Anesthesiology

Anesthesiology

1. A NESTHESIOLOGY

2. Pain, a Burden to be Borne In the early days, most people expected to experience pain in their lives Pain was one of God's punishments for the wicked and purifying trials for the good; For the woman in labor, pain was the spiritual experience that would transform her into a self-sacrificing mother.

3. Before anesthesia, the best surgeons were the fastest. Four Herculean men would hold a patient on a gurney and surgery would proceed. (“ PIGIL ANESTHESIA ”) Quick and simple procedures such as amputations were the majority of surgeries and most patients would just faint from the unbearable pain.

4. Original in the Royal College of Surgeons of England, London. Anesthesiology

5. HISTORY of ANESTHESIA Most commonly used substances to kill pain: opium derived from the poppy flower, Papaver somniferum . alcohol or wine , mandragora or mandrake from the plant Atropa mandragora , belladonna from the deadly nightshade, marijuana or Cannabis indica .

6. Anesthesia History Files 1800 June 25: Humphry Davy completes the introduction to his classic work, Researches, Chemical and Philosophical; Chiefly Concerning Nitrous Oxide, or Dephlogisticated Nitrous Air, and its Respiration What eventually evolved into anesthesia as we know it today was ushered in with the chance observation that the inhalation of nitrous oxide ("laughing gas") produced a state of intoxication during which people became highly amused and insensitive to pain.

7. Horace Wells (1815-1848), a New England dentist, experimented with anesthetics in the early 1840s. He attempted at a public demonstration of nitrous oxide anesthesia failed, humiliating him. Anesthesia History Files

8. Anesthesia History Files Charles Thomas Jackson (Massachusetts) In 1846, Jackson suggested to Morton (his student) that he use sulfuric ether

9. Ether was used : as a sedative in the treatment of tuberculosis, asthma and whooping cough, and as a remedy for toothache. Its anesthetic potential had never been exploited. Anesthesia History Files

10. On March 30, 1842, Crawford Long made the first use of ether as a surgical anesthetic when he removed a tumor from the neck of patient James Venable. Anesthesia History Files

11. On 16 th of October in 1846, Morton made his famous demonstration of surgical anesthesia at the Massachusetts General Hospital, using a hastily rigged apparatus to deliver ether to the patient.

12. In the subsequent bitter debate over who "discovered" anesthesia, Charles Thomas Jackson attempted to claim the achievement for himself. By 1873, however, Jackson had been admitted to an insane asylum where he died in 1880 Anesthesia History Files

13. Anesthesia History Files In late 1847 Simpson discovered the anesthetic properties of chloroform

14. Anesthesia History Files In 1847 he began to administer ether at St. George's Hospital in London and published a book on ether anesthesia. In 1853 and 1857 he administered chloroform to Queen Victoria for the births of Prince Leopold and Princess Beatrice Dr John Snow

15. Cocaine was first used to achieve topical anesthesia in 1884. Spinal and epidural anesthesia were discovered soon after and a combination of drugs was being used to allow optimal conditions for physicians to perform surgery.

16. While the surgeon's prestige and power soared, the anesthetist was a mere assistant--a nurse, intern or medical student. The development of the independent medical specialty of anesthesiology would not occur until the early 20th century Anesthesia History Files

17. After World War II ended in 1945, major developments in the field of anesthesiology opened new avenues of medical and surgical care that were previously unthinkable. Thus began the modern era of anesthesia. Anesthesia History Files

18. ROLE OF AN ANESTHESIOLOGIST Constantly changing and its unique role expanding  to include but not limit itself to: Provision of insensibility to pain Monitoring and restoration of homeostasis Diagnosis & treatment of painful syndromes Clinical Management of Cardiac and Pulmonary Resuscitation Evaluation of Respiratory function and application of Respiratory Therapy

19. The Anesthesiologists’ Role Deliver pain management and provide life sustaining care for the patients during surgery Treat acute and chronic pain via multidisciplinary approach Perioperative Physician Supervise post-operative care Intensivists

20. Anesthesiology Anesthesia – is a reversible condition of comfort, quiescence and physiological stability in a patient before, during and after performance of a procedure. General anesthesia – for surgical procedure to render the patient unaware / unresponsive to the painful stimuli.

21. Anesthesiology Surgical stress – evokes Hypothalamus- Pituitary-Adrenal axis and sympathetic system. Tissue damage during surgery induces coagulation factors and activates platelets leading to hypercoagulability of blood. Anesthesia decreases the components of surgical stress response.

22. ANESTHESIOLOGISTS’ ROLE During surgery 1.The Operating theater is still their domain 2.Provide utmost stability of the different vital organ systems during surgery by vigilant monitoring and interventions if necessary , during onslaught due to the stresses of surgery per se. 3.Provide adequate analgesia during surgery 4. Provide adequate sedation with the objective of negative recall or awareness

23. ANESTHESIOLOGISTS’ ROLE In Pain Management “ NO PAIN : PATIENTS GAIN ” Acute pain management - caused by trauma or other acute illnesses but more so in postoperative analgesia Chronic pain - alleviates patients sufferings due to chronic pain utilizing multi modal therapy approach Participate in the multidisciplinary management of cancer

24. PERIOPERATIVE PHYSICIAN: PREOP EVALUATION INTRAOP MEDICATIONS POSTOP PREPARATIONS AND MEDICATIONS

25. Ultimate Goals of Preanesthetic & Preoperative Assessment Reduce the morbidity of surgery Increase the quality but reduce the cost of preoperative care To return the patient to desirable functioning as quickly as possible Michael Roizen,ASA Refresher Course 2005

26. PREOPERATIVE EVALUATION, PREPARATION & PREMEDICATION present & past history Presence of coexisting diseases General survey of the patient (anticipate technical difficulties  spinal deformity, facial abnormalities & degree of hydration Preoperative orders – fasting prior to OR, preoperative medications & IV fluid maintenance  ordered during the visit  Consists of doing a good health history of the patient

27. ASA PHYSICAL STATUS CLASS I – no organic, physiologic, biochemical or psychologic disturbance CLASS II – mild to moderate systemic disturbance caused by the condition to be treated or concomitant disease. Example: Compensated Diabetes Mellitus CLASS III – severe systemic disturbance that limits activity. Example: recent Myocardial Infarction CLASS IV – severe systemic disturbance that is life threatening. Example: Cardiac Insufficiency or Advance Pulmonary disease CLASS V – Moribund subjected to surgery in desperation

28. Anesthesiology Preanesthetic medication: It is the use of drugs prior to anesthesia to make it more safe and pleasant. To relieve anxiety – benzodiazepines. To prevent allergic reactions – antihistaminics. To prevent nausea and vomiting – antiemetics. To provide analgesia – opioids. To prevent bradycardia and secretion – atropine.

29. TYPES OF ANESTHESIA GENERAL ANESTHESIA REGIONAL ANESTHESIA LOCAL ANESTHESIA