Presentation on theme: "THE FUTURE OF ANAESTHESIA PRACTICE IN THE NEXT DECADES Dr. B. RADHAKRISHNAN, Director & Principal Director & Principal Academy of Medical sciences, Pariyaram,"— Presentation transcript:
THE FUTURE OF ANAESTHESIA PRACTICE IN THE NEXT DECADES Dr. B. RADHAKRISHNAN, Director & Principal Director & Principal Academy of Medical sciences, Pariyaram, Kannur, Kerala.
WTG MORTON-1846 Ether Days Mystery Discovery of Relaxants Developments in to subspecialties
STORY I LIKE TO READ How Anaesthesia progressed - status and promotion in India. Travelling through Indian growth - pit falls – Possible cure
Growth of ISA in India – reflections of the past - Developments in India – largest democracy - ISA and Anaesthesia service in India Silver Jubilee (72 / 75) Golden Jubilee (97 / 02) Diamond Jubilee (07) 1956 – WFSA 1976 – AARS 1991 – SACA ISA – City / State / Regional Zones Formative years – Conference – CME (1981) – WFSA – Educational programmes Indian Journal of Anaesthesia Change of name – ISA Flag – Emblem (1969) control of society
EARLIER DAYS – 1846 AND AROUND UKVsUSA ChloroformVsEther a)Is Anaesthesiology a Medical Specialty? b)If put on professional category, would there be adequate practioners Margin of safety of Chloroform and Ether – Practice difference in UK Vs USA
UK developments in Anaesthesia starts early (Snows Anaesthesia research starts in 1847) Snow – Clovor – Hewitt – London Society of Anaesthesiologists (LSA)
GREAT EVENTS IN UK – RESPECTABILITY TO THE SPECIALTY Queen Victoria – Prince Leopold – Simpson Napoleon – III- Clover Edward – VIII- Hewitt Develops as individual specialty
USA - ATTITUDES TO ANESTHESIA Learning to do by doing Any one was welcome Step child of medical profession Non Medical personals Organizational development till 1915 – was erratic Brooklyn Society New York Society IARS
2010 – WHERE I AM Dramatic Changes Care giver/ quality in practice Fast track gets settled. Inhalational agents – Sevoflurane, Cycloflurone Newer analgesics – Infusion devices Analgesic Pharmaco kinetics tied to computerized delivery.
2010 – WHERE I AM EEG – Bispectral index (BIS) - EGADS (EEG Guided Anaesthesia delivery System.
CURRENT CHANGING SCENARIO 1.Awake intubation No longer street fight/ mandatory preparation Fibre Optic intubation Blind Nasal – Extreme Situtaion Torture – Not permitted – Criminal
CURRENT CHANGING SCENARIO 2. Cuff Pressure Saline Cuff Lignocaine Cuff Cuff pressure in adults Cuff in Paediatrics
CURRENT CHANGING SCENARIO 3. Line Flushing Over flushing/ Manual flushing Retro grade embolisation of air Saline Volume Continuous flush device RA to SA (6 Cm/3-12 Cm)
CURRENT CHANGING SCENARIO 4. Consent Informed Consent – Pre-Op Examination Investigations /consent over telephone Viacarious liabilities – Consent in different situation
CURRENT CHANGING SCENARIO Target organ Protection Protect Kidney not urine output. Metabolic Acidosis Treat lactose acidosis – but not with bicarbonate. Damage Control Surgery Damage Control Anaesthesia
CURRENT CHANGING SCENARIO Non Technical Skills Improvement for Anesthesiology (NOTECHS) (ANTS-System Hand Book) (University of Aberdeen) Team Work Leadership Professional Behavior Human Performance Cognitive Evaluation in Post operative phase CQM - CQI
THE WITNESSED SCENARIO CHANGE – CURRENT GOOD ANAESTHESIA PRACTICE Two tracks of anaesthesia practice - Slow X Fast Extension of service to perioperative care- and perioperative medicine/physician Development of pain management service Post operative pain/ acute pain and chronic pain management fasting protocol.
MONITORED ANAESTHESIA CARE (SURGERY UNDER SEDATION (SURGERY UNDER SEDATION) (Narcotic Sedation/ Anxiolytic Sedation/ Tranquillizer Sedation/ Anti histamine sedation)
MAC – Sedative + Anxiolytic + Analgesic 1985 (Mostly Apnoeic, Cyanotic) MAC in 2000 Midazolam + Alfentanil + Conversation MAC in 2010 (Madam are you comfortable?)
FUTURE OF ANESTHESIA AND ANAESTHESIA PRACTICE A) EXTINCT B) DOMINANT
PRACTICE OF FUTURE EXTINCT -Non-medical Assistants -(Short term course – Promotion) -Promotion by our own tribe -No Anaesthesiologists in Operating Rooms -Anaesthesia will be remotely controlled -ICUs will be managed by Pulmonary Physician -Blood will be synthetic -No blood Bank
PRACTICE OF FUTURE DOMINANT Acute care beds Surgery – Trauma Conventional surgery Pain Management-Aggressive Anaesthesia – Administered and monitored by Computers. Endotracheal intubation - Robots Regional Anaesthesia – Change in application
PRACTICE OF FUTURE DOMINANT Simulators in conduct Newer drugs- Target pointed Blood transfusion Anaesthesia residency programme Anaesthesia Machines – Speaking machines Intellectual base/ linking/ foundation/ care givers Overall developments of medicine Sharing of information
PLANNING THE FUTURE OF ANAESTHESIOLOGY (Dr. Longnecker/ David. E – University of Pennsylvania) Chill winds of competition – Survival Socio economic situation Changing policies and will power/ Politics Awareness and consumer demand Scaling of service Demand and supply of Physician +- future man power need.
PLANNING THE FUTURE OF ANAESTHESIOLOGY (Dr. Longnecker/ David. E – University of Pennsylvania) Credentialing for systems and Practioners Visionary departments Quality based globally acceptable medical education – affordable and acceptable
The future of Anaesthesia – Global Until 1940s – developments Discovery of muscle relaxants Future depends on Social awareness / Social needs / Cost bearing Changes – fast track / slow track – (conventional) Developments Emergence of artificial blood/ gene therapy / new drugs (SAFE) / biotechnological changes Anaesthesia machines - remote control / voice control / smart machines Acute care beds Robotic interventions / Regional / Requirement of anaesthetists? / Future monitors – smart monitors Documentation –EHR- leasing Patient safety – prime concern
Future of our tribe in India Have we progressed? How far? 30000/ 14500 Innovation / islands of progress General quality / progress? Practice controllers Medical Council of India - Academic National Board of Examinations - Academic Government of India - Snails Pace- quality Professional Organizations - Quality in education Teachers and Trainers Predict possibility Reorganization of teaching Remodeling of practice Quality implementation Standardization – Mistakes of the past ISA – Organisational pride Non -aggressive Saints of Medicine
THE FUTURE Future depends on how far practice of Anaesthesia kept in hands of Anaesthesiologist -
Acceptability and respectability will be ensured when average Anaesthesia Practitioner shows he/she is a) Understand pathogenesis and possible haemodynamics in any situation, may be able to explain the same b) Sufficiently skilled in conduct of anaesthesia whether GA/RA/MAC
c) Adequate understanding to interpret monitor datas and run intensive care situations