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93 Cards in this Set
- Front
- Back
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Coined phrase "anesthesia is a sleep like state that allows for painless surgery"
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Oliver Wendell Holmes
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Who demonstrated ether in Massachusetts at the Ether dome
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William Morton
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Who invented the first vaporizer
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William Morton
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What is anesthesia
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medical/physical manipulation that makes a patient not sensitive to pain
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How were most anesthetics trialed
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as recreational chemicals
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What were some of the early anesthetics
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opium, alcohol, coca leaves, phlebotomy, nerve compression, cold, and speed
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what was made from poppy seeds
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opium
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used to cure altitude sickness
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coca leaves
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how was phlebotomy used
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to bleed them dry then operate
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what was the problem with nerve compression
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may cause permanent damage
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who used speed as a trait for surgery
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Listen- killed 3 in one surgery
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who produced diethyl ether
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Valerius Cordus
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Ether was first developed as what
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recreational drug
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Use of ether in Europe can be directly related to what
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ETOH tax
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Diethyl ether was made from what
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alcohol and sulfuric acid
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How did Valerus Cordus test his diethyl ether
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put chickens to sleep and wake them back up
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who discovered photosynthesis
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Joseph Priestly
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who accuratley discovered how to produce and store nitrous oxide
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Joseph Priestly- burning of mercuric oxide
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Who did extensive research on nitrous oxide and published a book on NO2 and its effects on the body
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Humphrey Davy- it soothed his tooth ache
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who was the first person to call nitrous oxide laughing gas
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Humphrey Davy
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where did samuel colt learn to make nitrous oxide
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working in a tanning factory
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what are the properties of nitrous oxide
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never a liquid must be stored as a gas
not easy to prepare, purify, or store, would give you a good buzz and is very addicting |
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What patent did Samuel Colt have
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Colt Revolver patent- went on a traveling show tour to earn money
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who perfected chloroform by purifying, detailing and publishing it
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Jean Baptiste Andre Dumas
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Problem with chloroform
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narrow margin of error, produced lots of nausea, and more toxic than ether
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who delivered the first paid ether anesthetic during what type of procedure?
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Crawford Long- during a vascular tumor removal from the neck but didnt publish findings
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How did Long compare his analgesic efficacy
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by amputating two fingers of a slave child without the use of ether
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Who called himself the professor of chemistry and went on a traveling show to show off nitrous oxide
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Gardner Colton
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What dentist failed in his demonstration to extract a tooth using nitrous oxide and why
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Horace Wells- didnt use enough nitrous oxide
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Who trained William Morton in nitrous oxide anesthesis
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Horace Wells
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what was the first vaporizer
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a glass, pull over tube into which an ether soaked sponge could be placed
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Who is credited for delievering the first ether anesthetic
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William Morton- colored it orange
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Who established the process of donating body to science
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Edmund Andrews- A&P Professor
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what did Andrews learn from dissecting bodies
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That humans need oxygen delivered with the anesthetic- he put 20% oxygen with his anestheic gases to provide for the metabolic requirements while administering anesthesia
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Who worked with chloroform for the relief of childbirth pain
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Sir James Simpson
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Who explained that pain came from tissue damage and is not only an emotion
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Sir James Simpson
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Who gave chloroform to Queen Victoria during the birth of Prince Leopold
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Dr. John Snow
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Who is considered to be the first anesthesiologist
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Dr. John Snow- taught other physicians to give anesthesia and started developing it as a specialty
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What drug causes Vfib adn increased mortalitiy
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chloroform
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What was the "Blessing of the Age"
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Chloroform during Childbirth
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Who was the first lady to graduate nursing school- 1st nurse
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Nightingale
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Who introduced Carbolic acid to clean instruments
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Lister
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Who introduced the Germ Theory
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Pasteur
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Who worked together to bring cleanliness to the operating room
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Nightingale, Lister, Pasteur
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Who was the first nurse anesthetist
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Sister Bernard
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What are the traits of a good anesthetist
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observant, trained in patient care and not expecting to be a surgeon
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What is drug induced unconsciousness
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when a patient doesn't perceive or recall
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What is important to be able to study and manipulate anesthesia
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must be able to measure it - example is faces pain scale
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Why were people dying because of anesthesia in the beginning
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part time anesthesia providers
Infection |
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Why did nurses patients survive more than Dr's patient
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Cleanliness of the nurses
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Who is the founder of the AANA
