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history of AnesthesiA And introduction to the speciAlty ● 17 Figure 2.1 “Ether Day, 1846” Pictured are Gilbert Abbott (the patient), John Collins Warren, MD (the surgeon), William T. G. Morton (the anesthetist) and Henry J. Bigelow, MD (the junior surgeon). Painting by Warren and Lucia Prosperi. Photograph by Andrew Ryan. Reproduced with permission from Massachusetts General Hospital, Archives and Special Collections. (Fig. 2.1). This demonstration occurred at the Massachusetts General Hospital on October 16, 1846 inside what is known today as the “Ether Dome.” After administering the ether, Morton said to Dr. John Collins Warren, the surgeon: “Your patient is ready, sir.” Under general anesthesia, Dr. Warren removed a congenital vascular malformation from 20-year-old Edward Gilbert Abbott’s neck. After the surgery, the patient replied, “I did not experience pain at any time, though I knew that the operation was proceeding.” Dr. Warren then famously remarked, “Gentlemen, this is no humbug.” This demonstration was indeed a landmark in the history of anesthesia. Before anesthesia, surgery was considered a terrifying last resort, and without adequate pain control available (agents such as alcohol, morphine, herbals were used with variable success), surgeons were judged by their speed and patients had to be strapped down and endure excruciating pain. Anesthesia made it possible for surgeons to take more time to do a better job, and to perform more complex operations. The success of ether anesthesia was welcomed by the public as the “greatest gift ever made to suffering humanity.” Dedicated to the discovery
18 ● AnesthesiA student survivAl Guide Figure 2.2 The Ether Monument, Boston, Massachusetts. (Photograph J. Ehrenfeld, M.D.). of ether and reliable anesthesia, “The Ether Monument” was constructed in Boston Public Garden in 1868 to commemorate the first public demonstration of inhalational anesthesia (Fig. 2.2). Chloroform and the Queen In addition to ether, another agent, chloroform, was introduced into clinical practice by James Simpson in 1847. Although chloroform was more potent and easier to use, it had significant side effects. However, it was John. Y. Snow who
Page 2 and 3: Anesthesia Student Survival Guide
Page 4 and 5: Editors Jesse M. Ehrenfeld, MD, MPH
Page 6 and 7: Foreword As anesthesiologists and H
Page 8 and 9: Contents Case Studies xvii Section
Page 10 and 11: ContEntS ● xi 19 Physiology and A
Page 12 and 13: Contributors Basem Abdelmalak, MD S
Page 14 and 15: David C. Lai, MD Partner, Allenmore
Page 16 and 17: CASE STUDIES In order to focus your
Page 18 and 19: CASE StUDIES ● xix inhalation ane
Page 20 and 21: CASE StUDIES ● xxi around the job
Page 22 and 23: CASE StUDIES ● xxiii ● Although
Page 24 and 25: CASE StUDIES ● xxv ● You plan a
Page 26 and 27: CASE StUDIES ● xxvii ● What oth
Page 28 and 29: CASE StUDIES ● xxix Chapter 23 Ca
Page 30 and 31: CASE StUDIES ● xxxi of her left h
Page 32 and 33: CASE StUDIES ● xxxiii speechless.
Page 34 and 35: CASE StUDIES ● xxxv things go ver
Page 36 and 37: How to Be a “Star” Student, Car
Page 38 and 39: hOw tO Be A “stAr” student, CAr
Page 40 and 41: Pre-Op Holding Area Preoperative Ev
Page 48 and 49: History of Anesthesia and Introduct
Page 52 and 53: history of AnesthesiA And introduct
Page 60 and 61: Pharmacology Section II
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The Preoperative Patient Evaluation
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THe PreoPerATIve PATIenT evAluATIon
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Therapy-based indications radiation
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Table 8.5 Formulation an anesthetic
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Anesthesia Equipment and Monitors B
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AnesthesiA eQuiPment And mOnitOrs
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● ● ● AnesthesiA eQuiPment An
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Table 11.3 Data typically obtained
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Anesthetic Techniques: General, Sed
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Anesthetic techniques: GenerAl, sed
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Table 12.2 Stages of general anesth
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Table 12.6 (continued) Anesthetic t
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Anesthetic Techniques: Regional Ant
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Figure 13.2 Surface anatomy for neu
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Table 13.1 Risks of neuraxial anest
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Anesthetic techniques: reGionAl ●
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Table 14.6 Advantages, disadvantage
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Table 14.11 Transfusion of bloodpro
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Chapter 15 IV, Gastric Tube, Arteri
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iv, GAstric tube, ArteriAl & centrA
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Common Intraoperative Problems Fran
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Pneumothorax Uncommon, but may spon
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COMMON INTRAOPERATIVE PROBLEMS ●
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Table 16.3 Common intraoperative dy
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Table 16.3 (continued) Problem Diff
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Systems Physiology and Anesthetic S
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Chapter 20 Physiology and Anesthesi
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PhysioloGy And AnesthesiA for Gener
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Anesthesia for Urological Surgery P
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AnesthesiA for uroloGicAl surGery
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Physiology and Anesthesia for Pedia
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PhysioloGy And AnesthesiA for PediA
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Table 22.6 Common pediatric emergen
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Physiology and Anesthesia for Elder
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PhysioloGy And AnesthesiA for elder
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Chapter 24 Ambulatory Surgery and O
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AmbulAtOry Surgery ANd Out-Of-Or (O
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Perioperative Acute and Chronic Pai
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PerioPerAtive ACute And ChroniC PAi
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Chapter 27 Postoperative Anesthesia
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POstOPerAtive AnesthesiA CAre unit
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Introduction to Critical Care Bever
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introduction to criticAl cAre ● 4
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SVR = [(MAP - CVP)/CO] ´ 80 introd
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● ● ● ● ● introduction to
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Chapter 29 Professionalism, Safety,
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ProfessionAlism, sAfety, And teAmwo
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Chapter 30 Quality Assurance, Patie
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QuAlity AssurAnce, PAtient And Prov
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Chapter 32 Clinical Simulation in A
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Table 32.1 Matrix of categories of
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CliniCAl simulAtion in AnesthesiA e
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ASA Difficult Airway Algorithm Appe
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518 ● ANESTHESIA STUDENT SURVIVAL
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