01. Introduction to Anesthesiology

8/6/2019 01. Introduction to Anesthesiology

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INTRODUCTIONINTRODUCTIONTO ANESTHESIOLOGYTO ANESTHESIOLOGY

Yohanes Rudijanto, dr., SpAn.Yohanes Rudijanto, dr., SpAn.

KSM AnestesiologiKSM Anestesiologi

RS ImmanuelRS Immanuel -- BandungBandung


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Short CVShort CV

Medical DoctorMedical Doctor

FK UNPAD, 1991FK UNPAD, 1991

Anesthesiology residency programAnesthesiology residency program St. Lukes Medical Center, ManilaSt. Lukes Medical Center, Manila

20022002 20042004

Anesthesiology adaptation programAnesthesiology adaptation program FK UNHAS, MakassarFK UNHAS, Makassar

20052005 -- 20062006


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1910 2006


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History of AnesthesiaHistory of Anesthesia

In USAIn USA

Modern anesthesia began on March 1842Modern anesthesia began on March 1842

whenwhen dr. Crawford W. Longdr. Crawford W. Long administeredadministeredsulfuric ether to James Venablesulfuric ether to James Venable

Dr. LongDr. Long didnt reporteddidnt reported his discovery inhis discovery in

medical journalmedical journal


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Oct. 16, 1846Oct. 16, 1846 William T.G. MortonWilliam T.G. Morton aadentist demostrated ether anesthesia atdentist demostrated ether anesthesia at

Massachussetts General HospitalMassachussetts General Hospital

WhileWhile John C. WarrenJohn C. Warren a surgeona surgeonsuccessfully removed a vascular lesionsuccessfully removed a vascular lesion

from the left side of a patient, Edward G.from the left side of a patient, Edward G.AbbotAbbot


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Morton's ether inhaler (1846)


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"Gentlemen, this is no humbug "William Morton standing, upper right

John Warren in the right with his hand in patients leg


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In Europe (1853)In Europe (1853)

Dr. John SnowDr. John Snow gavegave

chloroform to Queenchloroform to QueenVictoria for the birth ofVictoria for the birth ofPrince LeopoldPrince Leopold

Dr. Snow went to publishDr. Snow went to publish

and studied chloroformand studied chloroformanesthesia thus becominganesthesia thus becomingrecognized as therecognized as the 1st1stanesthesiologistanesthesiologist


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Regional AnesthesiaRegional Anesthesia

Carl KollerCarl Koller (1857(18571944), opthalmologist1944), opthalmologist Use cocaine as local anestheticsUse cocaine as local anesthetics

August BierAugust Bier Use Heinrich Quincke techniqueUse Heinrich Quincke technique

Introduce Spinal anesthesia, 1899Introduce Spinal anesthesia, 1899

IV regional technique with procaine, 1908IV regional technique with procaine, 1908 Edward TuohyEdward Tuohy, 1944, 1944

Introduce Epidural anesthesiaIntroduce Epidural anesthesia


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Regional AnesthesiaRegional Anesthesia

1902,1902, Harvey CushingHarvey Cushing

Coined the phrase regional anesthesiaCoined the phrase regional anesthesia

technique of blocking brachial or sciatic plexustechnique of blocking brachial or sciatic plexusunder direct vision during general anesthesiaunder direct vision during general anesthesia \\

John J. BonicaJohn J. Bonica

multidisciplinary pain clinicmultidisciplinary pain clinic

The Management of PainThe Management of Pain,, now 3now 3rdrd edition, isedition, isregarded as a classic of the literature ofregarded as a classic of the literature ofanesthesiaanesthesia


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General vs Regional AnesthesiaGeneral vs Regional Anesthesia


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Caudal analgesiaCaudal analgesia


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Axillary blockAxillary block

I/ : operation onI/ : operation onlower arm andlower arm and

handhand


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WHATIS ANESTHESIOLOGY?WHATISANESTHESIOLOGY?


