CHALLENGES FACED BY PRACTISING ANAESTHESIOLOGISTS

1. CHALLENGES FACED BY PRACTISING ANAESTHESIOLOGISTS DR.C.RATHNA KUMAR CONSULTANT ANAESTHESIOLOGIST

2. NOTHING IN THE WORLD IS WITHOUT A CHALLENGE • TO BE A SUCCESSFUL ANAESTHESIOLOGIST ONE SHOULD HAVE A HIGH DEGREE OF KNOWLEDGE , SKILL AND MENTAL AND PHYSICAL STAMINA TO FACE THE CHALLENGES • OUR PROFESSION IS MANY A TIMES EQUATED TO THAT OF THE PILOTS.

3. CLASSIFICATION OF CHALLENGES • PROFESSIONAL • HEALTH • FAMILY LIFE & OTHER SOCIAL ACTIVITIES

4. PROFESSIONALWORKING SET UP • PRIMITIVE SET UP - ATTRACTING MIDDLE CLASS • POORLY EQUIPPED THEATRES • LITTLE IMPORTANCE TO ANAESTHESIA & I C U • FORCED TO WORK TAKING ALL RISKS & COMPROMISES • ANYTHING GOES WRONG WE ARE BLAMED • SET UP CONTINUES TO WORK WITHOUT ANY CHANGE BUT FOR THE ANAESTHESIOLOGIST • THANKS TO THE C P A AND M C I

5. MINIMUM MANDATORY REQUIREMENTS IN THE OPERATION THEATRE • A WELL MAINTAINED ANAESTHESIA MACHINE • MINIMUM 2 O2 AND N2O CYLINDERS ATTACHED TO THE MACHINE AND 1 EACH KEPT STANDBY • TWO WORKING LARYNGOSCOPES WITH BLADES OF ALL SIZES • AIRWAYS OF ALL SIZES • ENDOTRACHEAL TUBES OF ALL SIZES • SUCTION APPARATUS • TILTABLE OPERATING TABLE • DIFFICULT INTUBATION AIDS LIKE STYLET , MAGILL’S FORCEPS

6. AN ANAESTHETIST’S ASSISTANT • UNINTERRUPTED POWER SUPPLY FOR ESSENTIAL EQUIPMENTS • ALL EMERGENCY DRUGS & AMBU BAG WITH O2 TUBINGS • A STETHOSCOPE , SPHYGMOMANOMETER , PULSE OXIMETER , ECG MONITOR • A DEFIBRILLATOR

7. ESSENTIAL NARCOTICS & VAPOURIZERS • N P O FOR ATLEAST 6 HOURS • MAINTAINENCE OF ANAESTHESIA RECORD • INFORMED & WRITTEN CONSENT • A MECHANICAL VENTILATOR

8. TIMING OF SURGERY • UNLESS AN EMERGENCY,DISCUSS AND FIX • DAY TIME IS BETTER • VIGILANCE IS ESSENTIAL

9. PREOPERATIVE EVALUATION • OFTEN NEGLECTED • EVALUATE AS EARLY AS POSSIBLE • GOOD HISTORY • RELEVANT INVESTIGATIONS • SPECIALISTS OPINION AS REQUIRED • IMPORTANT IN MEDICOLEGAL CASES • FITNESS IS OUR DECISION • OPTIMIZATION BEFORE SURGERY • GOOD RAPPORT WITH THE PATIENTS AND FAMILIES

10. IS THE CENTRE APPROPRIATE FOR A CASE? • NO PROTOCOL • ISA SHALL FORMULATE ONE

11. CAREFUL PREOPERATIVE INSTRUCTIONS • NO ANTIBIOTICS JUST BEFORE ANAESTHESIA • NO DRUG WITHOUT OUR KNOWLEDGE TO BE GIVEN IN THE PERIOPERATIVE PERIOD

12. ANAESTHETIC MANAGEMENT • CHOICE OF ANAESTHESIA SHOULD BE OURS • PERFECT COCKPIT DRILL • ENSURE GOOD I/V LINES • ASSURE THE SAFETY OF PTS POSTOP AND LEAVE • MOST RISKY PERIOD-WHILE SHIFTING TO POSTOP WARD • FOR ICU CARE GOOD NETWORK IS REQUIRED

13. INSTITUTE AND FREELANZING PRACTICE • SCHEDULE • CONTOL OF OT • CONTROL OF STAFFS • OPTIMIZATION • REPLACEMENT RISK • OFFS FROM DUTY • INCOME

14. HEALTH PROBLEMSSTRESS • HYPERTENSION-HR>100/MT, DBP>1OOMM HG • INSOMNIA AND OTHER SLEEP DISTURBANCES • IRRITABLITY • ANXIETY • HEADACHE • ASTHMA • LACK OF CONCENTRATION • ACIDITY • BODYACHE • DEPRESSION AND OTHER CHANGES IN BEHAVIOUR • SUICIDAL TENDENCY • SUBSTANCE ABUSE

15. CAUSES OF STRESS • SENSE OF INSECURITY • CHANGING WORKING ENVIRONMENT • LACK OF CONTROL OVER WORKING TIME • LACK OF CONTROL OVER OT MANAGEMENT • UNSATISFIED EGO

16. MANAGEMENT OF STRESS • A BREAK FROM ROUTINE • MENTAL RELAXATION TECHNIQUES LIKE YOGA • MAINTAIN PHYSICAL FITNESS • SOME LEISURE ACTIVITY • DISCIPLINED ANAESTHETIC PRACTICE

17. FAMILY AND OTHER SOCIAL ACTIVITIES • PLANNING OF HOLIDAYS • RISE IN PRACTICE • COMPETITION • CATASTROPHES • ILLNESS AND DISABILITY • INVESTING IN EQUIPMENTS • ALLOTING TIME FOR SELF & FAMILY • ATTENDING CME AND CONFERENCES • PRACTICE PRESSURES-UNETHICAL METHODS • INCREASED RISKS OF ACCIDENTS

18. TAKE HOME MESSAGE • DO A DIGNIFIED & SAFE PRACTICE OF ANAESTHESIA • FACE CHALLENGES WITH A BRAVE HEART • BE CONTENDED • OUR SPECIALITY HAS THE POTENTIAL TO DO GREAT BENEFIT & HARM TO THE PATIENT