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Eric Anesthesia Pharm 2025 > History of Anesthesia > Flashcards

History of Anesthesia Flashcards

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1
Q

Define anesthesia

A

Lack of feeling or sensation
Artificially induced loss of the ability to feel pain
To permit the performance of surgery or painful procedures

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2
Q

Define general anesthesia

A

A drug-induced loss of consciousness. Patients are not arousable; even by painful stimulation

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3
Q

T/F: The term General anesthesia insinuates intubation and mechanical ventilation is necessary

A

False

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4
Q

Considerations for general anesthesia

A

Maintain patent airway
Positive pressure ventilation
Cardiovascular support

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5
Q

Define regional anesthesia

A

Insensibility caused by interrupting the sensory nerve conduction of a particular region of the body (Peripheral, Spinal, Epidural)

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6
Q

Level of consciousness during regional anesthesia

A

unchanged; Ventilatory/airway protection is maintained

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7
Q

Define sedation

A

A spectrum of consciousness between “awake” and “unconscious”

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8
Q

Describe RASC during minimal sedation

A

responsiveness: to verbal commands
airway: unaffected
spontaneous vent: unaffected
Cardio fx: unaffected

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9
Q

Describe RASC during moderate sedation

A

responsiveness: to verbal/touch
airway: no assistance needed
spontaneous vent: adequate
Cardio fx: usually maintained

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10
Q

Describe RASC during deep sedation

A

responsiveness: after repeated touch/stimulation
airway: assistance may be required
spontaneous vent: poss inadequate
Cardio fx: usually maintained

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11
Q

First ever forms of anesthesia

A

Plants…poppy, coca leaves
Acupuncture
Ethylene fumes from geologic fault lines beneath Apollo’s temple
Cannabis vapor
Carotid compression

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12
Q

Beliefs of hippocrates

A

Accommodate the operator
Avoid sinking down and turning away

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13
Q

Who was Dioscorides?

A

Wrote the first pharmacology book; Materia Medica

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14
Q

Describe the Materia Medica

A

Authoritative for 15 centuries
5 volumes; plants, animal and mineral products
360 medical properties (antiseptic, anti-inflammatory)

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15
Q

Features of mandragora and wine

A

Hallucinogenic
Human shaped
Magical properties

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16
Q

What was used in the middle ages as an anesthetic? Reversal?

A

Soporifics….sponges
½ ounce opium
Juice of mandrake leaves
Juice of hemlock
3 ounces of hyposcyamus (L-isomer of atropine)
Sufficient water

Reversal: vinegar

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17
Q

Who discovered diethyl ether?

A

Valerius Cordus

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18
Q

Describe diethyl ether

A

Made from sulfuric acid and ethyl alcohol
Tested on chickens

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19
Q

What does ether mean?

A

greek for “ignite”

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20
Q

T/F: Ether was used recreactionally

A

true

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21
Q

Why were inhalation agents used as the first anesthetics?

A

No IV technology

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22
Q

Who were Sir Christopher Wren and Robert Boyle?

A

Created IV therapy using a goose quill
Administered alcohol into a dog’s vein

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23
Q

Who discovered NO? What was his occupation? Any other discoveries?

A

Joseph Priestly
English chemist; oxygen and photosynthesis

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24
Q

Who was Humphry Davy? occupation?

A

Chemist; Discovered potassium, sodium, calcium, magnesium….
He suggested NO for surgical pain control but it did not take off

