Term
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Definition
First coined the term anesthesia, make the patient insensate and not remember the pain from surgical anesthesia. Not his son**its senior not jr.
Did a lot to get docs to know moving from pt that were dead to alive ones it carried a fever. |
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| Anesthesia started with "trial and error" |
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Definition
Cocoa leave
alcohol
opium
phlebotomy-bleed them until they are unconscious
nerve compression
cold-we do this now* |
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Term
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Definition
ether-known before him but he was credited with it bc he did extensive writing and investigating into it.
distilled sulfuric acid in alcohol.
Chickens went to sleep when he and paraclesious were working with the ether.
Credited with discovering ether. |
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Term
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Definition
| had ether frolicks..breath from a pig bladder with a straw. The frolick was actually nitrous oxide because ether is breathed in from a liquid on a cloth.. |
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Definition
Nitrous Oxide. Burning ammonium and iron filings. Why?? concerned with unhealthy air at the time. wanted "healthier air" in their patients.
invented photosynthesis. Trained as a clergy man and was a chemist
(2ns and an o) |
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Term
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Definition
| spas with fresh air..500 pg book. get rid of problems in the air. recreational chemical. noticed it relieved bad headaches and normal headaches. thought it might be good for relieving surgical pain. looked at ether a little too. coined the phrase "laughing gas" |
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Definition
| tinning factory nitrous oxide. interested in makine $$ to apply to us gov patent. would sell wiffs of nitrous oxide on the road to raise money for patent for revolver. Ended up selling revolvers (gun) during the civil war. |
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Term
| John Baptiste Andre Dumas |
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Definition
investigated usage and published chlorophorm. produced as a naturally occuring form as seaweed. Comes in plexi glass today. As a gas found to be a good anesthetic. Took the place of Ether. Dumas did not use it as a gas..just discovered its usage.
american-guthrie. using it to set bones |
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Term
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Definition
| worked as a doc. We dont know his education. Gave the first ether surgery for removal of neck tumor. **first paid anesthetic. $2.00** but didnt publish his work. (Pain vs surgery without pain) |
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Definition
| used ether to ease the pain of tooth extracted. Never allowed to experiment on hospital pt again. Ether didnt work. |
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Definition
| dentist, watched a traveling show demonstrating nitrous oxide. Got with Colton and had Wells give him nitrous oxide while Wells had his tooth pulled. Wells shows how this could be used for surgery. in order to be a complete anesthetic you need 103% nitrous on. The reason this failed is there was no nurse in the room. This failed but no one asked the patient about feeling pain..he actually never felt pain |
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| better fit dentures but it was painful. Took lessons from Horrace Wells. Met Charles Jackson the chemist and told him to try ether. Good cause ether transports as a liquid vs nitrous as a gas. Did presentation at Ether Dome. was late to his presentation bc waiting on device to be made. changed the color and added a scent. |
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Term
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Definition
| respiratory stimulant, soluble (blood picked it up nicely) ether bond makes an anesthetic very cardiac stable. |
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Term
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Definition
| A and P professor. Oxygen in nitrous oxide wasn't available to pt. Added oxygen to circuit added 20%. In jail on several occasions for cadaver thieves. Added oxygen to circuit and was a body snatcher. |
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Term
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Definition
| Redefined "pain". actual or potential tissue damage. Before this pain we deserved for someone who did something wrong. wanted something easier than ether..took too long. Explored chloroform. Popularized chloroform.. |
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Definition
| 1st Anesthesiologist. Gave Queen Victoria chloroform for her childbirth. It worked and she promoted it. |
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Definition
brought infection a long way. First middle to upper class well educated women to go to nursing school. Died of Syphilis.
Helped with infection by washing your hands and cleaning after each patients when they left. |
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Term
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Definition
Wash everything with carbolic acid.
