INTRODUCTION TO ANAESTHESIADR UNNIKRISHNAN P ASSISTANT PROFESSORDEPT OF ANAESTHESIATRAVANCORE MEDICAL COLLEGEKOLLAM, KERALA, INDIA

Where to go.....?

Follow your heart

Know your heart

…..and most importantly……..have a heart!

Where to go.....?

If your favourite place in the world is

the operating room, be a surgeon.

If your favorite place in the hospital is

the operating room, be an

anesthesiologist.

TRUE OR FALSE

You are more familiar with a surgical

knife [1] and catgut than an

oropharyngeal airway ….[2]

You have observed breast lump

excision or appendicectomy[3] better

than a peripheral vein cannulation…[4]

More often, learning to drive a car will

prove easier and useful, than learning

to fly an aeroplane!

….. Anaesthesiology…….?

What we do…

Practice clinical pharmacology and

physiology!

Administrators of medications to alter

physiology and pathology: immediate

response!

What we do..

Analysts and rapid problem solvers!

Team leaders.

What we do…

Our working environment: complex,

technical, requires multi-tasking!

Why anaesthesiology?

Clinical and Basic Research!

Skills

Assessment of patient readiness for surgeryAirway management! Pharmacology!Resuscitation!Fluid replacement! Postoperative pain control!Regional anesthesia!Oxygen transport!Operative stress reduction!

We go to…..

• Operating rooms!• • Intensive care units!• • Labor and delivery suite!• • Pain clinic!• • Radiology suite!• • Gastroenterology suite!• • Ambulatory care centers

Procedures .

Procedures Sedation outside ORLabour analgesiaCentral venous cannulationArterial cannulationIntubationPercutaneous tracheostomyLumbar punctureACLS

Our tools….

• • Inhaled anesthetics!• • Local anesthetics!• • Induction agents!• • Muscle relaxants!• • Opioids!• • NMDA antagonists!

Why anaesthesia?

The Objectives• Loss of awareness / Amnesia!• Analgesia!• Reduce movement in response to stimuli!• Minimize autonomic responses to surgical stimuli!• Muscle relaxation- if required!• Autonomic Regulation!

Youngster !

Unlike many other medical specialties,

anesthesiology is young.!

• Availability of effective surgical

anesthesia:~150 years.!

• Greatest advances: since 1950.!

What a change!

1950: Death rate from anesthesia 1 : 1,500!

1995: Death rate from anesthesia 1 : 250,000!

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Big moment

This demonstration occurred at the

Massachusetts General Hospital on

October 16, 1846

Dr. Warren removed a congenital

vascular malformation from 20-year-

old Edward Gilbert Abbott’s neck. After

the surgery, the patient replied, “I did

not experience pain at any time,

though I knew that the operation was

proceeding.”

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Safety

PULSEOXIMETER [1990]ETCO2[1996]TRANS ESOPHGEAL ECHO[TEE]BISPECTRAL INDEX [BIS]ENTROPYFOB- INTUBATION / LAVAGEPULMONARY ARTERIAL CATHETER

Steps

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Evaluation

History

Physical examination

Lab tests

Optimization

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Prepare them; prepare ourselves

Preop ordersExplanationPreparing OTEquipments and drugsChoice of anaesthesiaInduction, IntubationMonitoring Reversal and extubationPACU

Spinal and Epidural anaesthesia

Specializations

Critical care Cardiac AnaesthesiaPain and palliative careNeuroanaesthesiaObstetric , Pediatric Anaesthesia

Thoughts …….

Good judgment is based on experience

and experience is based on bad

judgment.

Savor your successes but do so quickly

and then move on—dwelling on them

causes overconfidence.

Thoughts …….

Some patients you think will get better

will get worse.

Some patients you think will get worse

will get better.

When you’re making decisions on

rounds, put personal problems aside.

Hello……

You get to interact with the whole menagerie of medical and surgical specialties

What suits one customer might not suit the next;individualize your Rx .....always

Support! different situations by specific tools.

Patient is more imporant than our ego; call for help, whenever patient is in danger

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Thank youvisit me @ www.thelaymedicalman.blogspot.in

www.facebook.com/groups/anaesthesiaindia

Macintosh noted: “for the surgeon the spinal ends with the injection of the agent; for the anesthetist it begins with the injection of the agent.”

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