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Introduction to Anesthesiology
Narendra P L MD PDCC FCARCSI(pri),MRCS-I
Dept. of Anesthesiology & Intensive Care
BLDE Univ...
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...
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...
Some Basic Questions
• I am a student /intern-I don’t need to
learn Anaesthesia
• I am not specialising in Anaesthesia
• I...
Why should I know it ?
• Airway skills –life saving
• Expertise in IV access-life saving
• CPR-Life giving
• Some knowledg...
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...
Clinical Roles of the anesthesiologist
1. OR ,RR, LR, ER
2. ICU, ward, Respiratory care unit
3. Pain clinic
4. CPR team, E...
Expanding Role of
Anesthesiologist
• The anesthesiologist is the perioperative
physician
• From Surgical Anesthesia to Cri...
Evolution of anesthesia
Early Records-

East

•  Sumerians the 
opium poppy (
Papaver somniferum)
3400 BC
•

 Sushruta

Samhita  - wine with
incen...
China
• Hua Tuo AD 145220 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 a...
Middle Ages and Renaissance
• 1200 - 1500 A.D. in England, a potion
called dwale was used as an anesthetic.
contained bile...
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 Gi...
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...
Birth of modern Anaesthesia
• 1913,Chevalier Jackson-use of direct
laryngoscopy as a means to intubate the
trachea
• Sodiu...
The 21 st century-digital
revolution
What I need to learn as
Student /Intern
• Recognise Breathing problems
• Mask Ventilation
• Airway manuevres
• Intubation ...
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
Anaest...
Basic drugs for sedation
• Midazolam
• Lorazepam
• 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 t...
Contraindications for
Regional Anaestesia
• Absolute-Coagulopathy,
• Patient Refusal,Local Infection
• Relative-Preexistin...
Spinal Anaesthesia
• Video-3
regional anesthesia
• Intradermal infiltrating and nerve blocks »
Bier block ( intravenous regional anesthesia
of the arm)...
• Techniques of anesthesia
1. GA
2. RA or LA
Choice of anesthesia : technique, agents
1. LA
2. GA
3. RA
4. MAC
How to choo...
advantages of anesthesia
1. good operating condition
2. no suffer to pain
3. decrease stress response to surgery
4. mainta...
Challenges of anesthesia
• Alter physiology and control
• Adequate but not too much

• Anticipate ,Prevent & Treat
Complic...
Care of the anesthetized patient
• 1. preanesthetic care
Routine preanesthesia evaluation
1. History
2. physical examinati...
Care of the anesthetized patient
• 2. anesthetic care
- preinduction phase
- induction phase
- maintenance phase
- emergen...
Care of the anesthetized patient
• 3. postanesthesia care
3.1 immediate : RR or PACU
3.2 late postanesthesia care
- pain c...
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...
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 Anba...
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%
...
Satisfaction as Anaesthetist
• Overall, 78%-149

(i.e.58% in grade 4 and
20% in grade 5) in our
study of
anaesthesiologist...
• Look Ahead and Explore
• Anesthesiologists are those who do not
run way from challenges of life
•

Thank You
Introduction of Anesthesiology
Introduction of Anesthesiology
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Introduction of Anesthesiology

  1. 1. Introduction to Anesthesiology Narendra P L MD PDCC FCARCSI(pri),MRCS-I Dept. of Anesthesiology & Intensive Care BLDE University ,BIJAPUR,Karnataka India
  2. 2. Meaning of Anaesthesia • Greek  an-, "without"; and , aisthēsis, "sensation” refers to the inhibition of sensation .
  3. 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. 4. Origin of Anaesthesia word Oliver Wendell Holmes Sr August 29, 1809 – October 7, 1894
  5. 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. 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. 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. 8. Thus • Anaesthetic skills are life saving and pain releiving • learning is a must for every doctor
  9. 9. • 1. Scope of anesthesiology • 2. Roles of anesthesiologist
  10. 10. CPR
  11. 11. Providing operative conditions provide good operating conditions while maintaining physiology
  12. 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. 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. 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. 15. Evolution of anesthesia
  16. 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. 17. China • Hua Tuo AD 145220 2nd century AD. by mixing wine with a mixture of herbal extracts he called mafeisan 
  18. 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. 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. 20. 19 th Century • Crawford Long-1842 • employed ether as a general anesthetic for limb amputations and parturition
  21. 21. First successful demonstration • Re-enactment of the first public demonstration of  general anaesthesia
  22. 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. 23. Regional Anaesthesia • 1884 Sigmund Freud physiology actions cocaine • Carl Koller cocaine ophthalmological surgery
  24. 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. 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. 26. The 21 st century-digital revolution
  27. 27. What I need to learn as Student /Intern • Recognise Breathing problems • Mask Ventilation • Airway manuevres • Intubation skills • Intravenous Access
  28. 28. Basic Airway Skills • Video-1
  29. 29. Some Basic Equipment
  30. 30. Endotracheal Intubation
  31. 31. Endotracheal tubes
  32. 32. Basic Intubation Skills – Casualty Area • Assess • Cervical Spine Protection • Call for help
  33. 33. Indications for Intubation • Protection of Airway • Prevention & Treatment Aspiration • Administritation of General Anaesthesia • Mechanical Ventilation
  34. 34. Basic drugs for sedation • Midazolam • Lorazepam • Diazepam
  35. 35. Induction agents • Thiopental • Ketamine • Propofol
  36. 36. Muscle relaxants • Only trained personnel must use them • If doubt, don’t use
  37. 37. opioids • Morphine » meperidine » fentanyl , sufentanyl , alfentanil » remifentanyl • Moniter after administration
  38. 38. Triad of anesthesia • 1. unconsciosness • 2. analgesia • 3. muscle relaxation …..
  39. 39. Endotraheal Intubation • Video-2
  40. 40. Inhalational Agents • Chloroform • Ether • Halothane • Isoflurane • Sevoflurane • Desflurane
  41. 41. Monitoring-Eternal Vigilance • Presence of Anaesthetist • Non Invasive-SpO2,ETCO2,NIBP,Agent • Invasive-CVP,PA Catheter
  42. 42. Local and Regional anesthesia • Don’t take Local Lightly • Be Prepared for full resuscitation • Know the patient, • Know the drug •
  43. 43. Contraindications for Regional Anaestesia • Absolute-Coagulopathy, • Patient Refusal,Local Infection • Relative-Preexisting Neurological Disease,Cardiac Disease,
  44. 44. Spinal Anaesthesia • Video-3
  45. 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. 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. 47. advantages of anesthesia 1. good operating condition 2. no suffer to pain 3. decrease stress response to surgery 4. maintain physiologic balance
  48. 48. Challenges of anesthesia • Alter physiology and control • Adequate but not too much • Anticipate ,Prevent & Treat Complications
  49. 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. 50. Care of the anesthetized patient • 2. anesthetic care - preinduction phase - induction phase - maintenance phase - emergence phase
  51. 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. 52. The primary goal of the anesthetist ☺ to see the patient safety and comfortably through procedure
  53. 53. Anaesthesia Today • Video-4
  54. 54. Anaesthesia Today • Video -5
  55. 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. 56. The most common specialties • Anesthesiology • Family General Practice • Internal Medicine
  57. 57. How risky is Anesthesiology
  58. 58. Amount of Malpractice Payments,
  59. 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. 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. 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. 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. 63. • Look Ahead and Explore • Anesthesiologists are those who do not run way from challenges of life
  64. 64. • Thank You

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