Nurse Anesthesia History Exam 3

Magaw Publishes

"Observations in Anesthesia" in the Northwestern Lancent (1899 - about more than 3000 cases) "Observations of 1,092 cases from January 1, 1899 to January 1, 1900" "A review of over 14,000 surgical anesthetics" Interestingly, these articles reported the use of open- drop ether in over 14,000 anesthetics without a fatality.

In 1800 Davy wrote?

"as nitrous oxide in its extensive operation, appears to be capable of destroying physical pain, it may probably be used during surgical operations in which no great effusion of blood takes place". Sadly, he never followed up on his own supposition, & the discovery of modern anesthesia was still more than 40 years away.

Alice Magaws words:

'talk him to sleep', with the addition of as little ether as possible. We have one rule; patients are not allowed to talk, as by talking or counting, patients are more apt to become noisy & boisterous. Never bid a patient to "breathe deep," for in so doing, a feeling of suffocation is sure to follow, & the patient

Early Administration of Ether

-Early on, Ether was usually administered by a disinterested medical student, nurse, orderly, or some other individual, none of whom had any formal instruction in anesthesia. Induction was compared to asphyxiation, & patients struggled so much they had to be held down. Morbidity & mortality were encountered as a result of poor anesthetic technique.

Crawford W. Long (1815-1878)

-Never received full credit for discovery of ether during his life 1879: National Eclectic Medical Association declared that Long was the official discoverer of anesthesia

Discovery Wars

-No sooner was Morton's discovery made public (published in 12/1846 issue of Medical Examiner), than Crawford Long of Georgia, Horace Wells, & Charles Jackson vied for credit as the first to discover anesthesia. -Wells committed suicide, - Morton died in poverty of apoplectic seizures & CVA, -Jackson spent the last several years of his life in an insane asylum.

John Snow (1813-1858); England

-Queen Victoria was administered chloroform (by Snow) for the birth of Prince Leopold in 1853 - It was believed that women were to follow the Biblical advice that "in sorrow shall thou bring forth children"; thus, having anesthesia for childbirth was an anathema. But, if the Queen, who was also considered as head of the church, could have anesthesia for childbirth, others could, too.

Chloroform lessened use

-The clinical use of chloroform decreased & was eventually eliminated with the discovery of increasingly safer general inhalation anesthetics such as halothane (Fluothane), enflurane (Ethrane), methoxyflurnae (Penthrane), isoflurane (Forane), sevoflurane (Ultane), & desflurane (Suprane).

In 1936, Alice Magaws articles were cited as evidence in?

-a California civil suit that supported the contention that when administering anesthetics, nurses do not illegally practice medicine.

Joseph Priestly

-an English Unitarian minister, scientist, philosopher, & author -discovered oxygen (O2) in 1771 -isolated nitrous oxide (N2O) in 1772

Alice Magaw (1860-1928)

-used towels saturated with ether or chloroform, nearly suffocating the patients. Magaw was introduced to *open-drop ether by a visiting German surgeon*. It was a means of gradually introducing the irritating ether vapor into the respiratory tract & titrating the level of anesthesia. She had also tried using chloroform, N2O, scopolamine, & morphine, but favored ether. Because Alice Magaw was so skilled with this technique, she became known internationally as the "mother of anesthesia".

Ether anesthesia

-was considered safer than Chloroform, due to the side effects they each produced. -Chloroform was a cardiovascular depressant. -Ether was a *cardiovascular stimulant*. -With ether, the heart rate increased. -Ether was *not a respiratory depressant*. - Ether given in small doses with room air as vehicle -Ether was easy to formulate & transport, as well as to administer

Catherine S. Lawrence (1820-1904)

-was the *first nurse to administer anesthesia, during the Civil War (1861-1865)*. -During the Battle of Bull Run, she administered chloroform to wounded soldiers for emergency operations in the battlefield.

