Works Cited

Alkire, Michael T., Anthony G. Hudentz, and Giulio Tononi. "Consciousness and Anesthesia."
Science Magazine 7 Nov. 2008: n. pag. Print.
Although anesthesia undoubtedly induces unresponsive and amnesia, the extent to which
it causes unconsciousness is harder to establish. Certain anesthetics act on areas near the midline
and abolish behavioral responsiveness, but not necessarily consciousness. When a complex of
brain regions in the posterior parietal area is inactivated, consciousness vanishes. interrupting
cortical communication and causing a loss of integration. It vanishes when anesthetics produce
functional disconnection which interrupts the cortical communication and causing a loss of
integration or when they lead to bistable, stereotypic responses, causing a loss of information
capacity.
This source was useful because of the in-depth explanation about how the anesthetics
relate to the brain. It talks about the different lobes which was funny since we are learning about
them in psych at the moment, so I learn information about both subjects. I know an adequate
amount of detail involving anesthetics and the brain which is great. I wish I could find access to
the full text, but I have to subscribe to the website in order to. I plan to find the magazine at the
library to get more information.
"Anesthesia as a Career." American Society of Anesthesiologists. American Society of
Anesthesiologists, n.d. Web. 25 Oct. 2015. <http://www.asahq.org/>.
This web page describes in explicit detail what an anesthesiologist does. It also depicts
how many year of schooling he/she has gone through and what his role is. The fact that his role
extends out of the operation room is stated as well. Then, the webpage proceeds to describe the
same components with an anesthesiology assistant and a nurse anesthetist.
This source was very helpful to me. I know the differences between each persons job
whether it be roles, or just plain experience. I can probably now pick out who has had more
practice than another when in an operation room. Also, since I want to pursue a career in
anesthesiology, i know what to expect. I know who I will be working with, and how to do
become each occupation, schooling wise.

Blackwell, Amy Hackney, and Elizabeth Manar. "Anesthesia." UXL Encyclopedia of Science. 3rd
ed. Farmington Hills: Science in Context, 2015. N. pag. Print.
The encyclopedia entry first explains what exactly anesthesia is and then goes into detail
about different types of anesthesia. These types are known as local, regional, and general. Local
temporarily numbs a sensation in a small area of the body while the patient remains awake. This
is possible since the drugs act by preventing nerve cells from sending pain messages to the brain.
An example of when this type is used is during dental procedures. Regional anesthesia is when a
doctor injects local anesthesia into the patient's back. General anesthesia is when the patient is
rendered unconscious. In instance when this is used is open heart surgery. No pain is felt and no
memory of the times spent under anesthesia is there. Then it provides information about the
history of anesthesia. It explains how other substances such as opium, ether, chloroform, and
nitrous oxide were used.
This was useful to me because it gave me the basics of anesthesia which is essential for
me to know in the line of work I want to pursue. It gave me a clear idea of what regional
anesthesia is. Also, before this, I only thought that anesthesiologists were allowed to administer
the drug, but now I know that other people can as well. The history of anesthesia was particularly
interesting because it shows how innovative society is and how we have evolved from having
surgery without dulled senses.
Brown, Anthony R., et al. "Interscalene block for shoulder arthroscopy: Comparison with general
anesthesia." Journal of Arthroscopic and Related Surgery 9.3: n. pag. Print.
The objective of this study was to demonstrate that regional anesthesia has several
benefits over general anesthesia for this type of surgery. Forty patients had received general
anesthesia and sixty-three received a regional block. The interscalene block was found to have a
high degree of patient acceptance, safe, and effectiveness. It provided muscle relaxation and
inter-operative analgesia. post operative, regional anesthesia resulted in a shorter hospital stay,
fewer hospital admissions, and fewer side effects when compared to general anesthesia.
The journal entry was very informative and helpful to me since I had witnessed someone
undergoing an arthroscopic shoulder surgery while being under the regional block. I remember
the nurse who debriefed me before entering the operating room saying why they had used this
type instead of general. She then proceeded to go into extreme detail so I was not able to catch
all of the details, but this journal entry filled in some of the gaps.