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AnesthesiaAnesthesia berasal dari bahasa latinberasal dari bahasa latin

An ( = tidak )An ( = tidak )

AesthesiaAesthesia ( = rasa )( = rasa )anesthesia = tanpa rasa, disertai dengananesthesia = tanpa rasa, disertai dengan

hilangnya kesadaranhilangnya kesadaran

analgesia = tanpa rasa, tanpa disertai hilangnyaanalgesia = tanpa rasa, tanpa disertai hilangnya

kesadarankesadaran

BiusBius dari bahasa sansekertadari bahasa sansekerta

Be ( =Be ( = tanpatanpa))

Hoss (Hoss ( = sadar= sadar))Bius = tanpa sadar = anesthesiaBius = tanpa sadar = anesthesia

AnesthesiologyAnesthesiology : ilmu yg mempelajari hal: ilmu yg mempelajari hal--hal yghal yg

berhubungan dengan hal tsb di atasberhubungan dengan hal tsb di atas


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DefinitionDefinition

Anesthesiology is the practice

of medicine dedicated to therelief of pain and total care of

surgical patient before, during

and after surgery


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Although historically, Anesthesiologistshave been known primarily as

physicians who administer anesthesia

to alleviate pain and suppressconsciousness of the patient

undergoing surgery, they also provide

medical care and consultations in

many othersetting and situation inaddition to the operating room


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Scope of practiceScope of practice

1.1. In the operating roomIn the operating room

2.2. In the post anesthesia care unitIn the post anesthesia care unit

( recovery room )( recovery room )3.3. For pain managementFor pain management

4.4. In critical care and trauma medicineIn critical care and trauma medicine

5.5. During cardiac laboratory proceduresDuring cardiac laboratory procedures6.6. For diagnostic procedures andFor diagnostic procedures and

nonsurgical treatmentsnonsurgical treatments


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1. In the operating room

Anesthesiologists is the

perioperative physician (peri-meaning around), who provides

medical care to patient throughout a

surgical experience


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1. In the operating room

These include :

1. Preoperative

Evaluating the patient before surgery2. Intraoperative

Providing pain control and support of lifefunction during surgery

3. Postoperative

Supervising care after surgery and medicallydischarging the patient from recovery unit


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The role of the anesthesiologists

in the operating room

1) To provide continual medical assessmentofthepatient

2 ) To monitor and control the patients vital lifefunctions (HR and rhythm, breathing, BP, bodytemperature, andfluid balance)

3) To control the patients pain and levelofunconsciousness to make conditions idealforsafe and successful surgery


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The ORsThe ORs

14 mo/f Labioplasty


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The ORsThe ORs

32 yo/mA

damantinoma :AWAKE

INTU

BATION


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The ORsThe ORs

35 yo/fA

dnexaT

umor : PURE

E

PIDURA

LANE

ST

HE

SIA


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The ORsThe ORs

20 yo/mF

racture comp.V

T

h12 :

DOUBLE

LUMEN

TU

BE


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Melakukan Spinal AnestesiMelakukan Spinal Anestesi


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Melakukan Epidural AnestesiMelakukan Epidural Anestesi


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Intratekal (Spinal) vs EpiduralIntratekal (Spinal) vs Epidural


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2. In the post anesthesia care

unit (Recovery Room)

Where patients are transferred afterWhere patients are transferred aftersurgerysurgery

to emerge fully from the effect of anesthesiato emerge fully from the effect of anesthesia

The anesthesiologist decides when theThe anesthesiologist decides when thepatient has recovered enoughpatient has recovered enough

sent home following outpatient surgery orsent home following outpatient surgery ormoved to room or ward in the medical facilitymoved to room or ward in the medical facility


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3. For pain management

After surgery, the anesthesiologistsAfter surgery, the anesthesiologistsprescribes pain medication and techniquesprescribes pain medication and techniquesto manage painto manage pain

Anesthesiologists are uniquely qualified toAnesthesiologists are uniquely qualified toprescribe and administer drug therapiesprescribe and administer drug therapies

forfor acute, chronic, cancer and childbirthacute, chronic, cancer and childbirthpainpain


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PCEA (Patient Controlled EpiduralPCEA (Patient Controlled Epidural

Analgesia)Analgesia)


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Learning time !Learning time !