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25
Who first noticed amnesia properties of NO? occupation?
Horace Wells ; Dentist Noticed that a man under the influence of N2O had no recall of pain/injury Self administered for tooth extraction and uses on several dental patients
26
Why was use of NO for an amputation at Mass Gen in 1845 not impressive at the time?
The patient moved alot
27
Until what point was anesthesia administered with air? then it was administered with
1868; oxygen
28
Who was the first surgeon to administer NO without cyanosis?
Andrews
29
Who used the 1st anesthesia machine with nitrous/oxygen
Hewitt
30
Who was Crawford Long?
Delivered ether for a patient with 2 vascular neck tumors
31
Who was the dentist that used ether for a denture fitting?
William Morton
32
What year was the 1st successful public demonstration of ether? Where did it take place?
1846; Mass Gen Ether Dome
33
Why was the 1st successful public demonstration of ether considered "lucky"?
poor inhaler fit, no IV access, prolonged emergence, variable quality
34
What were Dr. Robinson Squibb's contributions?
Developed process for pure ether (1856) Founded Squibb pharmaceuticals….leading manufacturer
35
Disadvantages of ether
Flammable Prolonged induction Unpleasant, persistent odor High incidence of nausea/vomiting
36
What year was choloform discovered?
1831
37
who Defined pain: “actual or potential tissue damage”?
Sir James Simpson
38
An OB that experimented with chloroform following a dinner party
Sir James Simpson
39
Who was Dr. John Snow?
Full time anesthetist; “discovered” epidemiology when he traced London cholera outbreak to water source; delivered Queen Victoria's babies with choroform
40
Why was there controversy with chloroform?
cardiac deaths to. healthy individuals
41
The country Hyderabad studied almost 600 cases of what anesthetic and what did they conclude?
Chloroform; that its safe if given correctly, in smaller doses and if the patient is monitored for changes
42
When did chloroform fall out of favor and why?
about 1900; delayed hepatotoxicity in children and discovery of fatal vf in animals
43
3 physicians that used cocaine as an anesthetic?
Dr. Koller (eye surgery) Dr. Halsted (regional mandibular nerve block) Dr. August Bier (spinal anesthetic)
44
1st nurse anesthetist
Sister Mary Bernard
45
Why were nurses ideal as anesthetists?
Low pay Intelligent Focus
46
Who was the mother of anesthesia? what was she known for?
Alice Magaw; 14,000 open drop ether cases without death
47
Who was Agatha Hodgins ?
Opened one of 1st nurse anesthesia schools Taught in France Developed nitrous/oxygen techniques Founded AANA
48
Name and years of "recent" anesthetics?
cyclopropane 1934 halothane 1956 isoflurane 1981 desflurane 1992 sevoflurane 1995
49
issue with cyclopropane?
Violently explosive
50
issues with halothane
Hepatitis Slow onset
51
Discovery of isoflurane benefits?
Relatively safe Less nausea and vomiting Quicker onset than halothane
52
Describe desflurane
Rapid uptake and distribution! (most rapid onset and offset) High vapor pressure Large quantity to achieve anesthesia
53
What did Edmund Egar discover?
End-tidal concentration correlated to movement….MAC
54
Describe sevoflurane
Intermediate action between isoflurane and desflurane Unstable in soda lime; toxic degradation product concerns No new inhaled anesthetics since
55
What is the triad of anesthesia?
amnesia analgesia muscle relaxation
56
What causes amnesia?
Either Stimulation of inhibitory transmissions or Inhibiton of stimulatory transmissions (usally Ach and GABA)
57
What year was morphine first used
1805 from opium
58
Why were opiates initially not in favor?
high death rate
59
Today's analgesics?
Narcotics (opioids) Cyclooxygenase inhibitors Gabapentin (pregabalin) Acetaminophen Peripheral nerve blocks
60
First muscle relaxant
Curare in 1942
61
Why was there decreased mortality with use of muscle relaxants?
Decreased amount of anesthesia due to relaxation
62
Balanced anesthesia components?
amnesia analgesia muscle relaxation homeostasis
63
Who was Dr. Liston?
Believed surgical cases needed to be 20 min and less. Had 3 deaths from one amputation operation
64
Who was George Crile?
Cleveland clinic Light nitrous/oxygen anesthesia Local infiltration of procaine
65
Who was Harvey Cushing?
Regional blocks prior to emergence from ether Anesthetic records, BP/HR measurements
66
What was neurolept anesthesia in 1959 and what were the issues?
Opioids, antipsychotics (Haldol, droperidol), nitrous Blocked autonomic and endocrine response to stress High incidence of awareness, dysphoria, extrapyramidal movements
67
Describe anesthesia in the 1980s
- surgical stimulation produced despite lack of movement - Tachycardia - Hypertension - Insignificant? Except with CAD…. beta blockade - High dose opioid technique
68
What is the problem with the high dose opiod technique?
Pt takes a long time to wake up
69
What changes to anesthesia in the 2000s?
Opioid sparing techniques “multi modal” techniques
70
What are the phases of anesthesia?
- Preop period - Induction of anesthesia - Maintenance of anesthesia - Emergence from anesthesia - Post op period
71
Meds given during preop period
BZD, H1 and H2 blockers, bronchodilators
72
Meds given during induction period
Etomidate, ketamine, propofol, narcotics
73
Meds given during maintenance phase
Inhalation drugs, neuromuscular blockers, pressors, blockers
74
Meds given during emergence phase
NMB reversal, local anesthetics
75
What is stage 1 of anesthesia? Planes?
beginning of induction of general anesthesia to loss of consciousness -1st plane: no amnesia or analgesia -2nd plane: amnestic but only partially analgesic -3rd plane: complete analgesia and amnesia
76
What is Stage II of anesthesia? characteristics? Patient is at high risk of what during this stage?
loss of consciousness to onset of automatic breathing - eyelash reflex disappears -coughing, vomiting, struggling may occur -irregular respirations with breath-holding High risk of aspiration
77
What stage should the patient move quickest in and out of?
stage II
78
What is stage III of anesthesia? Planes?
onset of automatic respiration to respiratory paralysis (surgical plane)
79
4 planes of Stage III of anesthesia?
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)
80
What is stage 4 of anesthesia?
stoppage of respiration till death

Eric Anesthesia Pharm 2025 (9 decks)

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