Introduction to Anesthesiology

Narendra P L MD PDCC FCARCSI(pri),MRCS-I

Dept. of Anesthesiology & Intensive Care

BLDE University ,BIJAPUR,Karnataka India

Meaning of Anaesthesia

• Greek  an-, "without"; and , aisthēsis, "sensation” refers to the inhibition of sensation .

Oxford dictionary definition

•insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations:

Origin of Anaesthesia word

Oliver Wendell Holmes Sr

August 29, 1809 – October 7, 1894

  

The letter of “Anaesthesia”

• Holmes wrote: "Everybody wants to have a hand in a great discovery. All I will do is to give a hint or two as to names—or the name—to be applied to the state produced and the agent. The state should, I think, be called 'Anaesthesia.' This signifies insensibility—more particularly ... to objects of touch."

• Small, MR (1962). Oliver Wendell Holmes New York: Twayne Publishers. p. 55. "In a letter to dentist William T. G. Morton

Some Basic Questions

• I am a student /intern-I don’t need to learn Anaesthesia

• I am not specialising in Anaesthesia

• I am keen to learn –But I think its very risky

Why should I know it ?

• Airway skills –life saving

• Expertise in IV access-life saving

• CPR-Life giving• Some knowledge of GA ,LA, Pain

Relief whatever you may practice

Thus

• Anaesthetic skills are life saving and pain releiving

• learning is a must for every doctor

• 1. Scope of anesthesiology• 2. Roles of anesthesiologist

CPR

Providing operative conditions

provide good operating conditions while maintaining physiology

Areas of the practice of anesthesiology • 1. clinical anesthesia -in operating room

-Radiologic department : CT MRI INR RT -Cardiac laboratory : catheterization EPS

insertion of AICD,PCD -ECT

• 2. pain management• 3.intensive care and Respiratory Care • 4.CPR

Clinical Roles of the anesthesiologist

1. OR ,RR, LR, ER 2. ICU, ward, Respiratory care unit 3. Pain clinic 4. CPR team, EMS ,intravenous team

Expanding Role of Anesthesiologist

• The anesthesiologist is the perioperative physician

• From Surgical Anesthesia to Critical Care Medicine and Pain Medicine

• Administrative ,Co ordinating roles

Evolution of anesthesia

Early Records- East

•  Sumerians the opium poppy (Papaver somniferum) 3400 BC

•  Sushruta Samhita  - wine with incense of cannabis for anesthesia.[

• 8th century AD, Arab traders had brought opium to India[ and China.[21

China

• Hua Tuo AD 145-220 2nd century AD. by mixing wine with a mixture of herbal extracts he called mafeisan 

Primitive Anesthesia

• Ancient civilizations- opium poppy, coca leaves, mandrake root, alcohol

• Regional anesthesia in ancient times- compression of nerve trunks or the application of cold (cryoanalgesia)

Middle Ages and Renaissance

• 1200 - 1500 A.D. in England, a potion called dwale was used as an anesthetic. contained bile, opium, lettuce, bryony, and hemlock. 

19 th Century

• Crawford Long-1842

• employed ether as a general anesthetic for limb amputations and parturition

First successful demonstration

• Re-enactment of the first public demonstration of  general anaesthesia

World Anaesthesia Day

• On 16 October 1846, John Collins Warren removed a tumor from the neck of a local printer,Edward Gilbert Abbott. Warren reportedly quipped, "Gentlemen, this is no humbug.

• MGH Boston

Regional Anaesthesia

• 1884 Sigmund Freud physiology actions cocaine

• Carl Koller cocaine ophthalmological surgery

Journey of anesthesia

• Local anesthesia : chewed coca leaves and spat saliva

• The evolution of modern anesthesia : first with inhalation anesthesia=> local and regional anesthesia=> finally intravenous anesthesia

Birth of modern Anaesthesia

• 1913,Chevalier Jackson-use of direct laryngoscopy as a means to intubate the trachea

• Sodium Pentathal - first used in humans on 8 March 1934 by Ralph M. Waters

The 21 st century-digital revolution

What I need to learn as Student /Intern

• Recognise Breathing problems

• Mask Ventilation

• Airway manuevres

• Intubation skills• Intravenous Access

Basic Airway Skills

• Video-1

Some Basic Equipment

Endotracheal Intubation

Endotracheal tubes

Basic Intubation Skills –Casualty Area

• Assess

• Cervical Spine Protection

• Call for help

Indications for Intubation

• Protection of Airway• Prevention & Treatment Aspiration• Administritation of General