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Agatha Hodgins- canadian who did post graduate work in anesthesia
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Who is the Mother of Anesthesia
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Alice Magaw- 14000 anesthetics delivered without a death
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What % of anesthesia is administered by a CRNA
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75%
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Who should administer the anesthetic
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Someone who is:
good at it pays attention to detail has an adequate education cares well for their patient is a team player |
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What is the ideal anesthetic
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Rapid onest
side-effect free 100% reversible cheap Provide all 4 components of balanced anesthesia |
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What are the 4 components of Balanced Anesthesia
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Analgesic
Muscle Relaxation Amnesia Physiologic homeostasis |
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What is anlegisic
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pain control
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What two types of responses to pain do we have
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Somatic response-dermatome man
Autonomic Response-response of our vital signs to painful stimuli |
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What do most post-op complications come from
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not blunting the sympathetic response to stress
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What is the #1 post surgical complication
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DVT
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What is the cost of SNS response
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Hypermetabolism, Icreased cardiac workload, Impaired pulmonary function, Pain, Decreased GI motility, Hypercoagulation, Immunosuppression (Cortisol), Loss of muscle mass (catabolism), Decreased cognition
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What does decreased GI motility lead to
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infection from bacterial trasmigration- sepsis
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Visceral response to pain
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organ pain
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how do you get no movement to surgical stimulation
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Muscle relaxation
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what muscles relax
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skeletal
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What is retrograde amnesia
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loss of recall of previous instances before anesthesia given- this does not exist
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what is the loss of the ability to recall past experiences
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amnesia
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When does amnesia begin
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antegrade- when the drug gets to the receptor site in sufficient quantity to have a physiologic action and continues for a certain period of time
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What is physiologic homeostasis
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is the patient positioned correctly- is the IV working well- what are the Vital Signs- what is the urine output
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unconscious
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not following verbal commands
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Consciousness
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allows patients to respond to verbal commnands
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what is recall
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the retention of memory from perceived experiences
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What effects do sedatives have
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calming and soothing effect- may or may not be amnistic
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what is a hypnotic
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a drug that induces a sleep-like state
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can a patient be aware without having recall
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yes aware is just knowing whats going on around you
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What are the five phases of an anesthetic
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Pre-operative Period
Induction of anesthesia maintenance of anesthesia emergence from anesthesia post operative period |
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when is the most critical time for anesthesia incidences
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during the maintenance phase due to lack of attention
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What all did Dr. Arthur Guedel develop
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had four stages of anesthesia accepted doctrine
eye signs for anesthesia further defined the third stage into 4 planes Invented the cuffed ETT |
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Why did Guedel invent the cuffed ETT
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wanted to do low flow anesthesia- proved he could isolate the airway by submerging his dog into a fish tank
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What are the four stages of anesthesia
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Analgesia
Delirium Surgical Medullary Paralysis |
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Describe stage 1- analgesia
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Typical narcotized state
patient still conscious has smooth ventilation(guarding own airway) all reflexes intact some relief from pain |
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Describe stage 2- delirium
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excitement stage and begins with loss of conciousness
ventilations are irregular- sensitive airway patient may have motion nystagmus present- excitable pupils |
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What can happen during delirium stage
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bronchospasm, laryngospasm
vomit from very little stimulus airway is vulneralbe do not extubate room should be quite during this stage |
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Describe stage 3- surgical
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4 planes
plane I- respirations are smooth, regular, and deep lots of eye movements Plane II- IV - patient will go through remaining planes - pupils will dilate respirations get shallower, all protective airway reflexes are lost but patient is still breathing on his/her own |
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Describe stage 4- Meduallary Paralysis
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overdose-
cardiovascular and respiratory collapse Death |
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if patient is anesthetized adequately and you are giving an inhaled anesthetic what will the patient do upon incision
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Take a nice deep breath- which will deepen anesthesia
if not patient will hold breath and not breath any anesthetic and become lighter |
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How can you tell if a patient is deep enough to remove the airway
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if you suction the pharyngeal are and they dont hold their breath
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Balanced anesthesia stage I
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analgesia (Preliminary Induction)- sedate with opiods, benzo, or start inhaled GA
Preoxygenate |
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Balanced anesthesia stage II
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Excitement (transition)(Induction of General Anesthesia)
Administer IV GA +/- NMB or continued inhaled GA Secure airway, treat hiccoughs, myoclonus, decerebrate posturing, and masseter spasms |
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Balanced anesthesia stage III
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General Anesthesia (Maintenance of GA)
Adjust IV or inhaled GA, +/- opiods, +/- NMB. Avoid under dosing and overdosing |
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Last stage of balanced anesthesia
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reenter stage II- (Emergence from GA)
stop IV or inhaled GA and reverse NMB Treat breath holding, laryngospasm, vomiting and shivering PRN |
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Who redefined the elements relevant to anesthesia stating the muscle relaxation is not a logical part of anesthesia
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Prys Roberts
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What did Prys Roberts Depth of Anesthesia Chart contain
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Somatic and Autonomic Response to Pain
He stated that anesthesia should be classified according to the physical responses to pain rather than the drugs we are administering |
