the role of the anesthesiologist in pain management - a. husni tanra

CURRICULUM VITAE

Andi Husni Tanra ChairmanIndonesian Society of Anesthesiologist for Pain Management (ISAPM)

AnesthesiologyAn = tanpaEsthesia = perception,

feeling= rasa Anesthesiology=tanpa

rasa ( Ilmu tanpa nyeri)

First administration Ether anesthesia in 1846 William T. Morton (left) holding globe inhaler John C. Warren the surgeon Gilbert Abbott the patient

Inventor of anesthetic inhalation.

By whom pain in surgery was annulled .

Before whom in all time, surgery as agony.

Since whom Science has control of pain.

Two main tasks of anesthesiologists are:

1. Saving Life2. Alleviate suffering

The task of Anesthesiologist

Students, observing the airway while palpating temporal artery.(Basic Life Support)

Before Ether, amputation means agony and suffering. Now perioperative pain management alleviate suffering

After World War II Prof. Bonica was in charged injured soldier with severe pain.

He recognized that his own knowledge was in adequate to manage the complex and severe pain

A “team” approach is need

Mid of 1960 first multidisciplinary pain center was established in Seattle, USA

United Kingdom

Canada Australia France

John Bonica

Founding FatherOf Pain Madicine

Australian, New Zealand Collage of Anesthetists, Bulletin 2002, 2:12. 71-73

History of Pain Management

Anesthesiologists are physicians, who are experts in the diagnosis and treatment of acute and chronic pain

disorders.

• Operating roomhospitalsurgicenterphysician office

• Labor & delivery suite• Other procedural areas• Intensive care unit

(ICU)• PACU• Pain management

acutechronic / cancer

• “Code Blue” team• Respiratory

therapy• Administration

operating roomhospitalmedical school

• Educationhealth professionalspublic

• Research• Managers

Copyright © 2003 American Society of Anesthesiologists. All rights reserved

• 4 years college• 2 years internship• 4 years residency

training in anesthesiology

• 2 years subspecialty fellowship training in Pain Management.

Copyright © 2003 American Society of Anesthesiologists. All rights reserved

American Board of Anesthesiology

written examinationoral examination

recertification examinationsubspecialty certification in Pain

anagementCopyright © 2003 American Society of Anesthesiologists. All rights reserved

Why anesthesilogist?

Expertise in peri-operative pain management Expertise in Analgesics (opioid and non-

opioid) Regional nerve blocks

If acute pain is an alarm protection, tell us that something wrong in our body,

Chronic pain is a disease entity, is a disease of nervous system, which needs a pain speciality doctor.

we need pain spciality to treat pain disease.

It is impossibe to become an expert in every field, like this man.

“Indonesian society of anesthesiologist for pain management” (ISAPM)

This society is under the flag of PERDATIN, we had been recognized since 2010.

Pendidikan KMN insyaAllah akan kita mulai Oktober 2011

What is Interventional Pain Management?

Interventional pain management have been developing since 1960 by John Bonica, Seattle, USA

This was previously the role of Anesthesiologists, but now is opened to many other spesialists, ( neurosurgeons, neurologists , Orthopaedics, rehabilitation medicine, and so on).

American Society of Interventional Pain Physicians (ASIPP) was established since 1990.

Interventional Pain Management is only a small part of pain management.

IPM is Small but Big

Training at Pain Clinic in Onomichi Hospital, Japan

November 2006

Acupuncture is an elective subject for medical student

What is available in our hospital ?

November, 28th 2006

Opening of Pain Clinic and Acupuncture

Epidural steroid for radicular pain

STELLATE GANGLION BLOCK

1. Acupunture is our main modality• Needle stimulation• Heater Lamp• Cupping

2. Epidural Steroid Injection3. SGB Stellate Ganglion Block4. Nerve Blocks

• Suprascapular Block• Intercostal Block• Supraorbital Block• Infraorbital Block

5. Etc.

Modalities in Our Pain Clinic

1.It has been using for more than 2000 years for medical treatment

2.It is Eastern method.3.Promoting self healing4.Almost no side-effect5.Used in more 100 countries6.Is a treasury of KNOWLEDGE

Why Acupuncture???

Nasib dokter anestesi, tidak punya pasien, pasien di Ok milik dr. bedah, di ICU juga milik dr. bedah, interna, neuro dll, pasien di klinik nyeri jg adalah pasien kiriman dari dokter lain.

Ini berarti kita tergantung pada dokter lain. Ada kesan bahwa beberap kolega enggang

mengirim pasiennya ke klinik nyeri. Dokter anestesi yg akan berpraktek

menejemen nyeri merupakan paradigma baru.

.

Tapi tidak usah khawatri, sepanjang kita mempertahankan dan menjalankan “professionalisme” pasti kita akan dicari pasien.

Hanya dengan berperaktek menejemen nyeri, kita akan dikenal dan dihargai oleh pasien secara sadar, sebab pasien kita di OK, umumnya tertidur pulas, sedang di ICU setengah sadar bahkan setengah mati untuk mengingat kita apalagi untuk mengucap terimkasih.

The only place . . . . . . .alert appreciation

As WW, Prof, ini adalah hari yang paling indah dan enak bagiku, samasekali tdak merasa nyeri, walaupun saya sadar bahwa kanker tetap bersarang dalam tubuhku.

Tengah malam saya bangun shalat tahjud, untuk bersyukur pada Tuhan karena saya sdh bisa tidur shalat normal.

Sepanjang malam di shalatku tak henti2nya aku berdoa dan berterimakasi kepada Tuhan yg telah mengirim seorang dokter penolong dengan segala keihlasannya.

Rasanya habis airmataku, napasku terputus putus dalam mendoakan Prof, semoga Tuhan memanjangkan umur, memberi kesehatan serta memberkati Prof sekeluarga.

Saya sadar Prof, bahwa doa yang kupanjatkan kehadirat Ilahi, tak seimbang dengan, pertolongan Prof pdaku yang sudah 2 bulan tidak pernah tidur karena kesakitan.

Semoga Tuhan senantasa melimpahkan reski bagi Prof sekeluarga.

Wslm Ibu Darwis

Why we need to promote pain management as a speciality???Because…In many parts of Indonesia: - Many people may die in pain, but - Many more people dying with pain, - Even many more people living in painOur task to help them as a doctor

Take Home Message

San Diego, 2002