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Anesthesia Pharmacology > Lecture 1 - Intro, History & Vocab (Test 1) > Flashcards

Lecture 1 - Intro, History & Vocab (Test 1) Flashcards

1
Q

An artificially induced lack of feeling or sensation to pain can be described as _____?

A

Anesthesia
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2
Q

What is the purpose of using anesthesia?

A

To permit the performance of surgery or painful procedures.
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3
Q

What is General Anesthesia?

A

A drug-induced loss of consciousness.
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4
Q

Are patients arousable by painful stimuli under general?

A

No!
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5
Q

Do patients have to be intubated or vented under general?

A

Nope.
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6
Q

What typically becomes obstructed under general?

A

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)
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7
Q

Does the patient have to be breathing a volatile anesthetic to be considered under general anesthesia?

A

Nah.
Can use IV anesthetics to induce General!

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8
Q

When it comes to billing - I can bill anything that alters the patients LOC as General Anesthesia. True or False?

A

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.

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9
Q

Peripheral, spinal or epidural can be referred to as what type of anesthesia?

A

Regional
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10
Q

Does my LOC change if I am under regional anesthesia?

A

No.
However, you can give general in combo with regional to do so.
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11
Q

Insensibility caused by the interruption of sensory nerve conduction of a particular region of the body is referred to as ___________?

A

Regional Anesthesia

You may hear this referred to as “Peripheral Anesthesia” at times.
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12
Q

What are the 3 levels of sedation?

A

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13
Q

Is deep sedation considered general anesthesia?

A

Nah…but ‘almost’.
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14
Q

Which doctor tried the ether technique on a patient with two vascular neck tumors?

A

Crawford Long
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15
Q

Which dentist used ether for denture fitting?

A

William Morton
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16
Q

When was the first successful public demonstration of ether? The patient was motionless and had no recall.

A

1846
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17
Q

Dr. Robinson Squibb developed a process for ___________ ether.

A

Purifying
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18
Q

Ether has a very _____ onset, and even _______ offset.

A

Slow, Slower
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19
Q

What are the disadvantages of ether?

A

Flammable
Prolonged induction
Unpleasant, persistent odor
High incidence of nausea/vomiting
(not used in USA anymore)
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20
Q

Who was the first physician to define pain as, “actual or potential tissue damage”?

A

Sir James Simpson
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21
Q

What did Sir James Simpson experiment with following dinner parties?

A

Chloroform
Slide 17

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22
Q

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.

A

True
Slide 17

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23
Q

Who believed that God liked anesthesia because he made Adam go to sleep when he removed his rib?

A

Sir James Simpson
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24
Q

Who did Dr. John Snow anesthetize for the birth of her two children, Prince Leopold and Princess Beatrice?

A

Queen Victoria
Slide 17

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25
Q

Who met due to large numbers of chloroform-associated deaths?

A

Hyderabad Commissions
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26
Q

In 1888, the Hyderabad commission believed that the deaths associated with chloroform were caused by…

A

Bad anesthesia providers
Patients not being watched
Patients overdosing
(basically the technique/methods of providers, not necessarily the drug itself)
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27
Q

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.

A

Cardiac arrest
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28
Q

By 1894, who proved that children got liver failure from chloroform?

A

Guthrie
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29
Q

By 1900, Levy had a series of studies that showed that light chloroform stimulated what?

A

The autonomic nervous system.

Slide 18

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30
Q

Light chloroform anesthesia stimulating cardiac function can lead to what?

A

Ventricular fibrillation
Slide 18

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31
Q

What are two major adverse effects of chloroform discussed in class?

A

Hepatotoxicity
Ventricular fibrillation (Light Chloroform)

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32
Q

Treat the patient holistically (amnesia, analgesia, and muscle relaxant) is referred to as?

A

The Triad
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33
Q

If you are unconscious, your nerve will not transfer painful stimuli to the brain. True or False?

A

False
Slide 24

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34
Q

When do we give analgesia, before or after we cause the pain?

A

Before :)
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35
Q

How does amnesia work?

A

Stimulating inhibitory transmissions by the use of Acetylcholine
or
inhibiting stimulatory transmissions by the use of GABA.
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36
Q

Why were narcotics not favored in the past?

A

Due to a lot of respiratory arrests and deaths.
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37
Q

What are some of the synthetic derivatives of opioids?

A

Fentanyl derivatives, demerol, hydromorphone
Slide 26

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38
Q

What types of analgesia drugs does multimodal pain relief include?

A

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

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39
Q

What plant does morphine come from?

