Lecture 1 - Intro, History & Vocab (Test 1) Flashcards
An artificially induced lack of feeling or sensation to pain can be described as _____?
Anesthesia
Slide 2
What is the purpose of using anesthesia?
To permit the performance of surgery or painful procedures.
Slide 2
What is General Anesthesia?
A drug-induced loss of consciousness.
Slide 3
Are patients arousable by painful stimuli under general?
No!
Slide 3
Do patients have to be intubated or vented under general?
Nope.
Slide 3
What typically becomes obstructed under general?
The airway - you may have to jaw thrust, put in an oral airway, use pressure support or even intubate
(BUT this is not the definition of General Anesthesia)
Slide 3
Does the patient have to be breathing a volatile anesthetic to be considered under general anesthesia?
Nah.
Can use IV anesthetics to induce General!
Slide 3
When it comes to billing - I can bill anything that alters the patients LOC as General Anesthesia. True or False?
True!
If you give a little versed and the patient gets sleepy, you can bill that as General - even though that is not the actual definition.
Peripheral, spinal or epidural can be referred to as what type of anesthesia?
Regional
Slide 4
Does my LOC change if I am under regional anesthesia?
No.
However, you can give general in combo with regional to do so.
Slide 4
Insensibility caused by the interruption of sensory nerve conduction of a particular region of the body is referred to as ___________?
Regional Anesthesia
You may hear this referred to as “Peripheral Anesthesia” at times.
Slide 4
What are the 3 levels of sedation?
Slide 5
Is deep sedation considered general anesthesia?
Nah…but ‘almost’.
Slide 5
Which doctor tried the ether technique on a patient with two vascular neck tumors?
Crawford Long
Slide 14
Which dentist used ether for denture fitting?
William Morton
Slide 14
When was the first successful public demonstration of ether? The patient was motionless and had no recall.
1846
Slide 15
Dr. Robinson Squibb developed a process for ___________ ether.
Purifying
Slide 15
Ether has a very _____ onset, and even _______ offset.
Slow, Slower
Slide 15
What are the disadvantages of ether?
Flammable
Prolonged induction
Unpleasant, persistent odor
High incidence of nausea/vomiting
(not used in USA anymore)
Slide 16
Who was the first physician to define pain as, “actual or potential tissue damage”?
Sir James Simpson
Slide 17
What did Sir James Simpson experiment with following dinner parties?
Chloroform
Slide 17
True or False: The religious thought back in the day was that women deserved to feel pain during childbirth due to Eve eating the dang apple in the Garden of Eden.
True
Slide 17
Who believed that God liked anesthesia because he made Adam go to sleep when he removed his rib?
Sir James Simpson
Slide 17
Who did Dr. John Snow anesthetize for the birth of her two children, Prince Leopold and Princess Beatrice?
Queen Victoria
Slide 17
Who met due to large numbers of chloroform-associated deaths?
Hyderabad Commissions
Slide 18
In 1888, the Hyderabad commission believed that the deaths associated with chloroform were caused by…
Bad anesthesia providers
Patients not being watched
Patients overdosing
(basically the technique/methods of providers, not necessarily the drug itself)
Slide 18
The Hyderabad Commission that met in 1891 said you could also have _________ before or after respiratory arrest and that’s why deaths occurred from chloroform.
Cardiac arrest
Slide 18
By 1894, who proved that children got liver failure from chloroform?
Guthrie
Slide 18
By 1900, Levy had a series of studies that showed that light chloroform stimulated what?
The autonomic nervous system.
Slide 18
Light chloroform anesthesia stimulating cardiac function can lead to what?
Ventricular fibrillation
Slide 18
What are two major adverse effects of chloroform discussed in class?
Hepatotoxicity
Ventricular fibrillation (Light Chloroform)
Slide 18
Treat the patient holistically (amnesia, analgesia, and muscle relaxant) is referred to as?
The Triad
Slide 24
If you are unconscious, your nerve will not transfer painful stimuli to the brain. True or False?
False
Slide 24
When do we give analgesia, before or after we cause the pain?
Before :)
Slide 24
How does amnesia work?
