Introduction to Anesthesiology

Meaning of Anaesthesia

Greek an-, "without"; and , aisthsis,

"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 namesor the
nameto be applied to the state produced
and the agent. The state should, I think, be
called 'Anaesthesia.' This signifies
insensibilitymore particularly ... to objects
of touch."

Small, MR (1962). Oliver Wendell Holmes New York: Twayne Publishers. p. 55. "In a letter to dentist William
 Some Basic Questions
I am a student /intern-I dont 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
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

Midazolam
Lorazepam
Diazepam
 Induction agents

Thiopental

Ketamine

Propofol
 Muscle relaxants

Only trained personnel must use them

If doubt, dont use

 opioids

Morphine meperidine fentanyl ,

sufentanyl , alfentanil remifentanyl

Moniter after administration

 Triad of anesthesia

1. unconsciosness
2. analgesia
3. muscle relaxation ..
Endotraheal Intubation
 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

Dont 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
 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 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
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 care
Routine preanesthesia evaluation
1. History
2. physical examination
3. laboratory evaluation
4. ASA classification
Preanesthetic preparation
Premedication
 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
The most common specialties

Anesthesiology

Family General Practice

Internal Medicine
How risky is Anesthesiology
Amount of Malpractice Payments
 Average working hours per week

<50 hrs28%
51-60 hrs22%
61-70 hrs15%
71-80 hrs12%
>81 hrs23%
 Thank You