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4. In critical care and trauma medicine

Anesthesiologist provide medicalAnesthesiologist provide medicalassessment and diagnosis, respiratoryassessment and diagnosis, respiratoryand cardiovascular support and infectionand cardiovascular support and infectioncontrolcontrol

Emergency situation : AnesthesiologistEmergency situation : Anesthesiologistprovide airway management, cardiacprovide airway management, cardiac

and pulmonary resuscitation, advancedand pulmonary resuscitation, advancedlife support, pain control andlife support, pain control andpreparation for emergency surgerypreparation for emergency surgery


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Critical Care IN ACTION !Critical Care IN ACTION !


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Central Venous CatheterizationCentral Venous Catheterization

and CVP monitoringand CVP monitoring


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ICU patientICU patient

43 yo/mM

ult.

fracture + PE

: CPA

P non-invasive ventilation


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10 yo/f Post trepanasi +

Pneumonia

5 days old/fTracheo-

esophageal fistula


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25 yo/m Caisson disease

Hyperbaric

chamber


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5.During cardiac laboratory procedure

Anesthesiologists are available during

cardiac catheterization and angioplastyprocedures for emergency airway

management or resuscitation if

necessary


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6. For diagnostic procedures and

non surgical treatment

Anesthesiologists is involved in :Anesthesiologists is involved in :

radiological imaging or scanning proceduresradiological imaging or scanning procedures

gastrointestinal endoscopiesgastrointestinal endoscopies

in vitro fertilizationin vitro fertilization

lithotripsy procedureslithotripsy procedures

electroshock treatmentelectroshock treatment nutritional supportnutritional support

respiratory therapyrespiratory therapy


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MATERIMATERI KULIAHKULIAH PRA UTSPRA UTS

1.1. PENGANTAR ANESTESIOLOGIPENGANTAR ANESTESIOLOGI

2.2. FARMAKOLOGI KLINIKOBATFARMAKOLOGI KLINIKOBAT--OBAT ANESTESIAOBAT ANESTESIA

3.3. PERSIAPAN PRA ANESTESIA DAN PERAWATANPERSIAPAN PRA ANESTESIA DAN PERAWATANPASKA ANESTESIAPASKA ANESTESIA

4.4. ANASTESIA LOKAL DAN REGIONALANASTESIA LOKAL DAN REGIONAL

5.5. PENATALAKSANAAN JALAN NAFASPENATALAKSANAAN JALAN NAFAS6.6. RESUSITASI JANTUNG PARURESUSITASI JANTUNG PARU

7.7. TERAPI OKSIGENTERAPI OKSIGEN


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MATERIMATERI KULIAHKULIAH PASKA UTSPASKA UTS

1.1. DASAR DASAR ICUDASAR DASAR ICU / CRITICAL CARE/ CRITICAL CAREMEDICINEMEDICINE

2.2. TERAPI CAIRAN & TRANSFUSI DARAHTERAPI CAIRAN & TRANSFUSI DARAH3.3. GANGGUAN ELEKTROLITGANGGUAN ELEKTROLIT4.4. KESEIMBANGAN ASAM BASAKESEIMBANGAN ASAM BASA5.5. PEMBERIAN ANESTESIA PADA PEMBEDAHANPEMBERIAN ANESTESIA PADA PEMBEDAHAN

DARURATDARURAT

6.6. PEMBERIAN ANESTESI PADA KASUSPEMBERIAN ANESTESI PADA KASUSTERTENTUTERTENTU

7.7. PENATALAKSANAAN NYERIPENATALAKSANAAN NYERI


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THANKTHANK

YO

UYO

U


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01. Introduction to Anesthesiology

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