Lecture 1 History of Anesthesia Test 1 Flashcards
What is Anesthesia?
Artificially induced loss of the ability to feel pain/ lack sensation or feeling to permit the performance of surgery.
What is General Anesthesia?
A legal drug-induced loss of consciousness, not arousable even under painful stimuli.
What is Regional Anesthesia?
Insensibility is caused by interrupting the sensory nerve conduction of a particular region of the body. (Peripheral, Spinal, Epidural).
The level of consciousness is unchanged, the airway is protected.
What are the three spectrums of sedation?
Minimal, Moderate, and Deep
Under minimal sedation what is the patient’s
Responsiveness:
Airway condition:
Spontaneous Ventilation condition:
CV function:
Under minimal sedation what is the patient’s
Responsiveness: To verbal commands
Airway condition: Unaffected
Spontaneous Ventilation condition: Unaffected
CV function: Unaffected
Under moderate sedation what is the patient’s
Responsiveness:
Airway condition:
Spontaneous Ventilation condition:
CV function:
Under moderate sedation what is the patient’s
Responsiveness: To verbal and touch
Airway condition: No assistance is needed
Spontaneous Ventilation condition: Adequate
CV function: Usually maintained.
Under deep sedation what is the patient’s
Responsiveness:
Airway condition:
Spontaneous Ventilation condition:
CV function:
Under deep sedation what is the patient’s
Responsiveness: After repeated painful stimuli
Airway condition: Assistance might be required
Spontaneous Ventilation condition: Possibly inadequate
CV function: Usually maintained
During the time of ______________ (person). The most important person in the operating room was the surgeon. The patient was to do everything they could to make it easy on the surgeon.
Hippocrates
Who wrote the Materia Medica?
What is the Materia Medica?
Dioscorides
First pharmacology book, 5 volumes long, 360 medical properties.
What human-shaped plant was used as a hallucinogenic and believed to have magical properties?
Mandragora
What was the main method of delivering anesthetics during the middle ages?
Soporific sponges
Who combined sulfuric acid and ethyl alcohol to make Diethyl Ether and tested it on chickens?
Valerius Cordus
Who created IV access using a goose quill and tested the administration of alcohol in a dog’s vein?
Sir Christopher Wren
Robert Boyle
Who discovered Oxygen, Nitrous Oxide, and Photosynthesis?
Joseph Priestly
Who discovered our elements (K+, Na+, Ca2+, Mg2+) and suggested the use of nitrous for surgical pain control?
Humphry Davy
Who was a dentist known for using nitrous on their patients that experience no recall of pain/injury?
Horace Wells
Who was the Chicago surgeon to first administer nitrous with oxygen without cyanosis?
Andrews
Who was the first person to develop the first anesthesia machine with nitrous and oxygen?
Hewitt
Who was the doctor that delivered ether for a patient with 2 vascular neck tumors?
Crawford Long
Which dentist used ether for denture fittings?
William Morton
What year was the first successful public demonstration of ether? The patient was motionless and had no recall.
Who performed this procedure at Mass General?
1846
William Morton
Letheon spread to England in 60 days
Who developed a process for purifying ether and founded a pharmaceutical from this?
Robinson Squibb
Name 4 disadvantages of ether.
Flammable
Prolonged induction
Bad Odor
N/V (high incidence)
What anesthetic was independently discovered in 1831 in the US, France, Germany, and Great Britain?
Chloroform
Who was an obstetrician in Scotland that defined pain and justified the use of anesthetics from a quote from Genesis?
Sir James Simpson
Who was a full-time anesthetist that attended Queen Victoria for her two births? What is he famous for?
John Snow
Discovering epidemiology after tracing the London cholera outbreak to a water source
Due to the big number of deaths from chloroform, the ____________ Commission met to discuss the use of this anesthetic.
Hyderabad
Who proved that children got hepatotoxicity from chloroform?
Guthrie
Who discovered that receiving a light amount of chloroform stimulated the ANS (SNS) and can lead to V-fib in animals?
