INTRODUCTION

TO ANESTHESIOLOGY

Yohanes Rudijanto, dr., SpAn.

KSM Anestesiologi
RS Immanuel - Bandung
 Short CV
 Medical Doctor
 FK UNPAD, 1991
 Anesthesiology residency program
 St. Luke‘s Medical Center, Manila
 2002 – 2004
 Anesthesiology adaptation program
 FK UNHAS, Makassar
 2005 - 2006
1910 2006
 History of Anesthesia
 In USA
 Modern anesthesia began on March 1842
when dr. Crawford W. Long administered
sulfuric ether to James Venable
 Dr. Long didn’t reported his discovery in
medical journal
 History of Anesthesia

 Oct. 16, 1846 William T.G. Morton a dentist

demostrated ether anesthesia at
Massachussetts General Hospital
 While John C. Warren a surgeon
successfully removed a vascular lesion from
the left side of a patient, Edward G. Abbot
Morton's ether inhaler (1846)
"Gentlemen, this is no humbug "
William Morton standing, upper right
John Warren in the right with his hand in patient’s leg
 History of Anesthesia

 In Europe (1853)
 Dr. John Snow gave
chloroform to Queen
Victoria for the birth of
Prince Leopold
 Dr. Snow went to publish
and studied chloroform
anesthesia thus becoming
recognized as the 1st
anesthesiologist
 Regional Anesthesia
 Carl Koller (1857–1944), opthalmologist
 Use cocaine as local anesthetics
 August Bier
 Use Heinrich Quincke technique
 Introduce Spinal anesthesia, 1899
 IV regional technique with procaine, 1908
 Edward Tuohy, 1944
 Introduce Epidural anesthesia
 Regional Anesthesia
 1902, Harvey Cushing
 Coined the phrase “regional anesthesia”
 technique of blocking brachial or sciatic plexus
under direct vision during general anesthesia \
 John J. Bonica
 multidisciplinary pain clinic
 The Management of Pain, now 3rd edition, is
regarded as a classic of the literature of
anesthesia
General vs Regional Anesthesia
Caudal analgesia
 Axillary block

 I/ : operation on
lower arm and hand
WHAT IS ANESTHESIOLOGY ?
 Anesthesia berasal dari bahasa latin
An ( = “tidak” )
Aesthesia ( = “rasa” )
anesthesia = tanpa rasa, disertai dengan hilangnya
kesadaran
analgesia = tanpa rasa, tanpa disertai hilangnya
kesadaran

Bius dari bahasa sansekerta

Be ( = “tanpa” )
Hoss ( = “sadar” )
Bius = tanpa sadar = anesthesia

Anesthesiology : ilmu yg mempelajari hal-hal yg

berhubungan dengan hal tsb di atas
 Definition

Anesthesiology is the practice

of medicine dedicated to the
relief of pain and total care of
surgical patient before, during
and after surgery
Although historically, Anesthesiologists
have been known primarily as
physicians who administer anesthesia
to alleviate pain and suppress
consciousness of the patient
undergoing surgery, they also provide
medical care and consultations in many
other setting and situation in addition to
the operating room
 Scope of practice

1. In the operating room

2. In the post anesthesia care unit
( recovery room )
3. For pain management
4. In critical care and trauma medicine
5. During cardiac laboratory procedures
6. For diagnostic procedures and
nonsurgical treatments
 1. In the operating room

Anesthesiologists is the
“perioperative physician” (peri-
meaning ” around” ), who provides
medical care to patient throughout a
surgical experience
 1. In the operating room

These include :

1. Preoperative
Evaluating the patient before surgery
2. Intraoperative
Providing pain control and support of life
function during surgery
3. Postoperative
Supervising care after surgery and medically
discharging the patient from recovery unit
 The role of the anesthesiologists
in the operating room