Anaesthesia• Mechanical Ventilation

Basic drugs for sedation

• Midazola m

• Lorazepa m

• Diazepam

Induction agents

• Thiopental

• Ketamine

• Propofol

Muscle relaxants

• Only trained personnel must use them

• If doubt, don’t use

opioids

• Morphine » meperidine » fentanyl , sufentanyl , alfentanil » remifentanyl

• Moniter after administration

Triad of anesthesia

• 1. unconsciosness • 2. analgesia• 3. muscle relaxation …..

Endotraheal Intubation

• Video-2

Inhalational Agents

• Chloroform• Ether• Halothane• Isoflurane• Sevoflurane• Desflurane

Monitoring-Eternal Vigilance

• Presence of Anaesthetist

• Non Invasive-SpO2,ETCO2,NIBP,Agent

• Invasive-CVP,PA Catheter

Local and Regional anesthesia

• Don’t take Local Lightly

• Be Prepared for full resuscitation

• Know the patient,

• Know the drug •

Contraindications for Regional Anaestesia

• Absolute-Coagulopathy,• Patient Refusal,Local Infection

• Relative-Preexisting Neurological Disease,Cardiac Disease,

Spinal Anaesthesia

• Video-3

regional anesthesia

• Intradermal infiltrating and nerve blocks » Bier block ( intravenous regional anesthesia of the arm) » spinal anesthesia » caudal epidural anesthesia » lumbar epidural anesthesia

• Techniques of anesthesia 1. GA 2. RA or LAChoice of anesthesia : technique, agents 1. LA 2. GA 3. RA 4. MACHow to choose 1. the operation 2. the patient 3. the anesthetist 4. the surgeon

advantages of anesthesia

1. good operating condition 2. no suffer to pain 3. decrease stress response to surgery 4. maintain physiologic balance

Challenges of anesthesia

• Alter physiology and control

• Adequate but not too much

• Anticipate ,Prevent & Treat Complications

Care of the anesthetized patient

• 1. preanesthetic careRoutine preanesthesia evaluation 1. History 2. physical examination 3. laboratory evaluation 4. ASA classificationPreanesthetic preparationPremedication

Care of the anesthetized patient

• 2. anesthetic care - preinduction phase - induction phase - maintenance phase - emergence phase

Care of the anesthetized patient

• 3. postanesthesia care 3.1 immediate : RR or PACU 3.2 late postanesthesia care - pain control -complication -monitoring

The primary goal of the anesthetist ☺ to see the patient safety and comfortably through procedure

Anaesthesia Today

• Video-4

Anaesthesia Today

• Video -5

Malpractice Risk according to Speciality

• Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D.

• New England Journal of Medicine 2011;Aug 18; 365(7):629-6

The most common specialties

• Anesthesiology

• Family General Practice

• Internal Medicine

How risky is Anesthesiology

Amount of Malpractice Payments,

Anaesthesiology as a Career Vis-À-Vis Professional Satisfaction in

Developing Countries

• Sanjeev Singh1, Arti Singh Anbarasu Annamalai and Gaurav Goel

• J Anesthe Clinic Res 4: 304

Average working hours per week•

• • <50 hrs–28% • • 51-60 hrs–22% • • 61-70 hrs–15% • • 71-80 hrs–12% • • >81 hrs–23%

What career would you like to

opt for in your post graduation?

• 1. Anaesthesiology 11% • 2. Surgery 8% • 3. Pediatrics 7% • 4. Medicine 17% • 5. Radiology 21% • 6. Ophthalmology 3% • 7. Orthopedics18% • 8. Others (Please Specify) 1%

Satisfaction as Anaesthetist

• Overall, 78%-149 (i.e.58% in grade 4 and 20% in grade 5) in our study of anaesthesiologists were satisfied bytheir professional work.

• 11% wanted to choose anaesthesiology as a career because of increasing value of anaesthesiologists and not much initial cost required in setup

• Look Ahead and Explore

• Anesthesiologists are those who do not run way from challenges of life

• Thank You