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Introduction of Anesthesiology

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  • 1. Introduction to Anesthesiology Narendra P L MD PDCC FCARCSI(pri),MRCS-I Dept. of Anesthesiology & Intensive Care BLDE University ,BIJAPUR,Karnataka India
  • 2. Meaning of Anaesthesia • Greek  an-, "without"; and , aisthēsis, "sensation” refers to the inhibition of sensation .
  • 3. Oxford dictionary definition • insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations:
  • 4. Origin of Anaesthesia word Oliver Wendell Holmes Sr August 29, 1809 – October 7, 1894
  • 5. 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
  • 6. 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
  • 7. 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
  • 8. Thus • Anaesthetic skills are life saving and pain releiving • learning is a must for every doctor
  • 9. • 1. Scope of anesthesiology • 2. Roles of anesthesiologist
  • 10. CPR
  • 11. Providing operative conditions provide good operating conditions while maintaining physiology
  • 12. 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
  • 13. 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
  • 14. Expanding Role of Anesthesiologist • The anesthesiologist is the perioperative physician • From Surgical Anesthesia to Critical Care Medicine and Pain Medicine • Administrative ,Co ordinating roles
  • 15. Evolution of anesthesia
  • 16. 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
  • 17. China • Hua Tuo AD 145220 2nd century AD. by mixing wine with a mixture of herbal extracts he called mafeisan 
  • 18. Primitive Anesthesia • Ancient civilizations- opium poppy, coca leaves, mandrake root, alcohol • Regional anesthesia in ancient timescompression of nerve trunks or the application of cold (cryoanalgesia)
  • 19. 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. 
  • 20. 19 th Century • Crawford Long-1842 • employed ether as a general anesthetic for limb amputations and parturition
  • 21. First successful demonstration • Re-enactment of the first public demonstration of  general anaesthesia
  • 22. 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
  • 23. Regional Anaesthesia • 1884 Sigmund Freud physiology actions cocaine • Carl Koller cocaine ophthalmological surgery
  • 24. 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
  • 25. 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
  • 26. The 21 st century-digital revolution
  • 27. What I need to learn as Student /Intern • Recognise Breathing problems • Mask Ventilation • Airway manuevres • Intubation skills • Intravenous Access
  • 28. Basic Airway Skills • Video-1
  • 29. Some Basic Equipment
  • 30. Endotracheal Intubation
  • 31. Endotracheal tubes
  • 32. Basic Intubation Skills – Casualty Area • Assess • Cervical Spine Protection • Call for help
  • 33. Indications for Intubation • Protection of Airway • Prevention & Treatment Aspiration • Administritation of General Anaesthesia • Mechanical Ventilation
  • 34. Basic drugs for sedation • Midazolam • Lorazepam • Diazepam
  • 35. Induction agents • Thiopental • Ketamine • Propofol
  • 36. Muscle relaxants • Only trained personnel must use them • If doubt, don’t use
  • 37. opioids • Morphine » meperidine » fentanyl , sufentanyl , alfentanil » remifentanyl • Moniter after administration
  • 38. Triad of anesthesia • 1. unconsciosness • 2. analgesia • 3. muscle relaxation …..
  • 39. Endotraheal Intubation • Video-2
  • 40. Inhalational Agents • Chloroform • Ether • Halothane • Isoflurane • Sevoflurane • Desflurane
  • 41. Monitoring-Eternal Vigilance • Presence of Anaesthetist • Non Invasive-SpO2,ETCO2,NIBP,Agent • Invasive-CVP,PA Catheter
  • 42. Local and Regional anesthesia • Don’t take Local Lightly • Be Prepared for full resuscitation • Know the patient, • Know the drug •
  • 43. Contraindications for Regional Anaestesia • Absolute-Coagulopathy, • Patient Refusal,Local Infection • Relative-Preexisting Neurological Disease,Cardiac Disease,
  • 44. Spinal Anaesthesia • Video-3
  • 45. regional anesthesia • Intradermal infiltrating and nerve blocks » Bier block ( intravenous regional anesthesia of the arm) » spinal anesthesia » caudal epidural anesthesia » lumbar epidural anesthesia
  • 46. • Techniques of anesthesia 1. GA 2. RA or LA Choice of anesthesia : technique, agents 1. LA 2. GA 3. RA 4. MAC How to choose 1. the operation 2. the patient 3. the anesthetist 4. the surgeon
  • 47. advantages of anesthesia 1. good operating condition 2. no suffer to pain 3. decrease stress response to surgery 4. maintain physiologic balance
  • 48. Challenges of anesthesia • Alter physiology and control • Adequate but not too much • Anticipate ,Prevent & Treat Complications
  • 49. Care of the anesthetized patient • 1. preanesthetic care Routine preanesthesia evaluation 1. History 2. physical examination 3. laboratory evaluation 4. ASA classification Preanesthetic preparation Premedication
  • 50. Care of the anesthetized patient • 2. anesthetic care - preinduction phase - induction phase - maintenance phase - emergence phase
  • 51. Care of the anesthetized patient • 3. postanesthesia care 3.1 immediate : RR or PACU 3.2 late postanesthesia care - pain control -complication -monitoring
  • 52. The primary goal of the anesthetist ☺ to see the patient safety and comfortably through procedure
  • 53. Anaesthesia Today • Video-4
  • 54. Anaesthesia Today • Video -5
  • 55. 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
  • 56. The most common specialties • Anesthesiology • Family General Practice • Internal Medicine
  • 57. How risky is Anesthesiology
  • 58. Amount of Malpractice Payments,
  • 59. 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
  • 60. Average working hours per week • • • <50 hrs–28% • • 51-60 hrs–22% • • 61-70 hrs–15% • • 71-80 hrs–12% • • >81 hrs–23%
  • 61. 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% ?
  • 62. 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
  • 63. • Look Ahead and Explore • Anesthesiologists are those who do not run way from challenges of life
  • 64. • Thank You