1) To provide continual medical assessment of

the patient
2) To monitor and control the patient’s vital life
functions (HR and rhythm, breathing, BP, body
temperature, and fluid balance)
3) To control the patient’s pain and level of
unconsciousness to make conditions ideal for
safe and successful surgery
 The ORs

14 mo/f Labioplasty
 The ORs

32 yo/m Adamantinoma : AWAKE INTUBATION

 The ORs

35 yo/f Adnexa Tumor : PURE EPIDURAL ANESTHESIA

 The ORs

20 yo/m Fracture comp.V Th12 : DOUBLE LUMEN TUBE

Melakukan Spinal Anestesi
Melakukan Spinal Anestesi
Melakukan Spinal Anestesi
Melakukan Spinal Anestesi
Melakukan Epidural Anestesi
Melakukan Epidural Anestesi
Melakukan Epidural Anestesi
Melakukan Epidural Anestesi
Melakukan Epidural Anestesi
Intratekal (Spinal) vs Epidural
 2. In the post anesthesia care
unit (Recovery Room)
 Where patients are transferred after
surgery
 to emerge fully from the effect of anesthesia
 The anesthesiologist decides when the
patient has recovered enough
 sent home following outpatient surgery or
moved to room or ward in the medical facility
 3. For pain management

 After surgery, the anesthesiologists

prescribes pain medication and
techniques to manage pain

 Anesthesiologists are uniquely qualified

to prescribe and administer drug
therapies for acute, chronic, cancer and
childbirth pain
PCEA (Patient Controlled Epidural
Analgesia)
Learning time !
4. In critical care and trauma medicine

 Anesthesiologist provide medical

assessment and diagnosis, respiratory
and cardiovascular support and
infection control
 Emergency situation : Anesthesiologist
provide airway management, cardiac
and pulmonary resuscitation, advanced
life support, pain control and
preparation for emergency surgery
Critical Care IN ACTION !
Central Venous Catheterization
and CVP monitoring
 ICU patient

43 yo/m Mult. fracture + PE : CPAP non-invasive ventilation

 ICU patient

10 yo/f Post trepanasi + 5 days old/f Tracheo-

Pneumonia esophageal fistula
ICU patient

Hyperbaric
chamber

25 yo/m Caisson disease

5. During cardiac laboratory procedure

Anesthesiologists are available during

cardiac catheterization and angioplasty
procedures for emergency airway
management or resuscitation if
necessary
6. For diagnostic procedures and non
surgical treatment
 Anesthesiologist is involved in :
 radiological imaging or scanning
procedures,
 gastrointestinal endoscopies
 in vitro fertilization
 lithotripsy procedures
 electroshock treatment
 nutritional support
 respiratory therapy
6. For diagnostic procedures and non
surgical treatment

Anesthesiologists is involved in :
 radiological imaging or scanning
procedures
 gastrointestinal endoscopies
 in vitro fertilization
 lithotripsy procedures
 electroshock treatment
 nutritional support
 respiratory therapy
 MATERI KULIAH PRA UTS
1. PENGANTAR ANESTESIOLOGI
2. FARMAKOLOGI KLINIK OBAT-OBAT ANESTESIA
3. PERSIAPAN PRA ANESTESIA DAN PERAWATAN
PASKA ANESTESIA
4. ANASTESIA LOKAL DAN REGIONAL
5. PENATALAKSANAAN JALAN NAFAS
6. RESUSITASI JANTUNG PARU
7. PENATALAKSANAAN NYERI
 MATERI KULIAH PASKA UTS
1. DASAR DASAR ICU / CRITICAL CARE MEDICINE
2. TERAPI CAIRAN & TRANSFUSI DARAH
3. GANGGUAN ELEKTROLIT
4. KESEIMBANGAN ASAM BASA
5. PEMBERIAN ANESTESIA PADA PEMBEDAHAN
DARURAT
6. PEMBERIAN ANESTESI PADA KASUS TERTENTU
7. PENATALAKSANAAN NYERI
THANK
YOU