Christopherson, Rose, et al. "Control of Blood Pressure and Heart Rate in Patients Randomized
to Epidural or General Anesthesia for Lower Extremity Vascular Surgery." Journal of
Clinical Anesthesia 8.7: n. pag. Print.
The objective of this experiment is to examine the degree of success at maintaining
patients randomized to epidural or general anesthesia for peripheral vascular surgery withing
predetermined blood pressure and heart rate limits. This is done in order to investigate
associations between hemodynamic control and intraoperative myocardial ischemia and
postoperative major cardiac morbidity. One hundred patients were the sample size. The results
were that the prevention of elevated intraoperative BP and rapid changes in HR may be more
successful with epidural than with general anesthesia.
The measurements and main results were very hard to understand because everything was
very technical. The objective as a whole was very interesting. Although, I did not fully
comprehend the results, I think that it was a good read. It was probably in no way useful to me
though since I cannot comprehend it.
Cooper, et al. "Fetal and Maternal Effects of Phenylephrine and Ephedrine during Spinal
Anesthesia for Cesarean Delivery." Anesthesiology 97.6 (2002): n. pag. Print.
A study was done to see the different effects of when at a cesarean delivery during spinal
anesthesia, a combination of phenylephrine and ephedrine was more useful than solely using
ephedrine. The study was a double blind and had the best results when just the phenylephrine
was being infused. Otherwise fetal acidosis, maternal nausea and vomiting may happen when
combining both substances or using the ephedrine alone.
This type of experiment is interesting to me and might be something i pursue further. This
is my first source of how anesthesia with a mix of drugs would result in. It provokes thought in
the many other different what ifs like what other drugs could be used. The method portion of this
source was extremely hard to understand though.
"Preventable Anesthesia Mishaps: a Study of Human Factors." Anesthesiology: n. pag. Abstract.
Print.
A critical incident analysis technique was used in a retrospective examination of the
characteristics of human error and equipment failure during anesthetic practice. This was done to
uncover patterns frequently occurring incidents. Interviews were conducted and 359 preventable
incidents were obtained. 82 % of the incidents involved human error with inadvertent changes in
gas low and breathing circuit disconnections being frequent problems. 14% were due to overt
equipment failures. But some of these can be tied into human error through suppose, inadequate
experience and insufficient familiarity with equipment.
Whenever I hear about complications involving anesthesia, I usually figured it was due to
the person administering it, but I also knew it was a lot of equipment faulty. Never did I really
connect the two together. I believe now that my perspective has changed. This new information
encourages me to be more careful in my surroundings in the operation room and also just in the
future for when I study to become an anesthesiologist.
Gaba, and DeAnda. "A Comprehensive Anesthesia Simulation Environment: Re-creating the
Operating Room for Research and Training." Anesthesiology: 387-94. Abstract. Print.

A re-creation of an anesthesiologist's task environment in an operating room is described.

The standard monitoring equipment in common use provides adequate inputs. These include the
ECG, invasive systemic arterial, central venous pressures, mass spectrometry, etc. the simulation
is very "hands-on" and requires performance of actual equipment. The systems operator and
simulation director takes up the roles as the surgeon and circulating nurse. the simulator
experiences were judges by twenty-one subjects. The authors suggest that anesthesia simulation
can be accomplished at nominal expense and has major potential for training, continuing
education, certification, and research.
I do not think this was helpful because I did not really see what the purpose of the
experiment was. It was a waste of time because it does not even tell me the why of it all. The
experiment probably does have a purpose, but I do not understand it. All i know is that people
were trying to recreate an anesthesiologists atmosphere and responsibilities during an
experiment.
Gomez, and Guatimosim. "Mechanism of Action of Volatile Anesthetics: Involvement of
Intracellular Calcium Signaling." Curr Drug Targets CNS Neurol Disord: n. pag.
Abstract. Print.
The abstract states that extensive efforts to characterize the mechanism of action of
volatile anesthetics. Their molecular and cellular actions are still a matter of debate. Volatile
anesthetics are used to primarily act upon synaptic transmission in the central nervous system,
but the proof of this is elusive. A change in neurotransmitter release and its direct interaction of
the anesthetic molecule is described. Calcium is one of the most important messengers in the
cells and its intracellular concentration may be modified by several agents including volatile
anesthetics. Voltage-gated calcium is then described and how it plays a key role in controlling
calcium.
Honestly, this journal entry was not very helpful for me. I thought that I would learn
general knowledge about the mechanism of action, but it was a whole other story. It is obvious
that this was written solely for other researchers so it is very hard to understand how the
mechanism is described. I do not think I learned anything from this entry and that is very
disappointing.

