Clinical Anaesthesiology Qiu Wei Fan Associate Professor Department of Anaesthesiology Rui Jin Hospital Shanghai Second Medical University 1 Contents The history of Anaesthesia The scope of anaesthesia Classification of Anaesthesia Methods Definition of the practice of anaesthesiology
Qiu Wei FanAssociate Professor
Department of AnaesthesiologyRui Jin HospitalShanghai Second Medical University
The history of Anaesthesia
The scope of anaesthesia
Classification of Anaesthesia Methods
Definition of the practice of anaesthesiology
Preoperative assessment and premedication
John Snow was the first to scientifically investigate ether and the physiology of general anaesthesia. Snow was also a pioneer in epidemiology who helped stop a cholera epidemic in London by proving that the causative agent was transmitted by ingestion rather than inhalation.
In 1847, Snow published the first book on general anaesthesia, On the Inhalation of Ether. When the anaesthetic properties of chloroform were made known, he also quickly investigated and developed an inhaler for that agent as well. He felt that an inhaler should be used in administering these agents in order to control the dose of the anaesthetic.
In 1893, then first organization of physician specialists in anaesthesia , the Society of Anaesthetists, was formed by J. F. Silk in England.
Three physicians stand out in the early development of anaesthesia in the United States after the turn of the century: Arthur E. Guedue, Ralph M. Waters, and John S. Lundy. Guedue was the first to elaborate on the signs of general amaesthesia after Snow’s original description. He advocated cuffed endotracheal tubes and introduced artificial ventilation during ether anaesthesia (later called “controlled respiration” by Waters).
The first organization of physician anaesthetists in the United States was the Long Island Society of Anaesthetists in 1911. That society was eventually renamed the New York Society of Anaesthetists and become national in 1936. It was subsequently renamed the American Society of Anaesthetists and later, in 1945, the American Society of Anaesthesiologists ( ASA ).
More than 1500 years ago, Chinese physician of traditional medicine already used some herb and alcohol to make patients unconscious and did some minor operations. In our country, the first department of Anaesthesiology was established in 1950 as soon as Professor Jue Wu returned to Shanghai, the People’s Republic of China from abroad.
Providing general or regional anaesthesia inside and outside the operating room
Intensive care units
Respiratory therapy departments
Postoperative pain relief
Anaesthetic research, teaching medical students, and assuming administrative and leadership positions on the medical staffs of many hospitals and ambulatory care facilities.
Nerve plexus block
1)Assessing,consulting, and preparing patients for anaesthesia
2)Rendering patients insensible to pain during surgical obstetric, therapeutic, and diagnostic procedures
3)Monitoring and restoring homeostasis in perioperative and critically patients
4)Diagnosing and treating painful syndromes
5)Managing and teaching of cardiac and pulmonary resuscitation
6)Evaluating respiratiry function and applying respiratory therapy
7)Teaching, supervising, and evaluating the performance of medical and paramedical personnel involved in anaesthesia,respiratory care, and critical care
8)Conducting research at the basic and clinical science levels to explain and improve the care of patients in terms of physiologic function and drug response
9)Involvement in the administration of hospitals, medical schools, and outpatient facilities as necessary to implement these responsibilities
Planning the conduct of ansesthesia starts normally after details concerning the surgical procedure and the medical condition of the patient have been ascertained at the preoperative visit.
Several of the large-scale epidemiological studies have indicated that inadequate preoperative preparation of the patient may be a major contributory factor to the primary anaesthetic causes of peri-operative mortality.
It is therefore essential that anaesthetist visit every patient in the word before surgery to assess “fitness for anaesthesia”, as this function cannot be undertaken by surgical staff.
Estabilish rapport with the patient
Obtain a history and perform a physical examinations
Order a special investigations
Assess the risks of anaesthesia and surgery and if necessary postpone or cancel the date of surgery
Institute preoperative management
Prescribe premedication and the anaesthetic management
Routine preoperative anaesthetic evaluation
Other known problems
Present therapy: Prescription, Nonprescription
Nontherapeutic: Alcohol, Tobacco
Previous anaesthetics, surgery, and obstetric deliverries
Review of organ systems
Last oral intake
Hematocrit or hemoglobin concentrationAll menstruating womenAll patients over 60 years of ageAll patients who are likely to experience significant blood loss and may require transfusion
Serum glucose and creatinine (or blood urea nitrogen) concentration: all patients over 60 years of age
Electrocardiogram: all patients over 40 years of age
Chest radiogram: all patients over 60 years of age
I A normal healthy patient other than surgical pathology- without systemic disease.
II A patient with mild systemic disease – no functional limitations.
III A patient with moderate to severe systemic disturbance due to medical or surgical disease- some functional limitation but not incapacitating.
IV A patient with severe systemic disturbance which poses a constant threat to life and is incapacitating.
V A moribund patient not expected to survive 24 hours with or without surgery.
E If the case is an emergency, the physical status is followed by the letter “E”-, “IIE”.
Class Mortality Rate
The preoperative note
The intraoperative anaesthesia record
The postoperative notes
Recommendations of any consultants
Anaesthetic plan: Use of specific procedures
Informed consent: Plan, alternative plans, their advantage and disadvantages ( risk of complications)
A preoperative check of the anaesthesia machine and other equipment
A review or reevaluation of the patient immediately prior to induction of anaesthesia
A review of the chart for new laboratory results or consultations
A review of the anaesthesia and surgical consents
The time of administration, dosage, and route of intraoperative drugs
All intraoperative monitoring( laboratory measurements, blood loss, and urinary output)
Intravenous fluid administration and transfusion
All procedures(intubation, placement of a nasogastric tube or placement of invasive monitors)
Routine and special techniques such as mechanical ventilation, hypotensive anaesthesia, one-lung ventilation, high-frequency jet ventilation, or cardiopulmonary bypass
The timing and course of important events such as induction, positioning, surgical incision, and extubation
Unusual events or complications
The condition of the patient at the end of the procedure
The patient’s condition
The patient’s recovery from anaesthesia
Any apparent anaesthesia-related complications
How do you take the history from a patient?
What is the meaning of the ASA classification?