Pastour- discovered there were things that could be boiled out of things like milk and alcohol. |
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Definition
| 1st nurse anesthetist. post graduate on the job anesthesia training. |
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Definition
| (1 of 2 ladies of anesthesia) Dr Mayos nurse, understood research and publishing and training of nurse anesthetist. Published 14000 cases of anesthisia with no anesthetic fatalities. Surgeons promoted nurse anesthesia after her publications. Some physicians thought it was a lucrative field and doc didnt know if they agreed with anesthesia being in anesthesia. |
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Term
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Definition
| (1 of 2 ladies of anesthesia)organizing nurse anesthetist. started American Association of Nurse Anesthetist. originally was nationaly and 1933 became AANA. |
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Term
| Components of an ideal anesthetic? |
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Definition
(loss of ability to feel pain to make surgery possible.)
1.high efficacy on a broad range of humans
2.drug-easy to admin,work fast on and off,few side effects, lowest concentrations possible, cheap too. |
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Term
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Definition
| perform a thorough and complete pre assessment. Responsibility of pt begins here. Emergency is the ONLY exception to this. |
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Term
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Definition
| obtain conformed consent, reasonable risk and hazards. Discuss risk and anesthesia option to pt in a language they understand. Must document that consent was obtained on your anesthesia record. This is not implied consent..only time implied consent is ok is EMERGENCY. |
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Term
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Definition
| formulate pt specific plan of care. Must include: surgery they are having wishes of pt physical condition of pt, current anesthesia practice and preferences of surgeon. All of it in the plan! Dont drop the doc! VIP |
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Term
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Definition
implement and adjust the care based on patients physiological response.
#1 time for adverse anesthesia incedence is during maintenance. |
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Term
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Definition
Monitor the pts physiologic conditions as appropriate for the type of anesthesia and specific pt needs. "constance attendance"
Monitor heart- 5 lead EKG, and auscultation, record blood pressure and heart rate q5 min.
Monitor oxygenation continously
clinical obseration, pulse ox and ABG analysis
Monitor Ventilation continuously. verify intubation of the trachea by auscultation, chest excursion, and end tidal CO2. If you hold their airway open with ANYTHING (hand) --> monitor end tidal CO2.
Temp: monitor of peds always under general anesthesia!
NMB agent: monitor status and function of this. clinical signs and symptoms are not ok. MUST have nerve stimulator!
Monitor positioning-protective measures
ABA rule! Always blame anesthesia |
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Term
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Definition
| complete accurate and timely documentation of pertinent info on the pt medical record. Dont write how you feel.. write how you checked something. Dont write all monitors and alarms on. thats a given. provides retrospective review and research data, and establishes a MEDICAL LEGAL RECORD |
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Term
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Definition
| transfer the responsibility for care of the pt to other qualified providers in a manner which assures continuity of care and pt safety. (taking the patient to recovery. "know when the pt is safe to transfer" Give report and make sure pt is stable to hand off. |
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Term
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Definition
Adhere to appropriate safety precautions as established within the instituition to minimize the risk of fire explosion electrical shock and equipment malfunction. document on medical record that the anesthesia machine and equipment were checked.
inspect machine and monitor
monitor integrity of the breathing system. **alarms must be on** |
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Term
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Definition
Precautions shall be taken to minimize the risk of infection to the patient, CRNA and other healthcare providers.
"Infection control" |
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Term
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Definition
anesthesia care shall be assessed to assure its quality and contribution to positive pt outcome.
*review on an ongoing basis
incorporate new techniques and knowledge into practice. |
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Term
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Definition
pre op (what your are going to give here)
plan and implement (entire process)
General Regional Local and MAC(monitored anesthesia care) monitoring but not actually give the anesthesia
Manage all medications, airway, fluid
discharge from operation
post op eval
chronic and acute pain management
emergency response team member |
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Term
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Definition
respect and maintain basic rights of patients.
personal dignity and ethical norms. |
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Term
| One of 4 components..what is analgesia? |
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Definition
stop physical sensation and also sympathetic response to that pain.
Somatic-easy to localize usually along spinal nerves, sharp pain pt can put their finger on it.
Visceral-pain of internal organs. usually duller achy and hard to get rid of, Summative diffuse and many ways of climbing the spinal cord, and you have more than 1 way of treating this pain. |
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Term
| One of 4 components...Amnesia |
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Definition
def:to not remember. Recall is perception with learning..
retrograde amnesia: causes you to loose ability of what happened before the drug was administered. (ex pentathol)THIS DOES NOT EXIST!
