Overview Of Anesthesia Flashcards
Who was the pioneer of chemistry?
Joseph priestly (1773)
Who coined the term “laughing gas” and what was it
Humphrey Davy & nitrous oxide
Who associated ether with the potential for anesthesia?
Crawford Long (1842)
In 1844 Horace Wells used what for a tooth extraction?
N2O
Who received credit for the first ether anesthetic
Morton in 1846 at mass general
First anesthetist
John snow
Who had first OB anesthetic performed on them
Queen Victoria in 1850
When was Na Lyme developed
1927
First nurse known to have specialized in anesthesia:
Sister Mary Bernard at St Vincent’s hospital in Erie PA in 1887
“Mother of anesthesia” for mastery of open drop ether
Alice Magow
First court ruling that threatened nurses providing anesthesia
Frank vs South of 1917
Nurses won
When was NANA founded and by who
Agatha Hodgins in 1934
AANA
founded by Agatha hodgins
Located in Illinois
4 month program
First certification exam developed
1945
CRNA credential adopted
1956
When was the first certification exam done via computers
1996
Three categories of anesthesia
MAC
Regional
General
MAC
monitored anesthesia care
Local sedation
Anesthesia on standby
Regional
Bier block
Epidural
Spinal
Axillary block
Scalene block
General
MAsk
LMA
ETT
Inhalation agents
Isoflurane
Sevoflurane
Desflurane
Isoflurane
Forane
Sevoflurane
Ultane
Desflurane
Suprane
What determines the selection of the type of anesthesia?
Patient condition
Surgical procedure
Patient preference
Surgeon preference
What is the ideal agent?
Stable in: temperature, humidity, light
Nonflammable in air, O2, N2O
Easily handled in liquid and gas forms
Potent
Ideal agents:
Poorly soluble in blood- rapid induction
Nontoxic
Not metabolized
Minimal side effects
No adverse interactions
Occurs when anesthetizing partial pressure achieved in the brain
Induction
3 characteristics of anesthesia
Amnesia
Analgesia
Akinesia
What are grundel’s signs
Stage 1 amnesia
Stage 2 delirium
Stage 3 surgical plane
Stage 4 overdose
Explain MAC
Minimum alveolar concentration of inhalation agent at 1 atmosphere which prevents movement in 50% of the subjects in response to a noxious stimuli
How much MAC do you need to prevent movement in 95% of patients
1.2-1.3
Strengths of N2O
Analgesia, rapid uptake/elimination, little cardiac/respiratory depression
Weaknesses of N2O
Expansion closed air space
Effect on B12 metabolism limits fio2
N/v
Toxic
Carcinogenic to provider and pregnant patients
Strengths of Isoflurane
Good muscle relaxation
Stable cardiac rate/rhythm
Weaknesses of Isoflurane
Pungent odor that cannot be used for mask induction or maintenance
Strengths of Desflurane
Rapid induction/ emergence
Weaknesses of Desflurane
Difficult to handle
New vaporizer
Costly
Strengths of Sevoflurane
Similar to Isoflurane
Can use for mask induction of adults or peds
Weaknesses of Sevoflurane
Unstable in CO2 absorbers
Metabolized to fluoride
New vaporizer
Costly
Causes fires
Thiopental
Barbiturate
3-5mg/kg/IV
Methohexital (brevital)
Barbiturate
1-1.5mg/kg/IV
kids rectally 25mg/kg
Can be used in propofol shortage
Midazolam (versed)
Benzodiazepine
1-3 mg IV
Etomidate (amidate)
Nonbarbiturate
0.2-0.3mg/kg/IV induction
No analgesic effects
Good for unstable cardiac patient or hypovolemic patient
Ketamine
Dissociative
1-2mg/kg/IV
Interferes with communication between limbic and thalamus
No resp depression
Bronchodilator
Propofol (diprivan)
Hypnotic
2-2.5mg/kg/IV induction
20-200mcg/kg/min infusion
Describes drugs which bind to morphine receptor
Useful for induction
Used for maintenance with inhalation
Opioids
Effect of mu2. Receptor
Depress ventilation
Decrease HR
physical dependence
Euphoria
Muscle rigidity
Narcan (naloxone)
Pure competitive antagonist for mu
Dose 20-40 mcq IV
peak 1-2 min
Duration 30-45 min
Flumazenil (Mazicon)
Pure benzodiazepine antagonist
Dose 0.2-1mg Q1 min
Inhalation agent
Faster and better and less side effects than other agents
Halothane (1956)
Caused renal issues
Methoxyflurane (1959)
Caused seizures in EEGs
Enflurane (1972)
Faster for onset and emergency and had less side effects than the previous
Isoflurane (1980)
______ and other nurses provided anesthesia during the Civil War
Catherine S Lawrence
(1861-1865)
____ organized lakeside general hospital school of anesthesia in Ohio
Agatha Hodgins
Dexmedetomidine (precedex)
Loading- 0.5-1mcg/kg IV over 10 min
Onset 10-20 min
Infusion: 0.4-0.7 mcg/kg/hr
Intraoperative anesthetic dose of fentanyl
2-50mcg/kg IV
Intraoperative anesthetic dose of sufentanil
0.25 mcg/kg IV
Intraoperative anesthetic dose of morphine
0.03-0.15 mg/kg IV