Hampton, Tracy. "Researchers Probe Nerve-Blocking Pain Treatment for Wounded Soldiers."
Journal of the American Medical Association 297.13 (2007): 2461-62. Print.

Regional Anesthesia is better than tradition general anesthesia for treatment of soldiers
with acute injuries. This is because they help prevent the development of chronic pain syndromes
that can persist well after wounds have healed. Chester Buckenmaier III had tested regional
anesthesia by placing a catheter near the specific nerve that transmitted pain from the wound and
then infused into the area a constant flow of nonaddictive local anesthesia. He then treated
approximately 800 more cases and he and his military colleagues have found that regional
anesthesia is an effective therapy for pain relief and recovery in combat amputees, may even be
better than general. General anesthesia is effective for providing analgesia for a surgical case, but
it does not stop the afferent signals from a wound from reaching the brain. A regional pain
blocker can weaken those signals. That is significant because scientists suspect that when
impulses from damaged nerves in a wounded limb are transmitted to the brain, the central
nervous system undergoes changes that can lead to persistent pain long after the wound heals.
Rollin Gallagher is conducting a longitudinal 2 year clinical study designed to determine whether
regional anesthesia given by Buckenmaiers team to soldiers with major traumatic injuries has
short- and long-term effects. These include reducing pain disability and lowering the incidence
and severity of mental health disorders. The results may help change the standard of health care
for disaster-type medicine. Researchers are beginning to view pain more as a disease than a
symptom. Pain can create pathophysiological and anatomical changes in the peripheral nerves,
the spinal cord, and the brain. Uncontrolled pain can depress the immune system and increase
stress responses, scenarios that can lead to inflammation and susceptibility to infection. Also, it
can have profound effects on mental health.
This source was helpful to me since it gave me a lot of insight on how early intervention
with regional anesthesia is emerging as a potentially promising way to prevent many of the longterm effects of severe acute pain. I learned a lot about how regional anesthesia is given in the
military and how regional anesthesia differs from general in regards to the brain. I never knew
that pain was being classified as a disease instead of a symptom. This seemed so odd to me but
after the journal entry explained it, I understood why pain could be a disease. I'm not exactly
sure if this could be helpful for anything other than background information to be honest.
Harrison, Neil L. "General Anesthesia Research: Aroused from a Deep Sleep?" Nature
Neuroscience: n. pag. Print.
This article is very interesting in that it compares what happens in the brain while
sleeping to what happens when a person is under anesthesia. A person sleeping can be woken up
relatively quickly but an anesthetized patient can only be awoken once the drug is removed.
There is a small area of the tuberomammillary nucleus (TMN) known to be important in
controlling sleep/wake states. It then goes on to talk about GABA receptors and different sleep
pathways. General anesthetics enable sedation and hypnosis. A criticism of the work is that the
substances may spread from the site of injection to other brain areas.
This source was very interesting since it gave me details about the different things that
are happening when someone undergoes anesthesia. However, this source was quite hard to read
and understand just by a few readings, so I will have to analyze it very carefully. There is a link
between general anesthesia and sleep but i'm not sure if I will pursue this topic.
Hertzler, Arthur E. "Technic of Local Anesthesia." Journal of the American Medical Association
109.25 (1937): n. pag. Abstract. Print.

