An Introduction to

Anesthesiology
Why an Introduction
The Past how it all began (An understanding of past guides future)

The Present.the current scenario

The Futurethat is yet to come
1
st
century AD
Bark of mandrake plant
Boiled in wine
Mandrake
Dropped over tissues to be cut
Europeans attempted to relieve pain
Used
Hypnosis
Alcohol ingestion
Topical pressure
Ice
The Lancet
One of the most renowned journals (Impact Factor 39.06)
First Edition

Arrival of Ether Anaesthesia
announced in first edition of
The Lancet of 1847
ETHER

In 16
th
century
Prepared by distilling sulphuric acid
By Valerus Cordus & Paracelsus
They observed that the compound caused chickens
to fall asleep and awake unharmed
Recommended for treating painful conditions
Recommendations not followed

NITROUS OXIDE
17
th
century
Another agent similar to ether
Similar as inhaled
Produced lightheadedness
Rather than an anesthetic, used to produce thrill
Came to be known as laughing gas
Casually noted as transiently relieved headache, &
briefly quenched toothache

Contribution of Clarke, Long &
Wells
Clarke, a chemistry student
18
th
century
Administered ether from a towel to a young
woman for tooth extraction and was successful
But his professors believed that the pain free
state was due to hysteria
Crawford Long, 2 months later
Administered ether on towel for excison of neck
tumors
Was successful

Could not publish papers on his work as he
practiced in a rural area

Urban dentists though had a lot of patients
From a dentists point of view,
Pain was not life threatening
Rather it was livelihood threatening
Horace Wells, a dentist, in an attempt to search
further methods to relieve pain
Agreed to have nitrous oxide administered to
himself for tooth extraction
Experiment was successful

Few weeks later,
Wells attempted a public demonstration
For tooth extraction

But probably he could not reach sufficient level
of anaesthesia,
Patient felt pain
Declared bogus by audience

Wells was dissappointed, although continued to
use the procedure in his practice for quite
sometime
Commited suicide
Morton
WTG Morton, William Thomas Green Morton
A graduate of Baltimore College of Dental Surgery
Shared practice with Wells
Had interest in anaesthesia
Continued experiments with ether
Learned that ether provided anaesthesia, without
causing respiratory or cardiovascular depression
He anaesthetised a pet dog successfully and his
confidence increased
He started secret experimentations with ether
Began to anaesthetise patients in his dental
office
He later received an invitation for public demo
Bullfinch Amphitheater, MGH, Boston, USA


Friday, October 16, 1846
Administerd ether to EG Abbot, before surgeon,
JC Warrens
Excision of vascular lesions on left side of neck
Instrument consisted of a large glass bulb, with a
coloured agent and a spout for inhalation
Abbot took the inhaler in his mouth,
Surgery proceeded
On completion, Abbot reported that the event
was painfree
Mortons demonstration was highly successful
But Morton was cleverenough & moneyminded

Concealed the identity of ether
Named it falsely as LETHEON
He spent all his time & Money promoting Letheon
He gave up his dental practice
Applied for patent
Was about to receive a large sum
When due to peculiar aroma he had to admit
that the active component ETHER
Soon a controversy was struck between the
various supporters
Ultimately the deal was quashed
After 20 years of litigation and poverty
Died at the age of 49, backed by his wife and 5
children leaving them penniless
October 16
th

World Anaesthesia Day
LABOUR PAIN RELIEF
James Young Simpson
First to use ether for labor analgesia in 1846
Drawbacks slow onset and explosive
Experimented for better analgesics


At a dinner party at his home
Simpson and the assembled group inhaled
CHLOROFORM themselves
Fell unconscious
Woke up delighted on their success
Simpson propagated his discovery, and within 2
weeks published an account in Lancet
Faced opposition
Social belief that labor pain is a natural
phenomenom
Any measure to ameliorate this would be against
Gods will
later JOHN SNOW relieved Queen Victoria of her
labor pain
Came to be known as FATHER OF ANAESTHESIA
John snow
She was also head of Church of England,
endorsed Obstetric anaesthsia
Relegious debate thus terminated

Walking Epidural

Cardiac Anesthesia
Neuro Anesthesia
Pediatric Anesthesia
Pain & Palliative Care
Critical Care
Perioperative Physician
Preoperative Care- PAC
Intraoperative Care- Induction, Maintenance, Reversal
Postoperative Care
The goals of preoperative evaluation include

To obtain baseline information about patients current physical status by
clinical examinations and appropriate investigations
Detection of co-morbid conditions if any, e.g. URI, anaemia
Assessment of risk and obtaining informed consent from patient /
guardian as appropriate
Allaying anxiety of patient by effective communication and
premedication wherever applicable
To provide safe anaesthesia care by planning anesthesia management
following preoperative evaluation

Disease detection and optimization of co-
morbid conditions
acute illnesses specially infectious diseases
changes due to a congenital anomaly
Chronic conditions that can interfere with anesthesia or postoperative
outcome
Risk Assessment
No single assessment or grading method has been established to
quantify risk associated with surgery and anaesthesia, the most
common reasons being:

Individual patient variability
Types of surgical procedures with varying risks associated with the specific
procedure
Risks may vary depending on location of the surgical procedure
Anaesthesia in Remote locations
Anesthesiologists are increasingly being asked to provide anesthetic
care in locations outside of the OR

These locations include: cardiac labs, psychiatric units, GI lab, etc

One must ensure that the location meets the ASA guidelines for
safety.
Objectives
Understanding that the standards of anesthesia care and patient
monitoring are the same regardless of location
the key to efficient and safe remote anesthetic relies on coordination
between the anesthesiologist and non-operating room personnel
Realize that remote locations have different safety concerns, such as
radiation and powerful magnetic fields
ASA Guidelines for non-operating room
anesthetizing locations
Reliable oxygen source with backup & failure alarm.
Suction source
Waste gas scavenging
Adequate monitoring equipment
Self-inflating resuscitator bag
Sufficient safe electrical outlets
Adequate light and battery-powered backup
Sufficient space
Compliance with safety and building codes
Remote facilities and equipment
Know the physical layout of the location, unfamiliar anesthetic
equipment, and anesthetic implications of the procedure being
performed prior to the induction of anesthesia.
Verify the availability of assistance
Check piped-in gases and gas tanks
Check suction
Check power outlets (i.e. grounding and electrical requirements)
Special consideration- children
Paediatric age group commonest where anesthesia will be required
Children do not cooperate during procedure
Premedication may be needed
IV can be difficult
Different sizes of IV cannulas, Face masks, circuits, monitors(BP cuffs/SPO2
probe), ETT, drug dilution, pedia drip, warming system
The next event is entry of robots into human body
Made possible by culmination of intricate medicine and fine
technology
Nanotechnology

Principle
Nanorobots very small
Biologically inert
Attach to very specific receptors

In brain GABA receptors- loss of consciousness
At NM junction- muscle relaxation
Opioid receptors- profound analgesia
Computer controlled GA
Neuroelectronic interfacing
Continuous detection of hypnotic state
Control of an infusion pump
Delivery of most appropriate dose of anesthetic
Regional Anesthesia
High spinal- overdose
Little to do- wait for metabolism and artificially ventilate
Nanotechnology- pi-pi complexe between bupivacaine and
nanoparticle
Rendering it harmless

Saxitoxin
Narcotics and opioids have respiratory depression and addiction
potential
Anesthetic bundled with liposomes
Nerve block lasting from weeks to months
Critical Care
Nanoatropine
Respirocytes
Clottocytes
Microbivores