A

The poppy plant, from which opium is derived from and turned into morphine.
Slide 26

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40
Q

What was used as an anesthetic for eye surgery by Dr. Koller?

A

Cocaine (slide 19)

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41
Q

Who first used cocaine as a regional nerve block on the mandibular nerve?

A

Dr. Halsted (Slide 19)

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42
Q

Who performed the first spinal anesthetic with cocaine and developed a regional block technique that is still in use today?

A

Dr. August Bier.
Developed the Bier Block
(Slide 19)

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43
Q

Who is the “mother of anesthesia” credited with 14,000 open drop either cases without a single death?

A

Alice Magaw :D (Slide 20)

44
Q

What are the 5 phases of Anesthesia?

A
  1. Preoperative period
  2. Induction of anesthesia
  3. Maintenance of anesthesia
  4. Emergence from anesthesia
  5. Postoperative period
    (Slide 31)
45
Q

Name one of the first nurse anesthetist that was a nun?

A

Sister Mary Bernard (Slide 20)

46
Q

What drugs are involved in the Preoperative period of Anesthesia?

A

BZD (Anxiety), H1 and H2 blockers (Acid Reflux), bronchodilators (For irritable airways)
(Slide 31)

47
Q

What drugs are used in the Induction phase of anesthesia?

A

Etomidate, ketamine, propofol, narcotics.
(Slide 31)

48
Q

What types of drugs are used in the Maintenance of anesthesia?

A

Inhalation drugs, neuromuscular blockers, pressors, blockers

(Slide 31)

49
Q

Name 3 reasons why the first nurse anesthetist were preferred over junior surgeons, surgery assistants, etc.

A

less pay
intelligent about patient care
attentive to patient care
(Slide 20)

50
Q

What drugs are used in the Emergence from anesthesia phase?

A

NMB reversal, local anesthetics
(Slide 31)

51
Q

Dr. Guedel is known for what contributions to anesthesia?

A

He was the first person to document anesthesia stages, he created airways and machines for anesthesia!
(Slide 33)

52
Q

Name the nurse anesthetist who is credited with opening one of the 1st nurse anesthesia schools, taught in France in WW1, and founded AANA?

A

Agatha Hodgins (Slide 20)

53
Q

How many stages of anesthesia are there?
Explain each briefly.

A

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)

54
Q

Name the anesthetic that was discontinued due to its violent explosive properties.

A

Cyclopropane
(Slide 21)

55
Q

Describe stage I of anesthesia and the 3 planes involved.

A

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)

56
Q

This anesthetic was known to cause hepatitis and have a slow onset of action.

A

Halothane
(Slide 21)

57
Q

What anesthetic has slow onset and slow offset and is relatively safe to give?
What kind of patient would this be best used on?

A

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)

58
Q

Describe stage II of anesthesia and its characteristics!

A

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)

59
Q

Describe stage III of anesthesia and its four planes.

A

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)

60
Q

What happens at stage IV of anesthesia?

A

Stage IV: stoppage of respiration till death (You are in too deep!)

Do not pass go and collect $200!!!

Slide 35

61
Q

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.

A

Desflurane
(Slide 22)

62
Q

Who is known to have performed all of the experimentation on Desflurane and developing “MAC”?

A

Dr. Edmund Egar

(Slide 22)

63
Q

What is MAC?

A

Minimal Alveolar Concentration

This is the “dose” of a volatile anesthetic.

(Slide 22)

64
Q

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?

A

Sevoflurane
Pediatrics
how much volume is purchased at one time

(Slide 22)

65
Q

What is no longer a concern of using Sevoflurane?

A

Creating toxic products from reacting with soda lime in the co2 absorbers that could be breathed back in by the patient.

(Slide 22)

66
Q

Would you want to extubate during Stage II of anesthesia? Why or why not?

A

NO! It can cause bronchospasm & the pt is at risk for aspiration during this stage.

Slide 34

67
Q

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?

A

4000 BC - 400 BC (slide 7)

68
Q

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?

A

4000 BC - 400 BC.

Carotid compression was used to briefly knock you unconscious. Acupuncture was also a form of treatment.

(Slide 7)

69
Q

During the time of Hippocrates, around 400 BC, who was the priority, the patient or the surgeon?

A

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)

70
Q

Who wrote the first pharmacology references?

What was this massive 5 volume work called?

A

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)

71
Q

The Materia Medica was in use for how many years?

A

15 centuries!! (Slide 8)

72
Q

What was the first true inhalation anesthetic agent?