The entry states the doses and methods of certain local anesthesia. Combining them with
epinephrine and general anesthesia is also described. Description of the equipment needed for
this work is included. different anesthesia are described via an anatomic basis. This useful
mainly to a general surgeon, not necessarily to one with a background in regional methods of
anesthesia.
The entry itself is very short, but the lists of the grouping of body parts for the purpose of
stating different anesthetic methods was interesting. This source is very outdated being that it
was written in 1973, but its interesting to see how far society has come since then. Other than the
grouping, there was not much to it.
"Howard County General Hospital." Howard County General Hospital. Johns Hopkins
University, n.d. Web. 21 Sept. 2015.
<http://www.hopkinsmedicine.org/howard_county_general_hospital/>.
This website provides information about the hospital such as its mission which is to
"Provide the highest quality care to improve the health of our entire community through
innovation, collaboration, service excellence, diversity and a commitment to patient safety." A
short history about the hospital is provided stating its journey from being founded in 1973 to
present day. Some facts about the hospital are included such as statistics about its diverse
employees and the Fiscal Year 2014 Utilization Statistics. Also, the tab named "Our Services"
gives an immense amount of information about everything they provide. Each topic has
subcategories have videos, doctor information, diagnostics and symptoms. The "Patient &
Visitor Information" tab talks about billing, insurance, medical record information, and how to
prepare for your stay. There is a lot of information about wellness classes, childbirth/new parent
classes, and free blood pressure screening & monitoring as well.
This source was very useful since it taught me information about the place that I intern.
Without viewing the website, I would not have known that the hospital provided services to more
than 220,000 people or that 3,550 babies were delivered in 2014. Also, I am quite fascinated with
how many things go on in the institution. So many things are happening at once and the website
gives a nice overall view of what occurs. It is very user-friendly and I have more insight on some
of the people I might be meeting and the different types of patients I may encounter.

Ivani, Giorgio, et al. "The European Society of Regional Anaesthesia and Pain Therapy and the
American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice
Advisory on Controversial Topics in Pediatric Regional Anesthesia." Regional
Anesthesia & Pain Medicine 40.5 (2015): n. pag. Print.

The European Society of Regional Anesthesia and Pain Therapy (ESRA) and the American
Society of Regional Anesthesia and Pain Medicine (ASRA) developed a joint committee practice
advisory on pediatric anesthesia (PRA). The performance of the PRA is associated with
acceptable safety and should be viewed as the standard of care. The use of test dosing should
remain discretionary and the use of air-loss resistance or saline-loss resistance techniques is
supported by expert opinion. The literature supporting one over the other is sparse and
controversial. Each technique can be used in children, as long as is is safely provided. The
ERSA/ASRA recommendations are intended to provide guidance for the safe practice of regional
anesthesia in children.
This source was useful in a way since I got to see how official committees would go about
certain things. But the actual content was really hard to understand and I kind of regretted getting
myself into such a long and tedious source. I could not understand whether they had made a lot
of progress since the entry only states one experiment. I do not think that I would want to
continue research on this topic for any of my projects though.

Improving the Safety of Epidural Steroid Injections Journal of the American

Medical Association 313.17 (2015). Print.

The epidural steroid injection is used to treat patients through two methods. The
interlaminar approach is where the tip of the needle is placed in the posterior epidural space. This
method may cause most of the drug to remain in the posterior epidural space. The transforaminal
approach is when the tip of the needle is placed in and intervertebral foramina where the spinal
nerve exits the spinal canal. Practitioners use the tranforaminal approach when a single nerve
root in one extremity is affected from a single lateral herniated disk and use the interlaminar
approach when several spine nerves are involved. Early studies suggest that the duration of pain
relief was longer with particulates, so one who performs the injection would probably use that.
There are usually only mild and transient adverse effects of an epidural steroid injection.
However, rare occurrences of catastrophic central nervous system injuries have been reported.
Tranforaminal injections of a particular steroid have resulted in cerebrovascular occlusion. Some
suggestions as to how to improve the safety of epidural steroid injections are listed. These are
very detailed such as using image guidance with appropriate anteroposterior, lateral, or
contralateral oblique views and a test dose of contrast medium when performing lumbar
interlaminar epidural steroid injections. The FDA also has a role in this somehow and envisions a
situation in which epidural steroid injections should warrant a contraindication warning in the
labeling of injectable corticosteroids. The future of epiduaral steroid injections involve the
continuation use of it for short term relief. But, research is being done as to ow to eliminate the
ocurrences of the rare neurological injuries associated with the injections.
This journal entry helped me get a better sense of what the the epidural steroid injections
do and how to perform them. And also the risks were explicitly stated in a way that I could
understand. The suggestions made for improving it was kind of hard to understand, but i believe
it was because of my lack of knowledge of the clinical references. It was described in the entry,
but not very clearly so I do not have an understanding of how the FDA relates. Overall, this was
a useful source but some areas went over my head unfortunately.
Kroll, et al. "Nerve Injury Associated with Anesthesia." Anesthesiology: 202-07. Abstract. Print.
The American Society of Anesthesiologists Closed Claims Study database was analyzed
by the journal entry authors to define the role of nerve damage in the overall spectrum of
anesthesia-related injury that leads to litigation. Out of 1,542 claims reviewed, 15% were for
anesthesia-related nerve injury. The ulnar neuropathy represents one-third of all nerve injuries.
the exact mechanism of injury was unclear in a large proportion of cases. Nerve damage claims
have a median payment of $56,000 which is significantly lesser compared to the @225,000
median payment for claims for disability injury not involving nerve damage.
This entry was interesting since it displayed a lot of statistics to me that I did not know of
previously. I finally got exposed to the legal side of anesthesia and the consequences of certain
blunders. I think it was helpful to me for my background knowledge, but i do not know how I
would convey that to a research idea that I could carry-through with in high school.

