Anesthesia Hx Flashcards
(43 cards)
Anesthesia Definition
Lack of feeling/sensation ; artificially induced loss of the ability to feel pain –> great for permitting surgery!
General Anesthesia
DRUG-INDUCED loss of consciousness. Pt. not arousable, ventilatory function often impaired, cardiovascular function may be impaired
Regional Anesthesia
Insensibility caused by interrupting the sensory nerve conduction of a specific region of the body
Ex:
Peripheral
Spinal
Epidural
Level of consciousness unchanged. Ventilatory, airway protection is maintained
Sedation
A “spectrum” of consciousness between awake and unconscious
Sedation Scale
Minimal:
Responsiveness = to verbal commands
Airway, spont. ventilation, cardiovascular function = UNAFFECTED
Moderate:
Responsiveness = to verbal, touch
Airway = No assistance needed
Spont. Ventilation = Adequate
Cardiovascular function = usually maintained
Deep:
Responsiveness = repeated or painful stimulation
Airway = assistance may be required
Spont. Ventilation = possibly inadequate
Cardiovascular function = usually maintained
Hippocrates
Accommodate the operator, “make it easy on the surgeon” rather than the patient
Dioscorides
Wrote Materia Medica which was used for 15 centuries; 360 medical properties (ie antiseptic, anti-inflammatory, etc)
Big on “Mandragora” –> Human shaped plant with “magical” and hallucinogenic properties
The Middle Ages
for sedation/analgesia, a common cocktail was mixed on a “soporifics,” ie sponges. This included:
-opium
-mandrake juice (harry potter plant)
-hemlock juice
-hyposcyamus (L-isomer of atropine)
-water
Reversal:
-inhaled vinegar (like ammonium salts)
Diethyl Ether
“Ether”
-first inhaled anesthesthetic (volatile anesthetic)
-made from sulfuric acid and ethyl alcohol
-ether: Greek for “ignite”
- Super flammable
-tested on chickens & dogs
- habit/addiction forming
Valerius Cordus
German botanist/physician who discovered ether
Why were volatile anesthetics first utilized before IV inducing agents?
IV “technology,” ie angiocatheters, IV tubing, etc was not yet available at the time.
Christopher Wren and Robert Boyle
- used a goose quill to create IV therapy
-administered alcohol into a dog’s vein - Members of the Royal Society of London
…“[paraphrase] I injected wine into a living dog, he was extremely drunk, he pisseth it out.”
Joseph Priestly
-English chemist
-discovered oxygen and nitrous oxide
- discovered photosynthesis
Humphry Davy
-English chemist
- discovered potassium, sodium, magnesium, etc.
-suggested nitrous oxide be used for surgical analgesia
- no one believed it. Became used recreationally
Horace Wells
-Dentist
-Noticed that under the influence of n2o, people have no recall of pain/injury
-Self administered n2o for tooth extraction and used it on several patients
-“humbug” –> because it’s not a paralytic and patients can still move when n2o is administered, it fell out of favor
Nitrous oxide
- volatile anesthetic
-analgesic and amnestic properties
-initially administered with air, now mixed with pure oxygen to prevent hypoxia
Andrews
-Chicago surgeon
-administered nitrous oxide with oxygen. No cyanosis!
Hewitt
-1st anesthesia machine with nitrous oxide/oxygen
Other guys who used Ether
Crawford Long:
- used ether for patient with 2 neck tumors
- also used whiskey with ether…. nice
William Morton:
- Dentist who used ether for denture fittings
First public display of the use of ether
-1846
- “Ether Dome” at Mass General in Boston
- Within 60 days, the use of ether had spread “across the pond”…. from America to Europe
- inhaler fit poorly, no way to quantify the ether that was actually inhaled.
- no IV access. No way to save the patient if they lost their BP lol
- Emergence from the use of ether was very prolonged
Dr. Robinson Squibb
-developed process for pure ether
- founded Squibb pharmaceuticals
What sucks about ether?
-flammable
-prolonged induction
-n/v, prolonging their stay in the hospital
Chloroform
-discovered in many different places around the same time. USA, France, Germany, Great Britain
-caused controversy d/t deaths of healthy individuals who underwent anesthesia from chloroform
-Hyderabad commissions 1888 and 1891; found that chloroform is actually pretty safe with proper administration and monitoring. Many deaths occurred without patient monitoring
-hepatotoxic in children, light administration seems to cause adrenaline spike, leading to fatal vf seen in animals
Sir James Simpson
-OB who used chloroform
- pain the result of “actual or potential tissue damage”
- Face religious opposition to his use of chloroform during child birth