Stimulating inhibitory transmissions by the use of Acetylcholine
or
inhibiting stimulatory transmissions by the use of GABA.
Slide 25
Why were narcotics not favored in the past?
Due to a lot of respiratory arrests and deaths.
Slide 26
What are some of the synthetic derivatives of opioids?
Fentanyl derivatives, demerol, hydromorphone
Slide 26
What types of analgesia drugs does multimodal pain relief include?
Using Cyclooxygenase inhibitors, Gabapentin, Acetaminophen, and regional/ peripheral nerve blocks other than opioids.
(A lot of CRNA are moving away from using Opioids d/t the increasing crisis)
Slide 26
What plant does morphine come from?
The poppy plant, from which opium is derived from and turned into morphine.
Slide 26
What was used as an anesthetic for eye surgery by Dr. Koller?
Cocaine (slide 19)
Who first used cocaine as a regional nerve block on the mandibular nerve?
Dr. Halsted (Slide 19)
Who performed the first spinal anesthetic with cocaine and developed a regional block technique that is still in use today?
Dr. August Bier.
Developed the Bier Block
(Slide 19)
Who is the “mother of anesthesia” credited with 14,000 open drop either cases without a single death?
Alice Magaw :D (Slide 20)
What are the 5 phases of Anesthesia?
- Preoperative period
- Induction of anesthesia
- Maintenance of anesthesia
- Emergence from anesthesia
- Postoperative period
(Slide 31)
Name one of the first nurse anesthetist that was a nun?
Sister Mary Bernard (Slide 20)
What drugs are involved in the Preoperative period of Anesthesia?
BZD (Anxiety), H1 and H2 blockers (Acid Reflux), bronchodilators (For irritable airways)
(Slide 31)
What drugs are used in the Induction phase of anesthesia?
Etomidate, ketamine, propofol, narcotics.
(Slide 31)
What types of drugs are used in the Maintenance of anesthesia?
Inhalation drugs, neuromuscular blockers, pressors, blockers
(Slide 31)
Name 3 reasons why the first nurse anesthetist were preferred over junior surgeons, surgery assistants, etc.
less pay
intelligent about patient care
attentive to patient care
(Slide 20)
What drugs are used in the Emergence from anesthesia phase?
NMB reversal, local anesthetics
(Slide 31)
Dr. Guedel is known for what contributions to anesthesia?
He was the first person to document anesthesia stages, he created airways and machines for anesthesia!
(Slide 33)
Name the nurse anesthetist who is credited with opening one of the 1st nurse anesthesia schools, taught in France in WW1, and founded AANA?
Agatha Hodgins (Slide 20)
How many stages of anesthesia are there?
Explain each briefly.
4!
Stage I: beginning of induction of general anesthesia to loss of consciousness
Stage II: loss of consciousness to onset of automatic breathing
Stage III: onset of automatic respiration to respiratory paralysis (surgical plane)
Stage IV: stoppage of respiration till death
(You are in too deep!)
(Slide 34)
Name the anesthetic that was discontinued due to its violent explosive properties.
Cyclopropane
(Slide 21)
Describe stage I of anesthesia and the 3 planes involved.
Stage I: beginning of induction of general anesthesia to loss of consciousness
1st plane: no amnesia or analgesia (Remembers everything, still hurting & follows commands!)
2nd plane: amnestic but only partially analgesic (Can still remember and hurt a little)
3rd plane: complete analgesia and amnesia (Does not remember hurting & not hurting, might remember counting backwards/etc.)
(Slide 34)
This anesthetic was known to cause hepatitis and have a slow onset of action.
Halothane
(Slide 21)
What anesthetic has slow onset and slow offset and is relatively safe to give?
What kind of patient would this be best used on?
Isoflurane
This is best used on a patient that will most likely remain intubated for a time period after the procedure. (Hospitalized, ICU pt, etc.)
*I for Isoflurane, Intubated, ICU
(Slide 21)
Describe stage II of anesthesia and its characteristics!
Stage II: loss of consciousness to onset of automatic breathing!