Horace Wells (1815-1848): Later years & Death

1/20/1845: Failed N2O demonstration at Massachusetts Gen hospital 1/1848: Moved to NY City; left wife & son in Hartford Began self-experimenting with ether & chloroform Became addicted to chloroform 1/21/1848: threw sulfuric acid on 2 prostitutes in street → NY's Tombs Prison As influence of drug waned, his mind started to clear Asked guards to escort him to house to get his shaving kit 1/24/1848 - Committed suicide in his cell by slitting his left femoral artery with a razor, after inhaling an analgesic dose of chloroform

Death from Anesthesia

1/28/1848*: The first fatality directly attributed to chloroform anesthesia (Hannah Greener) United Kingdom; healthy 15 year old girl Had successfully undergone diethyl ether anesthetic several months before for removal of a toenail Received chloroform for removal of another toenail Likely death due to overdose, aspiration of the water & brandy used to try to resuscitate her, or some combination

Chlororform invented:

1831

Florence Henderson

1904; trained at Mayo to become anesthetist

Frank Mccechan

1917- MDA--petitioned to medical board--anesthesia was practice of medicine Dr. Crile--defended CRNA's 1917**physician supervision first mentioned here

Dagmar Nelson Case

1934 ruling that Nelson and hospital were not in violation of the CA medication practice act. never acted independently; under supervision

Nurse anesthesia education post WW2

1945--> first NA certification exam

AANA implemented accreditation of NA programs in..

1954

Mandatory CE became effective

1978

MDA timelines 1936 1939 1940 1945 1955

36: name changed to American* Society of Anesthetist* 39: first anesthesia examinations given* 40: AMA recognized specialty 45: name changed to Anesthesiologists* 55: jubilee year

Chloroform

5 stages: 1 - The patient became insensible but retained consciousness. 2 - The patient entered a lethargic state in which some pain could be felt. *3 - The patient was physically incapable & could feel no pain.* 4 - The patient exhibited strenuous breathing & complete muscle relaxation. 5 - The patient suffered an (often fatal) paralysis of the chest muscles.

Anesthesia was first administered for Mayos brothers by?

Edith Graham (1867-1943).

Sir James Young Simpson (1811-1870)

First physician to demonstrate anaesthetic properties of chloroform on humans -1847: Simpson first demonstrated use of chloroform on humans, during experiment with friends. -This induced the loss of consciousness necessary for painless surgery. Chloroform was non-flammable & relatively rapid at producing anesthesia

court cases againest CRNAS

Frank V South-1917 Montana MDA V Montana BON 2007 Cali MDA V Brown 2012

Charles T. Jackson (1805-1880)

Gave chemistry lectures at Harvard to William T. G. Morton (about 1844), introducing him to the anesthetic properties of ether. Pamphlet prepared by Lord brothers, who were Jackson's attorneys, engaged to investigate & substantiate the legality of Jackson's claims to priority in the use of sulphuric ether for surgery (1848)

1930's anesthesiologist

MDA to differentiate movement to abolish NA when competition for work grew

Chloroform disadvantages

The quantity of chloroform required to differentiate stage 3 from stage 5 was small. Great skill was required to administer *chloroform safely, as the fatal dose was only ~30 ml*. Even if the patient survived the operation, 'delayed chloroform poisoning' could lead to problems such as liver damage. Chloroform is now regarded as a possible cause of cancer.

1922, Alice Hunt

Yale appointed to instructor

first elected president of NANA

agatha hodgins 1931-33

According to Virginia Thatcher, surgeons turned to nurses because they wanted people who would?

be satisfied with a subordinate role that the work required make anesthesia their one absorbing interest not look on the position of the anesthetist as one that put them in a position to watch & learn from the surgeon's technique accept comparatively low pay have the natural aptitude & intelligence to develop a high level of skill in providing the smooth anesthesia & relaxation the surgeon demanded

Lakeside Hospital

cleveland OH surgeon, George Crile, asked Agatha Hodgins to become first anesthetist combines nerve block with N2O

1990 reform

clinton signed crnas could practice without physician supervision-->next month rescinded by Bush

Horace Wells (1815-1848)

eliminating pain by inhalation of NO2 1844 used N20 on himself in 1844, painlessly. -1/20/1845: Demonstrated to surgeon, John Collins Warren & medical students at Massachusetts General Hospital (MGH) in Boston. -Patient screamed, demonstration failed, declared a hoax for another 60 years N20 wouldnt be used.

