1. ANESTHESIOLOGY

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

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
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.
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

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

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

9. Anesthesia History Files
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.

10. Anesthesia History Files
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.

11. On 16th 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. Anesthesia History Files
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

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. Anesthesia History Files
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

17. Anesthesia History Files
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.

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
3. Evaluate and assess the patient preoperatively and optimize these findings to the benefit of the pts in terms of risks.
Develop risk assessment in terms of the evaluation, identification of the details of the planned procedure and incorporate local management related to the anesthesia applied and the means of keeping the patient at an optimum level of stability.

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.
KWI- essence. Quiescence – покой, неподвижность.

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
utmost – предельный; vigilant – бдительный; onslaught – жестокая атака.

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
nagging - debilitating

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
 Consists of doing a good health history of the patient
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

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.
The aim is to relieve apprehension and facilitate smooth induction.
To supplement analgesic, amnesic action of anesthetics.
To prevent bradycardia and secretion.

29. TYPES OF ANESTHESIA GENERAL ANESTHESIA REGIONAL ANESTHESIA
LOCAL ANESTHESIA