-Eyelash reflex disappears
-Coughing, vomiting, struggling may occur (Aspiration can occur in this stage)
-Irregular respirations with breath-holding
-Will not wake up to sternal rubs!
(Slide 34)
Describe stage III of anesthesia and its four planes.
Stage III: 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)
(Slide 35)
What happens at stage IV of anesthesia?
Stage IV: stoppage of respiration till death (You are in too deep!)
Do not pass go and collect $200!!!
Slide 35
This anesthetic has the most rapid onset and offset of all volatile anesthetics, will evaporate rapidly if spilled and requires a larger amount for desired anesthesia vs. others.
Desflurane
(Slide 22)
Who is known to have performed all of the experimentation on Desflurane and developing “MAC”?
Dr. Edmund Egar
(Slide 22)
What is MAC?
Minimal Alveolar Concentration
This is the “dose” of a volatile anesthetic.
(Slide 22)
Volatile anesthetic that does not irritate the airway? Who is a good population use this on and what is a big factor on how expensive it is?
Sevoflurane
Pediatrics
how much volume is purchased at one time
(Slide 22)
What is no longer a concern of using Sevoflurane?
Creating toxic products from reacting with soda lime in the co2 absorbers that could be breathed back in by the patient.
(Slide 22)
Would you want to extubate during Stage II of anesthesia? Why or why not?
NO! It can cause bronchospasm & the pt is at risk for aspiration during this stage.
Slide 34
If your choice of anesthetic involved poppy plants and coca leaves, cannabis, and inhaling funny fumes around a Greek temple, your birthday is probably between what years?
4000 BC - 400 BC (slide 7)
Your anesthetist decides to turn your carotids into a chokepoint, and they also poke you with needles in order to knock you out for your procedure.
When was this type of “anesthesia” used?
4000 BC - 400 BC.
Carotid compression was used to briefly knock you unconscious. Acupuncture was also a form of treatment.
(Slide 7)
During the time of Hippocrates, around 400 BC, who was the priority, the patient or the surgeon?
The surgeon. The patient was expected to make things as easy for the surgeon/operator as possible. Pt was expected to lie still and not move. (Slide 8)
Who wrote the first pharmacology references?
What was this massive 5 volume work called?
Dioscorides (40-90AD).
This work was called the Materia Medica and listed 360 medical properties of all kinds of plants, animals, minerals, etc.
(Slide 8)
The Materia Medica was in use for how many years?
15 centuries!! (Slide 8)
What was the first true inhalation anesthetic agent?
Diethyl Ether
(slide 10)
What German Botonist, Physician Created Diethyl Ether?
Valerius Cordus
(slide 10)
What is Diethyl ether made from?
Sulfuric acid and ethyl alcohol
(slide 10)
In the early days of anesthesia, this human shaped root and some wine was all you needed.
Mandragora/mandrake root and wine had hallucinogenic, magical properties. (Slide 8)
What does the word “ether” mean?
Ignite. 💥
It would explode
(slide 10)
Why did inhalation anesthetic agents come about first before IV anesthetic agents?
Because the IV was not created yet.
(slide 10)
The Middle Ages brought about some advances in anesthesia, such as inhaled agents. How were inhaled meds given, and what do we call this method of administration?
Soporific is the term used for sponges that you place medicine on and then inhale, with the intention of going into a deep sleep. (Slide 9)
Why did “Diethyl ether recreational parties” become so popular at the time?
Because of the high tax on whiskey and alcohol. Diethyl ether was cheaper and easier to get high on.
(slide 10)
1/2 oz opium, juice of mandrake leaves and hemlock, 3 oz of hyposcyamus (L isomer of atropine), some water was the top soporific of the Middle Ages. What was the reversal agent?
Vinegar (slide 9)
What 2 poeple, who were members of the Royal Society of London, created the first IV therapy?
Sir Christopher Wren and Robert Boyle
(slide 11)
What was the first IV and bag made from?
Goose quill and a bladder
(slide 11)
What was the first “medication” administered IV into a dog’s vein?
:(
drinking alcohol
(slide 11)
Who said: “I have injected wine and ale in a living dog into the mass of blood by a veine, in good quantities, till I have made him extremely drunk, but soon after he pisseth it out.”
