WHY YOU SHOULD BE AN ANAESTHETIST
AND HOW TO BE ONE
“Corpus curare spiritumque”
"To care for the body and its breath of life"
WHAT EXACTLY ARE WE TALKING ABOUT?
It’s Easy To Say A pharmacologically induced and reversible
state of: Amnesia, Analgesia Loss of responsiveness Loss of skeletal muscle reflexes, Or decreased stress response.
Or all simultaneously.
Oliver Wendell Holmes ”Reversible lack of awareness,"
ANZCA The practice of administering
medications or gases that block the feeling of pain and other sensations, allowing medical and surgical procedures to be undertaken without causing undue discomfort to the patient.
Thomas Green Morton: a public demonstration of ether anaesthesia in
Boston, Massachusetts, on October 16, 1846.
Types of Anaesthesia Procedural sedation Conscious sedation Local anaesthesia Regional anaesthesia General anaesthesia
Yes, We Are Real Doctors
You Get To See Good Shit
You Get To Play With Very Cool Drugs
Local Anaesthetics Cocaine
(isolated 1859), used by Inca Americans for trephination (spit). Eye surgery 1884 Spinal anaesthesia 1898
Procaine (1905) Lignocaine (1943) Bupivicaine Ropivicaine
Inhalational Anaesthetic Agents
1275 Raymond Lullus played about with some chemicals and created “sweet vitriol”
Renamed by Frobenius in 1730 as ether (“heavenly”).
Priestley discovered nitrous oxide in 1772. Humphry Davy experimented upon himself in 1799 – “laughing gas”
Chloroform discovered by Simpson in 1831.
Inhalational Anaesthetic Agents
Isoflurane Sevoflurane Desflurane (Halothane) (Xenon – 80%) (Nitrogen - >4bar)
Intravenous Anaethetic Agents Benzodiazepines
Midazolam Barbiturates
Sodium thiopental Ketamine Etomidate Propofol
Propofol “Milk of human kindness”, “white magic”,
“Michael Jackson juice” Anaesthetic Sedative Antiepileptic Amnestic Antiemetic Antipruritic
As lamented by Fallopius: “when soporifics are weak, they are useless, and when strong, they kill.”
Propofol
Adverse effects: Apnoea Hypotension
Negative inotropy Vasodilatation
Pain on injection Myoclonus Priapism Addiction
Ketamine “Special K”, related to PCP Anaesthetic Analgesia, antineuropathic Bronchodilator Hallucinogen More cardiovascularly stable “Preserves airway reflexes”
Ketamine Adverse effects:
Hallucination/dysphoria Tachycardia/myocardial ischaemia Increased salivation Increased ICP Addiction Irritable bladder
Muscle Relaxants Depolarising:
Suxamethonium Non-depolarising:
Vecuronium Rocuronium Pancuronium Atracurium Cisatracurium Mivacurium
Analgesics Opioids
Alfentanil Fentanyl Remifentanil Morphine Methadone Endone Oxycontin Buprenorphine
Analgesics Anti-neuropathics
TCAs (nortriptyline) Antiepileptics (gabapentin) Antiarrhythmics (flecainide, lignocaine) Ketamine
Others Clonidine Clonazepam Simples
Vasoactives Metaraminol, ephedrine Noradrenaline, adrenaline GTN Dopamine, dobutamine Milrinone
Others Blood, platelets, FFP, cryoprecipitate Recombinant factor VII
Equipment
You Run Theatre
The Bad
The Patients
Intubate This
Or this
Or this
Or ventilate this
Or get this guy to fast for 6 hours
Nobody Cares What You Do
You Have To Work With Surgeons…
You Have To Work With Surgeons…
Training is Hard
You Don’t Need To Wait Six Months
You Can Only Ever Be In One Place
You Get To Go Home
You Get To Go To A Nice Home
The Rules
1.Air Goes In And Out2.Blood Goes Round And Round3.Oxygen Is Good4. Trust No One5.If In Doubt Give More Fluids6. Always Take a Break If Offered