Many meds that diminish recall from the time they are given.
Ante grade amnesia: diminishes recall that precedes form the time med begins to work until it wears off. |
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Term
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Definition
calms and relaxes you, sedative properties exist in a lot of medicines.
Hypnotic- puts you to sleep.
propofol can do both. |
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Term
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Definition
| retention of memory. There is a difference between aware and recall. Know whats going on but will not remember it tomorrow. |
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Term
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Definition
ability to be verbally responsive. Its not motion, (what surgeon thinks) they are not aware or recall but they are breathing.
It is: responding to verbal commands.
Difference b/w conscious sedation and anesthesia!
Awake-->respond to verbal commands. |
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Term
| One of 4 components..muscle relaxation |
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Definition
| we want to paralyze skeletal muscles. not just so pt wont cough..essential drastically dec tissue damage on intubation, facilitate surgical exposure, does not provide amnesia or analgesia. Component of anesthetic* Always use them unless contraindicated. |
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Term
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Definition
Physiologic Homeostasis: rest of the patient. what nurses are best at
fluid status
heart rate
body temp
blood count/oxygen delivery to tissue.
anything outside of what the surgeon is fixing. |
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Term
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Definition
| optimum balance of all physical systems. |
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Term
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Definition
| sympathetic response, inc in heart rate, inc in blood pressure, "stress response" fight or flight. Body is protecting itself from danger at a huge cost to the human being. |
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Term
Cost of SNS activation $$
"stress response" |
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Definition
Catabolic state of metabolism
preferential salvage of glucose for brain metabolism
increased cardiac workload
impaired pulm function
initial excitement will allow
decreased GI
hypercoag->shark bite blood needs to clot
immunosuppression-giving steroids
loss of muscle mass-convert to burning muscle and fat for fuel.
decreased cognition |
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Term
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Definition
decreasing catabolic state of metabolism and post op complications.
Decrease MI if you decrease work load of heart
dec post op pnueomia-dec stress on lungs
improved long term wound healing-decrease immunosuppression and glucose levels.
#1 complication in MOST is DVT-sig morbity 80% of pt in orthopedic surgeries could have this happen if we dont help this component. |
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Term
| Five phases of anesthetic |
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Definition
pre op
induction
maintenance
emergence from anesthesia
post op period
* our goal here is managing these steps with medications.
in each phase consider all 4 components
you may omit but consider all of them |
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Term
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Definition
pre op
consider homestasis
pain control
muscle relaxation
amnesia
decide what your patient needs |
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Term
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Definition
depth of anesthesia
four stages anesthesia
developed eye signs of anesthesia
further defined 4th stage into 4 planes
Developed cuff on ET tube.
Intubated his puppy Airway. "dunk dog experiments"
Wanted to teach providers to be aware and observant of their patient. |
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Term
stage 1 of anesthesia
Analgesia |
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Definition
| 1. analgesia-dose of anesthesia is low enough to cause pain control. |
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Term
stage 2 of anesthesia
Delirium |
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Definition
hear most about in the OR and everywhere!
*Anesthesia will put inhibitory asleep before excitatory in the brain. so all patients go through excitation phase.
Begins when they are unconscious and ends when they are in surgical anesthesia. At this time loud noises in the room will cause bronchospasm, pt will have nystagmus,dilated instead of constricted, erratic breathing. Dont have normal upper airway protecting mechanism.
old times.. room really quiet to prevent bronchospasms.
One that concerns us the ** pt moves down through this stage and when waking up they come through this too.
Nice easy rhythmic breathing they made it out of here.if not they are still in stage 2. (holding their breath) |
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Term
stage 3 of anesthesia
Surgical |
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Definition
deep enough for relaxation, marked moderate severe.
Thoracic surg
C section
Intra abdominal surg
resp pattern regular
pupils smaller
no upper airway reflexes. |
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Term
stage 4 if anesthesia
Overdose |
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Definition
| medullary paralysis, overdose and you'll kill them |
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