FALL23_NRAN80323_ANESTHESIA101.pptx

ANESTHESIA 101 Gregory Collins, DNP, CRNA PHYSICAL SCIENCE IN NURSE ANESTHESIA NRAN 80323 1 ANESTHESIA 101 OUTLINE: BRIEF HISTORY ANESTHESIA? CONTINUUM OF ANESTHESIA CASE SERIES ANESTHESIA GLOSSARY READING: NAGELHOUT / CH 1 / 114 HISTORY OF ANESTHESIA October 16, 1846: William T. G. Morton Perf...

ANESTHESIA 101 Gregory Collins, DNP, CRNA PHYSICAL SCIENCE IN NURSE ANESTHESIA NRAN 80323 1 ANESTHESIA 101 OUTLINE: BRIEF HISTORY ANESTHESIA? CONTINUUM OF ANESTHESIA CASE SERIES ANESTHESIA GLOSSARY READING: NAGELHOUT / CH 1 / 114 HISTORY OF ANESTHESIA October 16, 1846: William T. G. Morton Performed first public display of inhaled anesthesia with diethyl ether at Massachusetts General Hospital 1884: Karl Köller Demonstrated use of cocaine as local anesthetic HISTORY OF NURSE ANESTHESIA 1860s: Nurses provided first battlefield anesthesia 1878: Sister Mary Bernard First documented civilian practice of nurse anesthesia 1893: Alice Magaw Provided anesthesia for Mayo brothers in Rochester, MN 14,000 drip-ether anesthetics without a single “accident” Commonly known as “Mother of Anesthesia” Alice Magaw HISTORY OF NURSE ANESTHESIA Magaw, A. A review of over fourteen thousand surgical anesthesias. Surgery, Gynecology, and Obstetrics. 1906; 3: 795-799 HISTORY OF NURSE ANESTHESIA 1908: Agatha Hodgins First formal training of nurses/physicians at Lakeside Hospital in Cleveland, OH 1917: Frank/Hatfield v. Kentucky State Medical Association Confirmed right of nurses to administer anesthesia Supervision language introduced Agatha 1931: National Association of Nurse Anesthetists Hodgins Agatha Hodgins, founding President Changed to American Association of Nurse Anesthetists (1933) 1934: Chalmers-Francis v. Nelson Nurses practicing anesthesia did not violate medical practice act Medicine, nursing, dentistry? HISTORY OF NURSE ANESTHESIA 1982: Tax Equity and Fiscal Responsibility Act (TEFRA) Designed to ensure MD participation in anesthetic for reimbursement Separated reimbursement for supervision and medical direction Two payment systems depending on CRNA employment model 1986: Omnibus Budget Reconciliation Act Provision for direct reimbursement of CRNAs, regardless of practice model Ira P. Gunn, critical role in lobby and testimony 2021: American Association of Nurse Anesthesiology AANA officially changes name of organization Ira P. Gunn ANESTHES IA? COMPONENTS OF ANESTHESIA HYPONOSI S ANALGESI IMMOBILIT A Y MINIMAL SEDATION CONTINUUM OF ANESTHESIA RESPONSIVENESS AIRWAY REFLEXES MODERATE SEDATION/ANALGESIA DEEP SEDATION/ANALGESIA SPONTANEOUS VENT CARDIOVASCULAR GENERAL ANESTHESIA BARASH TABLE 33-5, p 883 GENERAL ANESTHESIA POST-OP ANALGESIA INDUCTI ON MAINTENA NCE EMERGE NCE OPEN ABDOMINAL LAPAROTOMY 66 y/o FEMALE Diagnosis: Free-air in abdomen, suspected small bowel perforation Procedure: Open abdominal laparotomy ASA III(E) PMHx: Poorly controlled HTN, ASA PHYSICAL STATUS: Used to diverticulitis, assess65 and communicate a patient’s pack/year smoker pre-anesthesia comorbidities. https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system OPEN ABDOMINAL LAPAROTOMY PLAN: GETA RSI Maintenance with TIVA TAP block for post-op analgesia GETA: General Endotracheal Anesthesia RSI: Rapid Sequence Induction TIVA: Total Intravenous Anesthesia TAP: Tranversus Abdominus Plane block FASCIAL PLANE BLOCK: Regional analgesia technique in which local anesthesia is injected between two layers of muscle fascia TOTAL KNEE ARTHROPLASTY 57 y/o MALE Diagnosis: Degenerative joint disease, right knee Procedure: Right total knee arthroplasty ASA II PMHx: HTN, Type II DM TOTAL KNEE ARTHROPLASTY PLAN: SAB Propofol sedation Intrathecal morphine for post-op analgesia SAB: Subarachnoid Block / “spinal anesthesia” Neuraxial Anesthesia: Regional anesthesia technique with direct effect on spinal nerve roots. Spinal, epidural, or caudal Intrathecal: Injection anesthesia into CSF TOTAL KNEE ARTHROPLASTY PLAN: GA with LMA Standard IV induction Maintenance with VAs at +/- 1 MAC Femoral nerve block for post-op analgesia GA: General Anesthesia LMA: Laryngeal Mask Airway Regional Anesthesia/Analgesia: Provision of sensory dysfunction to anatomic, dermatomal regions of the body TOTAL KNEE ARTHROPLASTY PLAN: GA with LMA Standard IV induction Maintenance with VAs at +/- 1 MAC Femoral nerve block for post-op analgesia VA: Volatile Anesthetic MAC: Minimal Alveolar Concentration LABOR ANALGESIA 24 y/o FEMALE Diagnosis: Active labor Procedure: Planned vaginal delivery ASA II PMHx: Gestational DM (diet controlled) LABOR ANALGESIA PLAN: CLE CLE: Continuous Labor Epidural Neuraxial Analgesia: Regional analgesia technique with direct effect on spinal nerve roots. Spinal, epidural, or caudal analgesia SCREENING COLONOSCOPY 52 y/o MALE Diagnosis: Family history of colon cancer Procedure: Screening colonoscopy ASA III PMHx: HTN, Type II DM, morbid obesity SCREENING COLONOSCOPY PLAN: Propofol sedation MACMonitored MAC: Anesthesia Care; billing term describing anesthesia personnel involvement in care of patient at any point along the anesthesia continuum SUMMARY Recognize the early scientific contributions that led to modern anesthesia. Identify the key players and their contributions to the history of nurse anesthesia. List the three broad components of anesthesia. Describe the continuum of anesthesia. List and define the strata and criteria of the ASA physical status tool. Become familiar with common terms and acronyms used in the language of anesthesia.