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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
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
Anaesthesiology - 1846Philosophy - PracticeAstrology - PredictionBiotechnologyComputer Technology
slide4

WTG MORTON - 1846

Ether Days

Mystery

Discovery of Relaxants

Developments in to subspecialties

story i like to read
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
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

slide7

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

slide8

UK developments in Anaesthesia starts early (Snow’s Anaesthesia research starts in 1847)

Snow – Clovor – Hewitt – London Society of Anaesthesiologists (LSA)

slide9

GREAT EVENTS IN UK – RESPECTABILITY TO THE SPECIALTY

Queen Victoria – Prince Leopold – Simpson

Napoleon – III - Clover

Edward – VIII - Hewitt

Develops as individual specialty

slide10

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
slide11

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

slide12

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

slide13

1990’s – (20 Years ago)

New drugs – Propofol

New relaxants – Vecrunonium, Atracurium

Isoflrane – Sevoflurane – Desflurane

Synthetic Narcotics – Fentanyl

slide14

Eid Tidal Monitors

Lignocaine makes slow exit – Bupivaccaine

Electronic Circuts

Analgesic Delivery – PCA

Pulse Oxymeter, PAP, Capnography

Laparoscopic Techniques

CT/MRI

LMA

slide15

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.

slide16

2010 – WHERE I AM

EEG – Bispectral index (BIS)

- EGADS (EEG Guided Anaesthesia delivery System.

slide17

CURRENT CHANGING SCENARIO

  • Awake intubation
      • No longer street fight/ mandatory preparation
      • Fibre Optic intubation
      • Blind Nasal – Extreme Situtaion
      • Torture – Not permitted – Criminal
slide18

CURRENT CHANGING SCENARIO

  • 2. Cuff Pressure
      • Saline Cuff
      • Lignocaine Cuff
      • Cuff pressure in adults
      • Cuff in Paediatrics
slide19

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)
slide20

CURRENT CHANGING SCENARIO

  • 4. Consent
      • Informed Consent –
      • Pre-Op Examination Investigations /consent over telephone
      • Viacarious liabilities – Consent in different situation
slide21

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
slide22

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

slide23

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.

slide24

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.

slide25

MONITORED ANAESTHESIA CARE

(SURGERY UNDER SEDATION)

(Narcotic Sedation/ Anxiolytic Sedation/ Tranquillizer Sedation/ Anti histamine sedation)

slide26

MAC –

Sedative + Anxiolytic + Analgesic

1985 (Mostly Apnoeic, Cyanotic)

MAC in 2000

Midazolam+Alfentanil+ Conversation

MAC in 2010

(Madam are you comfortable?)

slide28

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
slide29

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

slide30

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

slide31

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.

slide32

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

slide33
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

future of our tribe in india
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”

slide35

THE FUTURE

Future depends on how far practice of Anaesthesia kept in hands of Anaesthesiologist -

slide36

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
slide38

THANK YOU

BEST OF LUCK