amnesia, what neurotransmitter inhibits stimulatory transmissions?
- GABA
Regarding amnesia, which neurotransmitter stimulates inhibitory transmissions?
ACh
What is the primary benefit of muscle relaxants?
- Decreases the amount of other anesthetics needed (thus overall decreasing mortality)
What new factor was added to the anesthesia triad to form “balanced anesthesia”?
- Homeostasis
Which physician had three deaths in one operation?
- Dr. Liston
What was the practice of neurolept anesthesia?
- Very high doses of amnestic drugs (droperidol, haldol, etc) vs volatiles or analgesics.
What are the three stages of Anesthesia?
- Beginning of induction of general anesthesia to loss of consciousness
- Loss of consciousness to onset of automatic breathing
- Onset respiratory paralysis (surgical plane)
What characterizes stage 1 of anesthesia?
Stage 1:
- 1st plane - no amnesia or analgesia
- 2nd plane - amnestic but only partial analgesic
- 3rd plane - complete analgesia & amnesia
What characterizes stage 2 of anesthesia?
Stage 2
- eyelash reflex disappears
- coughing, N/V, struggling may occur
- irregular respirations
What planes characterize stage 3 of anesthesia?
Stage 3
- 1st plane - automatic respiration → eyeball movement stops
- 2nd plane - ocular cessation → intercostals start to paralyze & tear secretion increases.
- 3rd plane - pupillary dilation, desired plane prior to muscle relaxants
- 4th plane - complete intercostal paralysis → diaphragmatic paralysis (apnea)
What characterizes stage IV of anesthesia?
- Death (via medullary paralysis)
In what stage and/or plane of anesthesia would one expect to see lacrimation?
Stage 3 / 2nd plane
In what stage and/or plane of anesthesia would one expect to see onset of diaphragmatic paralysis?
Stage 3 / 4th plane
In what stage and/or plane of anesthesia would one expect the beginning of total amnesia/analgesia to occur?
Stage 1 / 3rd plane
In what stage and/or plane of anesthesia would one expect for the eyelash reflex to disappear?
Stage 2
In what stage and/or plane of anesthesia would one expect to see total and complete intercostal paralysis?
Stage 3 / 4th plane
In what stage and/or plane of anesthesia would one expect to see pupillary dilation?
Stage 3 / 3rd plane
In what stage and/or plane of anesthesia would one expect to see amnesia but only partial analgesia?
Stage 1 / 2nd plane
Who used cocaine as an anesthetic for eye surgeries?
- Koller
Who used cocaine as a mandibular nerve block?
- Halsted
What was Crile known for?
- Preemptive procaine at surgical site
- Lighter nitrous/oxygen
What was Cushing known for?
- Regional blocks before anesthetic emergence
- Anesthetic records
Who did extensive experiments with desflurane?
What else did this person do?
- Egar
- Develop MAC (minimal alveolar concentration)
Who used cocaine as a mandibular nerve block?
- Halsted