Kuehn, Bridget M. "Studies Probe Anesthesia, Sleep Links." Journal of the American Medical
Association 296.17 (2006): 2427-28. Print.

The two mechanisms of sleep and anesthesia are converging in research and may lead to
improved techniques for anesthesia and treating sleep deprivation. There are many differences
between a person sleeping and a person under anesthesia, there is an apparent overlap between
the two. A gene mutation in a certain specie of fly is known to regulate sleep and can determine
how much anesthetic is required. It then talks about another fly and how it would need twice as
much vaporized isoflurane to become sedated as did flies without the mutation. The single gene
mutation that reduces the sleep requirements of the minisleep flies also decreases their sensitivity
to anesthesia. The mechanisms behind sleep regulation appear to be conserved across species,
these findings may have relevance for humans one day. Also, rats were deprived of sleep for 24
hours in order to parallel them to burn victims on whether if they are sedated for weeks at a time
while undergoing painful procedures were getting adequate sleep. Researchers questioned
whether such sedation would cause patients to accumulate sleep debts, allowing them to get
adequate sleep or keeping them in a state where they neither garnered the restorative benefits of
sleep nor the detrimental effects of sleep deprivation. The entry then describes, in detail, how the
rat experiment was carried through. The results concluded that the sleep deprived rats were more
sensitive to anesthesia.
When first reading this entry, I found it very irrelevant and not useful at all until the very
end. I do not exactly see how comparing flies to humans without any given relationship is
justified. The entry states that the results may one day be useful for humans, but then have
conclusions for patients as if fact solely based on the experiment. The experiment was not
explained quite well but the results of how patients with sleep deprivation may require special
care was helpful. Patients with sleep apnea may face certain risks other usually do not. I knew
this from my general knowledge of anesthesia, but basing these finding off of an experiment
done on flies does not appeal to me. I do not think that this entry was worth reading to be quite
honest.
Livingston, Edward H. "What to Ask Your Surgeon Before and Operation." Journal of the
American Medical Association 313.5 (2015): n. pag. Print.
This article gives guidance as to what should be of concern when having surgery. Since it
is often a major, life-changing event, it is very important to know what should be asked. "Are
there other ways of treating the disease without surgery" is a very good question to ask. Also the
credentials for your doctor and hospital should be known. Ask everything from why are you not
board certified to what technology and equipment will you be using. You should be comfortable
with the hospital that you are having the procedure done at. Another good thing to ask is what
things you can do before surgery to insure the likelihood of good results. Finally, some questions
about what will happen after the surgery are described.
All in all, this entry was very "elementary" to me in that I knew everything already stated.
I thought that broadening my scope from anesthesia to surgery would be better and have more
information. Maybe it would even have given me more variety. I believe that being specific is
probably my best bet, even if it is just a certain type of surgery.
Mandava, Srinivas, Dr. Personal interview. N.d.

