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INTRODUCTION TO ANESTHESIOLOGY

Yohanes Rudijanto, dr., SpAn.


KSM Anestesiologi RS Immanuel - Bandung

Short CV

Medical Doctor

FK UNPAD, 1991 St. Lukes Medical Center, Manila 2002 2004

Anesthesiology residency program


Anesthesiology adaptation program

FK UNHAS, Makassar 2005 - 2006

1910

2006

History of Anesthesia

In USA Modern anesthesia began on March 1842 when dr. Crawford W. Long administered sulfuric ether to James Venable Dr. Long didnt reported his discovery in medical journal

History of Anesthesia

Oct. 16, 1846 William T.G. Morton a dentist demostrated ether anesthesia at Massachussetts General Hospital While John C. Warren a surgeon successfully removed a vascular lesion from the left side of a patient, Edward G. Abbot

Morton's ether inhaler (1846)

"Gentlemen, this is no humbug "


William Morton standing, upper right John Warren in the right with his hand in patients leg

History of Anesthesia

In Europe (1853) Dr. John Snow gave chloroform to Queen Victoria for the birth of Prince Leopold Dr. Snow went to publish and studied chloroform anesthesia thus becoming recognized as the 1st anesthesiologist

Regional Anesthesia

Carl Koller (18571944), opthalmologist

Use cocaine as local anesthetics

August Bier

Use Heinrich Quincke technique Introduce Spinal anesthesia, 1899 IV regional technique with procaine, 1908
Introduce Epidural anesthesia

Edward Tuohy, 1944

Regional Anesthesia

1902, Harvey Cushing


Coined the phrase regional anesthesia technique of blocking brachial or sciatic plexus under direct vision during general anesthesia \ multidisciplinary pain clinic The Management of Pain, now 3rd edition, is regarded as a classic of the literature of anesthesia

John J. Bonica

General vs Regional Anesthesia

Caudal analgesia

Axillary block

I/ : operation on lower arm and hand

WHAT IS ANESTHESIOLOGY ?

Anesthesia berasal dari bahasa latin An ( = tidak ) Aesthesia ( = rasa ) anesthesia = tanpa rasa, disertai dengan hilangnya kesadaran analgesia = tanpa rasa, tanpa disertai hilangnya kesadaran Bius dari bahasa sansekerta Be ( = tanpa ) Hoss ( = sadar ) Bius = tanpa sadar = anesthesia Anesthesiology : ilmu yg mempelajari hal-hal yg berhubungan dengan hal tsb di atas

Definition Anesthesiology is the practice of medicine dedicated to the relief of pain and total care of surgical patient before, during and after surgery

Although historically, Anesthesiologists have been known primarily as physicians who administer anesthesia to alleviate pain and suppress consciousness of the patient undergoing surgery, they also provide medical care and consultations in many other setting and situation in addition to the operating room

Scope of practice
1. In the operating room 2. In the post anesthesia care unit ( recovery room ) 3. For pain management 4. In critical care and trauma medicine 5. During cardiac laboratory procedures 6. For diagnostic procedures and nonsurgical treatments

1. In the operating room

Anesthesiologists is the perioperative physician (perimeaning around ), who provides medical care to patient throughout a surgical experience

1. In the operating room


These include : 1. Preoperative Evaluating the patient before surgery 2. Intraoperative Providing pain control and support of life function during surgery 3. Postoperative Supervising care after surgery and medically discharging the patient from recovery unit

The role of the anesthesiologists in the operating room


1) To provide continual medical assessment of the patient
2) To monitor and control the patients vital life functions (HR and rhythm, breathing, BP, body temperature, and fluid balance) 3) To control the patients pain and level of unconsciousness to make conditions ideal for safe and successful surgery

The ORs

14 mo/f Labioplasty

The ORs

32 yo/m Adamantinoma : AWAKE INTUBATION

The ORs

35 yo/f Adnexa Tumor : PURE EPIDURAL ANESTHESIA

The ORs

20 yo/m Fracture comp.V Th12 : DOUBLE LUMEN TUBE

Melakukan Spinal Anestesi

Melakukan Spinal Anestesi

Melakukan Spinal Anestesi

Melakukan Spinal Anestesi

Melakukan Epidural Anestesi

Melakukan Epidural Anestesi

Melakukan Epidural Anestesi

Melakukan Epidural Anestesi

Melakukan Epidural Anestesi

Intratekal (Spinal) vs Epidural

2. In the post anesthesia care unit (Recovery Room)

Where patients are transferred after surgery

to emerge fully from the effect of anesthesia

The anesthesiologist decides when the patient has recovered enough

sent home following outpatient surgery or moved to room or ward in the medical facility

3. For pain management

After surgery, the anesthesiologists prescribes pain medication and techniques to manage pain

Anesthesiologists are uniquely qualified to prescribe and administer drug therapies for acute, chronic, cancer and childbirth pain

PCEA (Patient Controlled Epidural Analgesia)

Learning time !

4. In critical care and trauma medicine

Anesthesiologist provide medical assessment and diagnosis, respiratory and cardiovascular support and infection control Emergency situation : Anesthesiologist provide airway management, cardiac and pulmonary resuscitation, advanced life support, pain control and preparation for emergency surgery

Critical Care IN ACTION !

Central Venous Catheterization and CVP monitoring

ICU patient

43 yo/m Mult. fracture + PE : CPAP non-invasive ventilation

ICU patient

10 yo/f Post trepanasi + Pneumonia

5 days old/f Tracheoesophageal fistula

ICU patient

Hyperbaric chamber

25 yo/m Caisson disease

5. During cardiac laboratory procedure

Anesthesiologists are available during cardiac catheterization and angioplasty procedures for emergency airway management or resuscitation if necessary

6. For diagnostic procedures and non surgical treatment

Anesthesiologist is involved in :
radiological

procedures, gastrointestinal endoscopies in vitro fertilization lithotripsy procedures electroshock treatment nutritional support respiratory therapy

imaging or scanning

6. For diagnostic procedures and non surgical treatment Anesthesiologists is involved in :


radiological imaging or scanning procedures gastrointestinal endoscopies in vitro fertilization lithotripsy procedures electroshock treatment nutritional support respiratory therapy

MATERI KULIAH PRA UTS


1. PENGANTAR ANESTESIOLOGI 2. FARMAKOLOGI KLINIK OBAT-OBAT ANESTESIA 3. PERSIAPAN PRA ANESTESIA DAN PERAWATAN PASKA ANESTESIA 4. ANASTESIA LOKAL DAN REGIONAL 5. PENATALAKSANAAN JALAN NAFAS 6. RESUSITASI JANTUNG PARU 7. PENATALAKSANAAN NYERI

MATERI KULIAH PASKA UTS


1. DASAR DASAR ICU / CRITICAL CARE MEDICINE 2. TERAPI CAIRAN & TRANSFUSI DARAH 3. GANGGUAN ELEKTROLIT 4. KESEIMBANGAN ASAM BASA 5. PEMBERIAN ANESTESIA PADA PEMBEDAHAN DARURAT 6. PEMBERIAN ANESTESI PADA KASUS TERTENTU 7. PENATALAKSANAAN NYERI

THANK YOU