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history of AnesthesiA And introduction to the speciAlty ● 19 popularized the use of chloroform for obstetric anesthesia. He was one of the first physicians to study and calculate dosages for the use of ether and chloroform, and personally administered chloroform to Queen Victoria when she gave birth to the last two of her nine children. By the end of the nineteenth century, many other advances in the field of anesthesia followed, as shown in Table 2.1. With the discovery of the local anesthetic properties of cocaine, infiltration anesthesia, nerve blocks, spinal, and epidural techniques were introduced. By the turn of the century, there were many advances in the area of airway management, such as orotracheal tubes used for intubation, laryngoscopes, and bag-mask ventilation devices. Soon, various intravenous induction agents were introduced, allowing patients to go off to sleep quickly, resulting in a more pleasant experience. Newer and better muscle relaxants became widely available, followed by safer and more clinically useful inhalational agents. Today, anesthesia is very safe, with mortality as low as 4–5 deaths per million of anesthetic administrations. This improvement in safety is in large part due to better patient monitoring, modern anesthetic drugs and equipment, and constant vigilance by the anesthesia provider. Monitors The earliest monitor was simply a finger on the pulse. Virginia Apgar (an anesthesiologist at Columbia who developed the now famous Apgar Score for newborns) had a case where she didn’t realize that the pulse she was feeling was her own, and the patient unfortunately had a poor outcome. When ECG machines came into being, they were not available in every room. One hospital in Sheffield, England had to borrow one from the university hospital a mile down the road – and someone to interpret the ECG as well! When President Kennedy was brought into the Parkland emergency room after being fatally shot, Buddy Giesecke (who later became Chairman of Anesthesia at the University of Texas) had to go to the anesthesia workroom to get the ironically named “bullet” cardioscope, which required him to push needle electrodes into the President. At the same time, Jim Carrico (a surgery resident who had just finished an anesthesia rotation) intubated the President’s trachea, but had neither pulse oximetry nor capnography at his disposal. Pepper Jenkins (who was Chair of Anesthesiology at UT Southwestern in Dallas at the time) helped recreate these scenes in Oliver Stone’s movie JFK, where Jenkins plays himself.
20 ● AnesthesiA student survivAl Guide Table 2.1 Historical dates of note. 1500 Bc the use of opium-like preparations in anesthesia recorded in the ebers papyrus 1275 ether discovered by spanish chemist raymundus lullius 1540 the synthesis of ether was described by German scientist valerius cordus 1665 first intravenous injection of an opiate through a quill 1773 Joseph priestly introduces nitrous oxide 1842 crawford W. long successfully uses ether during neck tumor excision in Jefferson, Georgia 1845 horace Wells publicly demonstrates the use of nitrous oxide in Boston – however, it is labeled a “failure” 1846 William t.G. Morton shows first successful public demonstration of ether anesthesia at Massachusetts General hospital, Boston. 1847 James young simpson uses chloroform for labor pain 1853 John snow administers chloroform to Queen victoria during childbirth 1878 William Macewan introduces oro-tracheal intubation with a flexible brass tube 1884 carl Koller discovers local anesthetic properties of cocaine 1889 August Bier describes spinal anesthesia for surgery 1894 Anesthetic charts introduced 1905 long island society of Anesthetists founded 1921 fidel pagés describes a lumbar approach to epidural anesthesia 1932 first barbiturate, hexobarbital, used clinically 1941 robert Miller and sir robert Macintosh introduce “Miller” and “Macintosh” blade concepts, respectively 1942 harold Griffith uses curare for the first time during an appendectomy 1956 Michael Johnstone introduces halothane, a halogenated inhalational agent 1960s fentanyl, ketamine and etomidate synthesized 1977 propofol is synthesized 1970s pulse oximeter is developed and becomes widely available for use in 1980s 1980s halothane gradually replaced by enflurane and isoflurane 1983 Archie i.J. Brain introduces laryngeal Mask Airway (lMA) 1986 AsA house of delegates passes “standards for Basic Anesthetic Monitoring” resolution 1990s sevoflurane and desflurane introduced into clinical practice 2000s Anesthesia information Management systems (AiMs) come into widespread use Airway Management Everyone rotating through anesthesia wants to learn how to intubate, but it is more important to learn the way to effectively bag-mask ventilate a patient. Early general anesthetics were given by “open drop” masks and required great
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 50 and 51: history of AnesthesiA And introduct
Page 60 and 61: Pharmacology Section II
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70 ● AnesthesiA student survivAl
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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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