Helen Lamb

founded and directed Barnes school of anesthesia in St Louis chaired the AANA Committee est. the minimum standards for school of nurse anesthesia**

1917 law case

kentucky: Frank V South court--> NA's not engaging in the unauthorized practice of medicine never overturned

Gertrude Fife

lakeside alum and direction *promoted idea of accreditation and advocated for national board exams

first formal training programs in anesthesia begun by/when/ first school

nurse 1909 est by Agnes McGee at St Vincents Hospital in portland OR-->6 week course

1986 reimbursement

reagan-->medicare and medicaid paid CRNA's directly for services--> first nurse specialty to be reimnurbsed

Mcgaw signs most carefully wached

respiration color quality of pulse

First meds for anesthesia?

Alkaloids of opium & mandragora & other herbs, as well as magic & hypnotism

Crawford Williamson Long (1815-1878) on March 30, 1842?

- Successfully removed a small tumor fromthe neck of James Venable under the influence of ether -Gave sulfuric ether on a towel & had patient inhale -First man to use ether for anesthesia* -1845: First obstetric anesthetist (ether for his wife) -didnt publish work

Henry Hill Hickman (1800-1830):

-1823: Began gruesome animal experiments in anaesthesia -Made the animal insensible/unconscious by rebreathing CO2 (almost suffocating it with CO2), then performed small operations (amputate a part of the animal to see if it could feel pain under this "anaesthesia") -called "surgical scumbug"

William T.G. Morton 1846?

-1846, Morton experimented with ether on himself & on small animals, and then in 1846 he painlessly removed a tooth from Eben Frost, a Boston merchant. -October 16, 1846: Morton gave ether to Edward Gilbert Abbot during a 10 minute operation by John C. Warren. Abbot indicated he felt no pain. -Oliver Wendell Holmes named Morton's procedure "anesthesia", & the era of modern anesthesia was officially born.

Edith Graham was succeeded by the most famous nurse anesthetist of all time?,

-Alice Magaw** -a graduate of Woman's hospital in chicago notice than any Mayo figure other than the Mayo brothers.

anesthesia apparatus

-Anesthesia apparatus evolved over time as agents evolved They went from saturating a towel with the agent, → to a mask covered with gauze, → to an "anesthesia machine" with oxygen supply directing oxygen over liquid in a jar attached to the machine, → to rudimentary vaporizers, → to modern-day heated vaporizers.

Humphrey Davy

-As early as 1799 -isolated by Joseph Priestly - nitrous oxide; laughing gas

-Morbidity & mortality were encountered as a result of poor anesthetic technique.

-Aspiration of gastric contents, asphyxiation due to respiratory obstruction, or unrecognized events such as low BP or cardiac arrhythmias (no clinical monitoring) -Also, in the mid-1800's, the concept of antisepsis hadn't been extended to surgery, and post-op infections were common. (Antibiotics weren't introduced until WWII.)

1986 NA programs required 1998 NA programs required to award 2007

Bachelors degree Masters aana adopted position statement for nurse anesthesia to have doctoral program by 2025

Catholic Church records document the earliest nurse to specialize in anesthesia was?

Sister Mary Bernard (1860-1924), St. Vincent's Hospital, Erie, PA in 1877. More nurse nuns were then trained.

Chloroform stage 3

Stage 3 was recommended for most surgical procedures. Contrary to popular belief, it was very difficult to chloroform a patient to that extent. A skilled anesthetist could take 5 minutes to render a patient suitable for surgery (stage 3).