the role of the anesthesiologist in pain management - a. husni tanra
Upload: department-of-anesthesiology-faculty-of-medicine-hasanuddin-university
Post on 13-Apr-2017
397 views
TRANSCRIPT
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