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