Dr. Srinivas Mandava received his medical degree from Bangalore Medical College and
has been in practice for 28 years. He graduated from Bangalore Medical College I n 1987. From
1992-1995, Dr. Mandava did his residency at Penn State University. He has worked at Howard
County General Hospital for about 12 years as an Anesthesiologist.
Matsukawa, Takashi. "Heat Flow and Distribution During Epidural Anesthesia." Anesthesiology:
n. pag. Print.
The author evaluated regional body heat content and the extent to which core
hypothermia after induction of epidural anesthesia resulted from altered heat balance and internal
heat redistribution. The experiment involved twelve minimally clothed male volunteers and only
six of them had a bilateral sympathetic block. The overall heat balance was determined from the
difference between cutaneous heat loss and metabolic heat production. Arm heat content had
decreased whereas leg heat content increased. The results state that core hypothermia during the
first hour after induction of epidural anesthesia resulted largely from redistribution of body heat
from the core thermal compartment to the distal legs.
The entry was easy to understand which was surprising seeing as I was expecting not to
understand. Body temperature is never really something I thought would get to that big of an
extent to get hypothermia. I knew that the body temperature is always regulated by the
anesthesiologist but I didnt believe that it was a big problem. This source was helpful because it
gave me insight into a different aspect about procedures.
Miller, Scott, and David Zieve. "Hydrocele." Medical Encyclopedia. N.p.: n.p., n.d. Medline
Plus. Web. 2 Oct. 2015.
This source first defines a hydrocele as a fluid-filled sack in the scrotum. This may be
caused by the buildup of the normal fluid around the testicle if the body does not drain well or
makes too much. A symptom of this is a swollen testicle that feels like a water balloon. The
article then goes into what types of exams and tests diagnose whether or not someone has one.
They are not harmful but when its a hydrocele from an inguinal hernia, a surgery should be done
to fix it as soon as possible. Possible complications from the surgery are listed. It then proceeded
to state some information about hydroceles in children such as how they are common in newborn
infants.
I once watched an operation called a hydrocelectomy and this entry has provided me with
a lot of background knowledge. I now know what had caused the hydrocele and what the
surgeons had performed was the removal of sac lining. I also learned the differences between
children getting them and adults. I can now pair what the surgeons were doing with why they
were doing it. I did not now previously that the hydrocele does not hurt, which is surprising
because when I saw it, I thought it would be very painful to have.

Neuro (Pharmacology-Anesthesia Drugs). Youtube. N.p., n.d. Web. 21 Oct. 2015.

<https://www.youtube.com/watch?v=phDGkNwetbM>.

This seems to be a college video review that provides the anesthesia drugs required to
know for the United States Medical Licensing Examination. The anesthetic agents are
categorized into inhaled anesthetics, non-volatile anesthesia, and local anesthesia. Each one of
these drugs are described, then the induction, maintenance, and emergence anesthetics are listed
and explained upon. The mechanism of action of each inhaled anesthetic drug was defined. The
toxicity of local anesthetics are depicted in detail afterwards. Finally, some non-volatile
anesthetics are expressed in relation to the surgery.
This source was very useful because it was exactly what I was looking for after seeing the
other video. It had filled the gaps that I needed information for. The different types of drugs were
describes well and their relationship with the stages were also very easy to understand. Each
drug has a purpose that is not related to others that seem similar and how this video clearly lists
everything was very nice. Although it was 20 minutes and very dragging, I found it worth it in
the end since it gave me a lot of background knowledge on the pharmacology of anesthesia.
Orebaugh, Steven L. Understanding Anesthesia. Baltimore: The Johns Hopkins University Press,
2012. Print.
As the title says, this book goes into thorough detail all about anesthesia. It gives an
introduction to anesthesia and surgery. A brief history about anesthesia is also described. Then
everything a person would need to know about general, regional, spinal, epidural, peripheral
nerve blocks and the complications of each are mentioned. The complications, risk assessment,
and safety of anesthesia as a whole is also provided. Also, special populations use regional
anesthesia, which is explained in the book. Finally, pain therapy is the last chapter.
Everything about this book was useful to me. It had everything I had previously learned
through a lot of my annotations and a lot of new information. The book was easy to read and had
many details and graphics, making it really reader-friendly. It was redundant with everything else
I learned, since everything could have been found in this book but it is okay. Literally everything
I had read in this book was helpful for me.
Sebel, Peter S., et al. "The Incidence of Awareness during Anesthesia: A Multicenter United
States Study." Anesthesia & Analgesia 99.3 (2004): n. pag. Print.
The incidence of awareness with recall during general anesthesia in the US is a
prospective cohort study that was conducted in seven academic medical centers. Patients were
scheduled for surgery using general anesthesia and then were interviewed in the postoperative
recovery room. Data from 19,575 patients were collected and only 25 awareness cases were
identified. About 1-2 people experience this phenomenon per 1000 patents. An additional 46
cases were reported as possible awareness and 1183 cases of possible intraoperative dreaming.
This source was helpful for me because it shows a lot of statistics on this particular topic
which my teacher had always brought up whenever referring to anesthesia. It is a very interesting
topic and I am thinking about doing more research on it. But, I am conflicted seeing as I am not
sure if I could make a project out of it. I know that I could always write a paper about this, but
being able to bring this idea to life would be really fascinating.
The Stages of Anesthesia: The Basics (Guedel's Classification). Youtube. N.p., n.d. Web. 24 Oct.
2015. <https://www.youtube.com/watch?v=JNkXT3PR1HQ>.

