Anesthesia
Anesthesia
Nero(AD 37-65) – greek and roman surgeons gave the potion of condemned (Wine And Vinegar)
Ambroise Pare – compression of blood vessels and nerves near surgical site in 16th century
Also found out that half frozen soldiers have higher pain threshold
Refrigeration anesthesia was revived in 1941 for amputation in world war II.
Joseph Priestley (1733-1804) – Laughing gas - NO2 and O2 combination
Crawford Williamson Long – administered the 1st ether anesthetic
James Simpson – instituted the use of chloroform anesthesia in 1847
Friedrich Trendelenburg – ET Anesthesia
Chevalier Jackson – Laryngoscope
Harvey Cushing – founded the unconscious/unaware anesthesia
Ether synthesized in 1540 by Cordus
Ether used as anesthetic in 1842 by Dr. Crawford W. Long
Ether publicized as anesthetic in 1846 by Dr. William Morton
Chloroform used as anesthetic in 1853 by Dr. John Snow
Local anesthesia with cocaine in 1885
Thiopental first used in 1934
Curare ( a muscle paralyzing agent) first used in 1942 - opened the “Age of Anesthesia”
Types of Anesthesia
General Anesthesia
Association pathway are broken in the cerebral cortex to produce more or less complete lack of sensory perception
and motor discharge
Unconsciousness is produced when blood circulating to the brain contains an adequate amount of anesthetic agent.
General anesthesia results in an immobile, quiet patient who does not recall the procedure.
Stages of General Anesthesia
From To Patient’s Reaction Nursing Action
Regular respiration
Position patient and prep
Surgical Loss of reflexes; Contracted pupils
skin only when
Anesthesia Depression of vital Reflexes disappear
anesthesiologist indicates
Relaxation function Muscle relax
this stage in reached
Auditory sensation loss
Danger Stage Prepare for
Respiratory failure; Not breathing
Vital functions cardiopulmonary
possible cardiac arrest Little or no pulse or heartbeat
too depressed resuscitation
Inhalational anesthesia refers to the delivery of gases or vapors from the respiratory system to produce anesthesia
Pharmacokinetics--uptake, distribution, and elimination from the body
2. Intravenous
A drug that produce hypnosis, sedation, amnesia and or analgesia that is injected directly into the circulation, usually
via the peripheral vein.
Nitrous Oxide
Halothane
Enflurane
Developed in 1963 by Terrell, released for use in 1972
Stable, nonflammable liquid
Pungent odor
Enflurane Systemic Effects
Potent inotropic and chronotropic depressant and decreases systemic vascular resistance-- lowers blood
pressure and conduction dramatically
Inhibits sympathetic baroreflex response
Sensitizes myocardium to effects of exogenous catecholamines-- arrhythmias
Respiratory drive is greatly depressed-- central and peripheral responses
increases dead space
widens A-a gradient
produces hypercarbia in spontaneously breathing patient
Isoflurane
Synthesized in 1965 by Terrell, introduced into practice in 1984
Not carcinogenic
Nonflammable,pungent
Less soluble than halothane or enflurane
Thiopental
Barbiturate
Water soluble
Alkaline
Dose-dependent suppression of CNS activity--decreased cerebral metabolic rate (EEG flat)
Noncompatibility
Tissue necrosis--gangrene
Tissue stores
Post-anesthetic course
Etomidate
Structure similar to ketoconozole
Direct CNS depressant (thiopental) and GABA agonist
Ketamine
Structurally similar to PCP
Interrupts cerebral association pathways -- “dissociative anesthesia”
Stimulates central sympathetic pathways
Propofol
Rapid onset and short duration of action
Myocardial depression and peripheral vasodilation may occur-- baroreflex not suppressed
Not water soluble-- painful (50%)
Minimal nausea and vomiting
Benzodiazepines
Produce sedation and amnesia
Potentiate GABA receptors
Slower onset and emergence
Diazepam
Often used as premedication or seizure activity, rarely for induction
Minimal systemic effects-- respirations decreased with narcotic usage
Not water soluble-- venous irritation
Metabolized by liver-- not redistributed
Lorazepam
Slower onset of action (10-20 minutes)-- not used for induction
Used as adjunct for anxiolytic and sedative properties
Not water soluble-- venous irritation
Midazolam
More potent than diazepam or lorazepam
Induction slow, recovery prolonged
May depress respirations when used with narcotics
Minimal cardiac effects
Water soluble
Naloxone is pure antagonist that reverses analgesia and respiratory depression nonselectively-- acts 30 minutes,
effects may recur when metabolized
Muscle Relaxants
Current use of inhalational and previous intravenous agents do not fully provide control of muscle tone
First used in 1942-- many new agents developed to reduce side effects and lengthen duration of action
Mechanism of action occurs at the neuromuscular junction
Neuromuscular Junction
Local Anesthetics
Followed general anesthesia by 40 years
Koller used cocaine for the eye in 1884
Halsted used cocaine as nerve block
First synthetic local-- procaine in 1905
Lidocaine synthesized in 1943
Local Anesthetics
Mechanism of action is by reversibly blocking sodium channels to prevent depolarization
Anesthetic enters on axioplasmic side and attaches to receptor in middle of channel
Local Anesthetics
Linear molecules that have a lipophilic and hydrophilic end (ionizable)
low pH-- more in ionized state and unable to cross membrane
adding sodium bicarb-- more in non-ionized state
Cocaine
South American Indians used to induce euphoria, reduce hunger, and increase work tolerance in sixth century
Many uses in head and neck-- strong vasoconstrictor,no need for epinephrine
Mechanism is similar-- blocks sodium channel, also prevents uptake of epinephrine and norepinephrine
Cocaine
May lead to increased levels of circulating catecholamines-- tachycardia, peripheral vasoconstriction
Safe limits (200-400 mg)-- use with epinephrine clinically