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THE FUTURE OF ANAESTHESIA PRACTICE IN THE NEXT DECADES

THE FUTURE OF ANAESTHESIA PRACTICE IN THE NEXT DECADES . Dr. B. RADHAKRISHNAN , Director & Principal Academy of Medical sciences, Pariyaram, Kannur, Kerala. . Anaesthesiology - 1846 Philosophy - Practice Astrology - Prediction Biotechnology Computer Technology.

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THE FUTURE OF ANAESTHESIA PRACTICE IN THE NEXT DECADES

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  1. THE FUTURE OF ANAESTHESIA PRACTICE IN THE NEXT DECADES Dr. B. RADHAKRISHNAN, Director & Principal Academy of Medical sciences, Pariyaram, Kannur, Kerala.

  2. Anaesthesiology - 1846Philosophy - PracticeAstrology - PredictionBiotechnologyComputer Technology

  3. We may extinct or We may dominate

  4. WTG MORTON - 1846 Ether Days Mystery Discovery of Relaxants Developments in to subspecialties

  5. STORY I LIKE TO READ How Anaesthesia progressed - status and promotion in India. Travelling through Indian growth - pit falls – Possible cure

  6. 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

  7. UK Vs USA • Chloroform Vs Ether • Is Anaesthesiology a Medical Specialty? • If put on professional category, would there be adequate practioners • Margin of safety of Chloroform and Ether – Practice difference in UK Vs USA EARLIER DAYS – 1846 AND AROUND

  8. UK developments in Anaesthesia starts early (Snow’s Anaesthesia research starts in 1847) Snow – Clovor – Hewitt – London Society of Anaesthesiologists (LSA)

  9. GREAT EVENTS IN UK – RESPECTABILITY TO THE SPECIALTY Queen Victoria – Prince Leopold – Simpson Napoleon – III - Clover Edward – VIII - Hewitt Develops as individual specialty

  10. 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

  11. 1970’s – (40 Years ago) Ether, Trilene, Ethyl Chloride, Halothane Gallamine, Curaree, Suxamethaonium, Morphine – Pethidine – Analgesics Controlled mandatory ventilation Lignocaine, Bupivaccaine ECG Monitor, Sphygmomanometer, Visual assement

  12. 1970’s – (40 Years ago) Fasting protocol - Most cruel Postoperative pain relief– SOS Fluids – Sugar/ Salt solution Red rubber tubes – Steel needle – IV canuala ??. Non disposable rubber tubes + clamps “Seemed Comfortable” – acceptability in Progress

  13. 1990’s – (20 Years ago) New drugs – Propofol New relaxants – Vecrunonium, Atracurium Isoflrane – Sevoflurane – Desflurane Synthetic Narcotics – Fentanyl

  14. Eid Tidal Monitors Lignocaine makes slow exit – Bupivaccaine Electronic Circuts Analgesic Delivery – PCA Pulse Oxymeter, PAP, Capnography Laparoscopic Techniques CT/MRI LMA

  15. 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.

  16. 2010 – WHERE I AM EEG – Bispectral index (BIS) - EGADS (EEG Guided Anaesthesia delivery System.

  17. CURRENT CHANGING SCENARIO • Awake intubation • No longer street fight/ mandatory preparation • Fibre Optic intubation • Blind Nasal – Extreme Situtaion • Torture – Not permitted – Criminal

  18. CURRENT CHANGING SCENARIO • 2. Cuff Pressure • Saline Cuff • Lignocaine Cuff • Cuff pressure in adults • Cuff in Paediatrics

  19. 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)

  20. CURRENT CHANGING SCENARIO • 4. Consent • Informed Consent – • Pre-Op Examination Investigations /consent over telephone • Viacarious liabilities – Consent in different situation

  21. 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

  22. 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

  23. 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.

  24. Blood - Blood products Artificial blood – replacement of human blood , genetic engineering (Crocodile blood/ bacteria ‘E’-Coli) Xeno transplantation PONV – Prophylaxis Gene Therapy and Brain repair Monitors – Forgiving drugs – Newer Anaesthesia delivery apparatus.

  25. MONITORED ANAESTHESIA CARE (SURGERY UNDER SEDATION) (Narcotic Sedation/ Anxiolytic Sedation/ Tranquillizer Sedation/ Anti histamine sedation)

  26. MAC – Sedative + Anxiolytic + Analgesic 1985 (Mostly Apnoeic, Cyanotic) MAC in 2000 Midazolam+Alfentanil+ Conversation MAC in 2010 (Madam are you comfortable?)

  27. FUTURE OF ANESTHESIA AND ANAESTHESIA PRACTICE • EXTINCT • DOMINANT

  28. 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 • ICU’s will be managed by Pulmonary Physician • Blood will be synthetic • No blood Bank

  29. 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

  30. 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

  31. 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.

  32. 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

  33. The future of Anaesthesia – Global Until 1940’s – 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

  34. 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”

  35. THE FUTURE Future depends on how far practice of Anaesthesia kept in hands of Anaesthesiologist -

  36. Acceptability and respectability will be ensured when average Anaesthesia Practitioner shows he/she is • 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

  37. c) Adequate understanding to interpret monitor datas and run intensive care situations

  38. THANK YOU BEST OF LUCK

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