This video gives an overview of all of the phases and stages of anesthesia. The video
describes the phases as induction, maintenance, and emergence. Induction has two phases with
the first being the administering of the anesthetic drug and the second is the regaining of
autonomic stability. Maintenance has three stages which includes a stage that has four planes.
Stage five is when the heart stops, so that is the maximum level. The video then tells what to do
in case of emergence.
It was extremely useful for me. This is because the different stages of anesthesia is vital
to know when providing anesthesia. Everything talked about in the video is relevant to what I see
in the operation room. Different medications are used to get various results. Each stage is very
different from the other and depends on which type of surgery has to be done. I wish it gave me
more information about the different drugs that are used to get to the different stages. The aspects
of people undergoing each stage was very well detailed and explained. I really liked this video
since it was very informative.
Suffrendini, Lori Ann. Personal interview. N.d.
Dr. Lori Ann Wilkinson Suffredini has over 6 years of experience in the field of
medicine. She graduated from Umdnj New Jersey School Of Osteo Medicine with her medical
degree in 2009. has a medical practice at 600 N. Wolfe Street, Blalock 1410, Baltimore,
Maryland. She specializes in anesthesiology and is affiliated with numerous hospitals in the
Baltimore area including Howard County General Hospital, and The Johns Hopkins Hospital .
Dr. Suffredini is accepting new patients at her medical office and practice location is: 600 N.
Wolfe Street, Blalock 1410, Baltimore, MD. She is available for appointments, preventative care,
medical care as well as ongoing patient care.

Torpy, Janet M. "General Anesthesia." Journal of the American Medical Association 305.10
(2011): n. pag. Print.
General anesthesia is used to produce unconsciousness. During general anesthesia, a
patient is not in a natural state of sleep even though he/she is unconscious. In the US,

anesthesiologists, certified nurse anesthetists, and anesthesiologist assistants are allowed to