A

Diethyl Ether

(slide 10)

73
Q

What German Botonist, Physician Created Diethyl Ether?

A

Valerius Cordus

(slide 10)

74
Q

What is Diethyl ether made from?

A

Sulfuric acid and ethyl alcohol

(slide 10)

75
Q

In the early days of anesthesia, this human shaped root and some wine was all you needed.

A

Mandragora/mandrake root and wine had hallucinogenic, magical properties. (Slide 8)

76
Q

What does the word “ether” mean?

A

Ignite. 💥
It would explode

(slide 10)

77
Q

Why did inhalation anesthetic agents come about first before IV anesthetic agents?

A

Because the IV was not created yet.

(slide 10)

78
Q

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?

A

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)

79
Q

Why did “Diethyl ether recreational parties” become so popular at the time?

A

Because of the high tax on whiskey and alcohol. Diethyl ether was cheaper and easier to get high on.

(slide 10)

80
Q

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?

A

Vinegar (slide 9)

81
Q

What 2 poeple, who were members of the Royal Society of London, created the first IV therapy?

A

Sir Christopher Wren and Robert Boyle

(slide 11)

82
Q

What was the first IV and bag made from?

A

Goose quill and a bladder

(slide 11)

83
Q

What was the first “medication” administered IV into a dog’s vein?
:(

A

drinking alcohol

(slide 11)

84
Q

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.”

A

Sir Christipher Wren and Robert Boyle

(slide 11)

85
Q

What English chemist disovered Oxygen and Nitrous Oxide?

A

Joseph Priestly

(slide 12)

86
Q

What British chemist suggested that Nitrous Oxide be used for surgical pain control?

A

Humphry Davy

(slide 12)

87
Q

What British chemist discovered Potassium, Sodium, Calcium and Magnesium?

A

Humphry Davy

(slide 12)

88
Q

Why was Nitrous not taken “seriously” and initially overlooked in its early aesthetic/pain control days resulting in it becoming a recreational entertainment?

A

Because it did not prevent the patient from moving.

(slide 12)

89
Q

What dentist used Nitrous during tooth extractions on patients (and on self) where his patients demonstrated they had no “recall” of pain/injury?

A

Horace Wells

(slide 13)

90
Q

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?

A

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)

91
Q

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)

A

Andrews

(slide 13)

92
Q

Who developed the first anesthesia machine that would give Nitrous AND Oxygen together?

A

Hewitt

93
Q

What continent was curare discovered on used by indigenous peoples? And what was curare used for?

A

South America; used for hunting game and wildlife (Kane said it’s derived from a plant)

(slide 27)

94
Q

Use of muscle relaxants (like curare) is beneficial to anesthetists because?

A

decreases the amount of anesthetic needed

(slide 27)

95
Q

What was once a triad is now a “Quad-ad”, but what 4th factor was added to “Amnesia”, “Analgesia”, and “Muscle Relaxation”?

A

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)

96
Q

Name some diagnoses where homeostasis while undergoing intense surgical stimulation would be really important to maintain

A

Coronary Artery Disease or Cerebral Vascular Disease

(- Kane)

97
Q

Decreasing the amount of anesthesia due to muscle relaxation leads to a _______ mortality rate.

A

Decreased

(slide 27)

98
Q

Surgeon known for un-aliving 3 people from 1 operation and could perform an amputation in under 3 mins.

A

Dr. Liston ☠️☠️☠️

(slide 29)

99
Q

Doctor who taught Agatha Hodgins and worked together in France during WWI.
He’s also known for the Cleveland Clinic

A

Dr. George Crile (1864-1943)

(slide 29)

100
Q

What technique was Dr. George Crile known for?

A

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)

101
Q

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)

A

Dr. Harvey Cushing (1869-1939)

(slide 29)

102
Q

Define highlights of Neurolept Anesthesia practice.

A
  • 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)

103
Q

Anesthesia technique that resulted in the following:
- blocked ANS
- blocked immune/endocrine response
- high level of awareness
- high incidence of extrapyramidal movements

A

Neurolept Anesthesia

(slide 30)

104
Q

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?

A

Opioids

(slide 30)

105
Q

What are some drawbacks to the high opioid dose technique in anesthesia?

A
  • Longer postop recovery times
  • increased PONV
  • decreased respiratory drive

(- Kane)

106
Q

By the 2000’s what were some anesthesia techniques that are still used today?

A
  • Multimodal techniques (MAGA - Not the racist one)
  • Opioid sparing technique

(slide 30)

Anesthesia Pharmacology (20 decks)

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