Sir Christipher Wren and Robert Boyle
(slide 11)
What English chemist disovered Oxygen and Nitrous Oxide?
Joseph Priestly
(slide 12)
What British chemist suggested that Nitrous Oxide be used for surgical pain control?
Humphry Davy
(slide 12)
What British chemist discovered Potassium, Sodium, Calcium and Magnesium?
Humphry Davy
(slide 12)
Why was Nitrous not taken “seriously” and initially overlooked in its early aesthetic/pain control days resulting in it becoming a recreational entertainment?
Because it did not prevent the patient from moving.
(slide 12)
What dentist used Nitrous during tooth extractions on patients (and on self) where his patients demonstrated they had no “recall” of pain/injury?
Horace Wells
(slide 13)
The early use of Nitrous effects on amnesia was argued by some to be due to what and not actaully from the drug’s anesthetic effect iself?
Hypoxic events. Because Nitrous was being given with just room air.
*and now we know that N2O is very water soluble and creates a huge [ ] gradient in the alveolus for O2 (reason why we need supplemental O2)
(slide 13)
What Chicago, US surgeon was the first to start giving Nitrous AND Oxygen together in anesthesia without cyanosis? (Is now a standard practice in the OR)
Andrews
(slide 13)
Who developed the first anesthesia machine that would give Nitrous AND Oxygen together?
Hewitt
What continent was curare discovered on used by indigenous peoples? And what was curare used for?
South America; used for hunting game and wildlife (Kane said it’s derived from a plant)
(slide 27)
Use of muscle relaxants (like curare) is beneficial to anesthetists because?
decreases the amount of anesthetic needed
(slide 27)
What was once a triad is now a “Quad-ad”, but what 4th factor was added to “Amnesia”, “Analgesia”, and “Muscle Relaxation”?
Homeostasis; we don’t want our BP and/or HR to be all over the place so lets find some homeostasis and keep our pt’s chill
*also why is anesthesia spelled wrong?!
(slide 28)
Name some diagnoses where homeostasis while undergoing intense surgical stimulation would be really important to maintain
Coronary Artery Disease or Cerebral Vascular Disease
(- Kane)
Decreasing the amount of anesthesia due to muscle relaxation leads to a _______ mortality rate.
Decreased
(slide 27)
Surgeon known for un-aliving 3 people from 1 operation and could perform an amputation in under 3 mins.
Dr. Liston ☠️☠️☠️
(slide 29)
Doctor who taught Agatha Hodgins and worked together in France during WWI.
He’s also known for the Cleveland Clinic
Dr. George Crile (1864-1943)
(slide 29)
What technique was Dr. George Crile known for?
Preemptive analgesia using a local anesthetic prior to surgery. (Would use local anesthetic on planned surgical site preop to interfere with pain transmissions up the spinal cord)
Also was a huge fan of light Nitrous/Oxygen anesthesia
(slide 29)
Which Dr. was known for regional blocks prior to emergence from ether; (HINT) He also hated happiness and is responsible for setting the standard to keep anesthesia records (BP/HR measurements)
Dr. Harvey Cushing (1869-1939)
(slide 29)
Define highlights of Neurolept Anesthesia practice.
- high doses of AMNESTICS, such as Haldol/Haloperidol and Droperidol
- less use of volatile and muscle relaxants
- high incidence of awareness & extrapyramidal movements
(slide 30)
Anesthesia technique that resulted in the following:
- blocked ANS
- blocked immune/endocrine response
- high level of awareness
- high incidence of extrapyramidal movements
Neurolept Anesthesia
(slide 30)
Common anesthesia technique in 1980’s that attempted to address the homeostasis (controlling tachycardia and HTN) of intraop pts by utilizing high doses of what med?
Opioids
(slide 30)
What are some drawbacks to the high opioid dose technique in anesthesia?
- Longer postop recovery times
- increased PONV
- decreased respiratory drive
(- Kane)
By the 2000’s what were some anesthesia techniques that are still used today?
- Multimodal techniques (MAGA - Not the racist one)
- Opioid sparing technique
(slide 30)