provide anesthesia. Propofol is a common medication used. It is used in the induction stage and
in smaller doses, can be used to provide sedation. Bensodiazepines decreases anxiety before
surgery. Narcotics can be used in order to prevent or treat pain. Some other include antiemetic
agents, to protect against nausea and vomiting, medications to manage blood pressure or heart
rate, muscle relaxants, and nonsteroidal anti-inflammatory drugs. Some common complications
of general anesthesia are nausea and vomiting after surgery. Sore throat and occasional damage
to teeth, gums, or lips from the insertion of airway tubes. Malignant hyperthermia, although
unlikely, can also develop. People with medical problems can experience a heart attack or stroke.
How to prepare for anesthesia is also described in this journal entry.
The journal entry was very useful in that it provided me with background knowledge.
Before reading this, I did not know that anesthesiologist assistants was even a real occupation. I
just figured that it only the anesthesiologist and the nurse anesthetist could administer anesthesia,
that was it, but this entry has proven me wrong. The list of medications were especially useful
since I have heard the names before in the operation room, but never truly knew what each one
was specialized for. The fact that medications that reduce anxiety may also help block memory
of events was new to me as well. I knew all of the complications except the malignant
hyperthermia, which is a rare inherited muscle disease, which can be triggered by some
anesthetic medications. The diagram involving the medical equipment used to make a person
unconscious was very well drawn and detailed enough to not be overpowering. It was helpful
since I can relate it to what I have seen in the operation rooms. I know for a fact that the
information in the picture is accurate. Overall, I think that the most useful aspect of this article
entry was the list of anesthetics that can be used for local anesthesia.
"Local Anesthesia." Journal of the American Medical Association 306 (2011): n. pag. Print.
Local Anesthesia is used to numb a specific area of the body so a patient won't feel pain
during a medical procedure. Dental surgery is an example of when you can use local anesthesia.
Sedation is often given along with local anesthesia for many types of procedures. Using local
anesthesia alone avoids side effects of sedation medications/medications used to produce general
anesthesia. Topical anesthesia places/sprays a solution on the skin/mucous membrane. It is then
absorbed into that area. If local anesthesia is injected, the skin is numbed and the tissue that lies
underneath. The anesthetic medicine then spreads around the area depending on the amount
given. Irrigation with local anesthesia solution bathes the surrounding area and tissues. The entry
then lists some common procedures done by using local anesthesia.
This source was very useful because local anesthesia is commonly used and it gave me a
lot of background information. I already knew most of what was said but I learned about some
common procedures the local anesthesia is used in. Also, I did not know that injection and
irrigation of anesthesia were different. I had never really thought about them as two different
procedures.
"Regional Anesthesia." Journal of the American Medical Association 306.7 (2011): n. pag. Print.
Regional anesthesia is administered to make a specific part of the body numb. There are
three types known as epidural anesthesia, spinal anesthesia (subarachnoid block), and nerve
blocks. Regional anesthesia is used most often for orthopedic surgery on an extremity, for

operations on the bladder and urinary tract, and female reproductive surgery. Anesthesiologists
are doctors who undergo special education in the medical management of patients who are
having procedures in order to provide anesthesia and/or relieve pain. Certified registered nurse
anesthetists are registered nurses who can also administer anesthesia because of their additional
education. Some patients may not be able to receive regional anesthesia due to medical
conditions. For spinal anesthesia, the skin on the lower back must be prepared by spreading an
antiseptic solution. After that, the anesthesia is injected through the skin, soft tissue, and
ligaments surrounding the spine until it reaches the subarachnoid space. Numbness starts from
the feet and moves upwards at a rate determined by many factors including the patients height
and the type of anesthesia given. Epidural anesthesia uses a larger needle and has a catheter
placed through the needle into the epidural space. A catheter ensures a longer term of anesthesia
and pain relief. Peripheral nerve blocks can provide pain relief as well as blocking motor
function. The solution is given as close to the nerve as possible without entering it.
The journal entry was very useful in that it added to my previous knowledge about the
three types of anesthesia. The detail it gave me while describing how to administer each was
very informative. Also, I learned that numbness from the spinal anesthesia starts at the feet which
I think is very interesting in fact, it might even be a cool topic to research. Also, I did not
previously know that a catheter can be placed through a needle. I am not exactly sure if I am
reading that sentence wrongly. The picture used is also very thorough and in-depth. It is very
useful seeing as I feel like I can administer anesthesia with such an ease.
Wilder, Robert T., et al. "Early Exposure to Anesthesia and Learning Disabilities in a PopulationBased Birth Cohort." Anesthesiology 110.4 (2009): 796-804. Print.
Anesthetic drugs administered to immature animals may cause changes and alterations in
behavior. In this experiment, anesthetic exposure prior to age 4 and the development of reading,
written language, and math learning disability (LD) were studied. Out of the 5,357 children, 593
received general anesthesia before the age of four. Exposure to anesthesia was a significant risk
factor for the later development of LD in children receiving multiple, but not single anesthetics.
Anesthesia itself may not contribute to LD or some external unidentified factors.
I do not think that this entry is useful to me. I felt like it was common knowledge that
having anesthesia before the age of 4 would have some type of effect, but not to this extent.
More research has to be done as well, so nothing is certain. The journal entry itself was really
hard to read but again, it may be due to my lack of clinical knowledge.