An Introduction to Anesthesiology

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An Introduction toAnesthesiology


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Why an Introduction


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The Past how it all began (An understanding of past gui

The Present.the current scenario

The Futurethat is yet to come


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1st

century AD

Bark of mandrake plant

Boiled in wine

Mandrake

Dropped over tissues to be cut


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Europeans attempted to relieve pain

Used

Hypnosis

Alcohol ingestion

Topical pressure

Ice


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The Lancet

One of the most renowned journals (Impact Factor 39.06)

First EditionArrival of Ether Anaesthesia

announced in first edition o

The Lancet of 1847


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NITROUS OXIDE

17thcentury

Another agent similar to ether

Similar as inhaled

Produced lightheadedness

Rather than an anesthetic, used to produce thrill

Came to be known as laughing gas

Casually noted as transiently relieved headache, &

briefly quenched toothache


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Contribution of Clarke, Long &Wells

Clarke, a chemistry student

18thcentury

Administered ether from a towel to a young

woman for tooth extractionand was successful

But his professors believed that the pain free

state was due to hysteria


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Crawford Long, 2 months later

Administered ether on towel for excison of neck

tumors

Was successful

Could not publish papers on his work as he

practiced in a rural area


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Urban dentists though had a lot of patients

From a dentists point of view,

Pain was not life threatening

Rather it was livelihood threatening


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Horace Wells, a dentist, in an attempt to search

further methods to relieve pain

Agreed to have nitrous oxide administered to

himself for tooth extraction

Experiment was successful


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Few weeks later,

Wells attempted a public demonstration

For tooth extraction

But probably he could not reach sufficient levelof anaesthesia,

Patient felt pain

Declared bogus by audience

Wells was dissappointed, although continued touse the procedure in his practice for quitesometime

Commited suicide


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Morton

WTG Morton, William Thomas Green Morton

A graduate of Baltimore College of Dental Surgery

Shared practice with Wells

Had interest in anaesthesia

Continued experiments with ether

Learned that ether provided anaesthesia, without

causing respiratory or cardiovascular depression


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He anaesthetised a pet dog successfully and hisconfidence increased

He started secretexperimentations with ether

Began to anaesthetise patients in his dentaloffice

Helater received an invitation for public demo Bullfinch Amphitheater, MGH, Boston, USA


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Friday, October 16, 1846

Administerd ether to EG Abbot, before surgeon,

JC Warrens

Excision of vascular lesions on left side of neck

Instrument consisted of a large glass bulb, with a

coloured agent and a spout for inhalation


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Abbot took the inhaler in his mouth,

Surgery proceeded

On completion, Abbot reported that the event

was painfree

Mortons demonstration was highly successful

But Morton was cleverenough & moneyminded


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Concealed the identity of ether

Named it falsely as LETHEON

He spent all his time & Money promoting Letheon

He gave up his dental practice

Applied for patent

Was about to receive a large sum


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When due to peculiar aroma he had to admit

that the active component ETHER

Soon a controversy was struck between the

various supporters

Ultimately the deal was quashed

After 20 years of litigation and poverty

Died at the age of 49, backed by his wife and 5

children leaving them penniless


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October 16th

World Anaesthesia Day


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LABOUR PAIN RELIEF

James Young Simpson

First to use ether for labor analgesia in 1846

Drawbacksslow onset and explosive

Experimented for better analgesics


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At a dinner party at his home

Simpson and the assembled group inhaled

CHLOROFORM themselves

Fell unconscious

Woke up delighted on their success

Simpson propagated his discovery, and within 2

weeks published an account in Lancet


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Faced opposition

Social belief that labor pain is a natural

phenomenom

Any measure to ameliorate this would be against

Gods will


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later JOHN SNOW relieved Queen Victoria of her

labor pain

Came to be known as FATHER OF ANAESTHESIA


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John snow


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She was also head of Church of England,

endorsed Obstetric anaesthsia

Relegious debate thus terminated


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Walking Epidural


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Cardiac Anesthesia

Neuro Anesthesia

Pediatric Anesthesia

Pain & Palliative Care

Critical Care


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Perioperative Physician

Preoperative Care- PAC

Intraoperative Care- Induction, Maintenance, Reversal

Postoperative Care


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The goals of preoperative evaluation include

To obtain baseline information about patients current physic

clinical examinations and appropriate investigations Detection of co-morbid conditions if any, e.g. URI, anaemia

Assessment of risk and obtaining informed consent from patiguardian as appropriate

Allaying anxiety of patient by effective communication and

premedication wherever applicable

To provide safe anaesthesia care by planning anesthesia mafollowing preoperative evaluation

Disease detection and optimi ation o


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Disease detection and optimization omorbid conditions

acute illnesses specially infectious diseases

changes due to a congenital anomaly

Chronic conditions that can interfere with anesthesia or pos

outcome


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Risk Assessment No single assessment or grading method has been establish

quantify risk associated with surgery and anaesthesia, the mcommon reasons being:

Individual patient variability

Types of surgical procedures with varying risks associated with the

procedure

Risks may vary depending onlocation of the surgical procedure


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Anaesthesia in Remote locations

Anesthesiologists are increasingly being asked to provide an

care in locations outside of the OR

These locations include: cardiac labs, psychiatric units, GI la

One must ensure that the location meets the ASA guideline

safety.

Obj ti


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Objectives

Understanding that the standards of anesthesia care and patie

monitoring are the same regardless of location the key to efficient and safe remote anesthetic relies on coordi

between the anesthesiologist and non-operating room personn

Realize that remote locations have different safety concerns, suradiation and powerful magnetic fields

ASA Guidelines for non operating room


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ASA Guidelines for non-operating roomanesthetizing locations

Reliable oxygen source with backup & failure alarm.

Suction source

Waste gas scavenging

Adequate monitoring equipment

Self-inflating resuscitator bag

Sufficient safe electrical outlets

Adequate light and battery-powered backup

Sufficient space

Compliance with safety and building codes


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Remote facilities and equipment

Know the physical layout of the location, unfamiliar anestheti

equipment, and anesthetic implications of the procedure beinperformed prior to the induction of anesthesia.

Verify the availability of assistance

Check piped-in gases and gas tanks

Check suction Check power outlets (i.e. grounding and electrical requiremen


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Special consideration- children

Paediatric age group commonest where anesthesia will be r

Children do not cooperate during procedure

Premedication may be needed

IV can be difficult

Different sizes of IV cannulas, Face masks, circuits, monitors(BP cuprobe), ETT, drug dilution, pedia drip, warming system


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The next event is entry of robots into human body

Made possible by culmination of intricate medicine and finetechnology

Nanotechnology

Principle


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Principle

Nanorobots very small

Biologically inert

Attach to very specific receptors

In brainGABA receptors- loss of consciousness

At NM junction- muscle relaxation Opioid receptors- profound analgesia

Computer controlled GA


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Computer controlled GA Neuroelectronic interfacing

Continuous detection of hypnotic state

Control of an infusion pump

Delivery of most appropriate dose of anesthetic

Regional Anesthesia


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Regional Anesthesia

High spinal- overdose

Little to do- wait for metabolism and artificially ventilate

Nanotechnology- pi-pi complexe between bupivacaine andnanoparticle

Rendering it harmless

Saxitoxin


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Saxitoxin

Narcotics and opioids have respiratory depression and addic

potential Anesthetic bundled with liposomes

Nerve block lasting from weeks to months

Critical Care


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Critical Care

Nanoatropine

Respirocytes

Clottocytes

Microbivores


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An Introduction to Anesthesiology

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