Levy
Which doctor used cocaine as an anesthetic for eye surgery?
Dr. Koller
Which doctor first used cocaine as a regional mandibular nerve block?
Dr. Halsted
Which doctor first used cocaine as a spinal anesthetic?
Dr. Bier
Who was the first nurse anesthetist?
Sister Mary Bernard
Who was the mother of anesthesia that had 14,000 anesthetic cases without a single death?
Alice Magaw
Who opened one of the first nurse anesthetist schools and founded the AANA?
Agatha Hodgins
What anesthetic was introduced in 1934 that was violently explosive?
Cyclopropane
What anesthetic was introduced in 1956 had a slow onset and many patients developed hepatitis from this?
Halothane
Which anesthetic was introduced in 1981 that is relatively safe and patients experience less N/V.
Isoflurane
Which anesthetic has rapid uptake and distribution (most rapid onset and offset), high vapor pressure, and requires a large quantity to achieve anesthesia?
Desflurane
Great for outpatient surgery
Who was the doctor known for his experimentation on desflurane? Discovered end-tidal concentration correlated to movement and determined the concentration of MAC.
Edmund Egar
Which anesthetic has an intermediate action between isoflurane and desflurane? Considered to be unstable in soda lime and toxic degradation product concerns.
Sevoflurane
The latest anesthetic, great for asthmatics no airway irritation
What is the anesthesia triad?
Amnesia
Analgesia
Muscle Relaxation
Note: today homeostasis is included
What are two ways our drugs can cause amnesia?
Stimulate inhibitory transmissions through ACh.
or
Inhibit stimulatory transmission through GABA.
What drugs are used in multi-modal pain relief?
Cyclooxygenase Inhibitor
Peripheral Nerve Blocks
Acetaminophen
Narcotics (Limited)
Gabapentin
C PANG
What will decrease the amount of anesthetic needed due to relaxation?
Muscle relaxant
Curare plant from South America
Which doctor is responsible for 3 deaths in one operation?
Dr. Liston
Which doctor worked in the Cleveland Clinic and used light nitrous/oxygen anesthesia and local infiltration of procaine?
He was a forerunner of preemptive analgesia.
George Crile
Who administered regional blocks prior to emergence from ether and developed early anesthetic records, BP/HR measurements.
Harvey Cushing
What is neurolept anesthesia?
The use of high doses of opioids and Antipsychotics (Haldol, droperidol, nitrous).
Block autonomic and endocrine responses to stress.
High incidences of awareness, dysphoria, extrapyramidal movements
Which doctor developed a reference chart for the stages of anesthesia, using pictures and words.
Dr. Guedel
What is the first stage of anesthesia?
What are the 3 planes involved in stage 1?
Stage 1: Beginning of induction of general anesthesia to loss of consciousness
1st plane: no amnesia or analgeis
2nd plane: amnesia, but only partial analgesia
3rd plane: complete amnesia and analgesia
What is the second stage of anesthesia?
What happens here?
Stage 2: Loss of consciousness to the onset of automatic breathing.
Eyelash reflex disappears
Coughing, vomiting, and struggling may occur
Irregular respiration with breath-holding
Highest chance of aspiration in this stage
Extubation during which stage of anesthesia will result in bronchospasm?
Stage 2
What is the third stage of anesthesia?
What are the 4 planes in stage 3?
Stage 3: Onset of automatic respiration to respiratory paralysis (surgical plane)
Plane 1: Automatic respiration to the cessation of eyeball movements
Plane 2: Cessation of eyeball movements to the beginning of intercostal muscle paralysis; secretion of tears increase
Plane 3: Beginning to complete intercostal muscle paralysis; pupils dilate; desired plane before NMB.
Plane 4: Complete intercostal paralysis to diaphragmatic paralysis (apnea).
What is the fourth stage of anesthesia?
Stoppage of respiration till death
Too much anesthetics given
