Dr. Puja Vimesh
World Anaesthesia Day commemorates the first successful demonstration of ether anaesthesia on October 16, 1846. This ranks as one of the most significant events in the history of Medicine and took place at the Massachusetts General Hospital, home of the Harvard School of Medicine. when William T.G. Morton, an enterprising dentist, administered ether to a young man who needed a tumor removed from his neck. The surgery was a success, and the modern age of anesthesia was born. All over the world, medical practitioners quickly realized the great benefits that anesthesia would bring to mankind.
How surgeons tackled pain before Anaesthesia was discovered?
Before anesthesia, surgeons used a grab-bag of techniques to mask pain, many of which have to make you wonder what they were thinking. Some surgeons employed “counterirritants,” rubbing nettles against a patient’s arm to supposedly distract him or her from the agony of the scalpel. Other surgeons might have been somewhat more successful with narcotics made from opium or marijuana. Booze could temporarily numb the pain but it also had the troubling tendency to make the patient puke or die. Perhaps the strangest technique was to render the patient unconscious before surgery with a sock in the jaw-an interesting spin on the job of an anesthesia tech.
We are truly fortunate to live at a time when medical professionals can help us get through surgical procedures with as little pain as possible. This is in direct contrast to the days before anesthesia-okay, a doctor didn’t want you to be in pain, but there wasn’t much he could do about it. An 18th century surgical manual reminded the reader that although amputation was extraordinarily painful, “there is still another consideration of much higher importance than any I have mentioned, I mean a less hazard of Life.” In other words, the limb goes or you die. Another 18th century surgical manual suggested that biting down on a piece of wood can help patients endure the pain of amputation, but above all the surgeon had to be fast: “cut quick with a crooked knife before covering the stump with the remaining skin.” An early 19th century writer, Fanny Burney, recorded a moving testimony of what surgery in those days meant for the patient. After a mastectomy, she wrote her sister about the “torturing pain” of the “dreadful steel.”
Discovery of Anaesthesia-a new milestone
Anaesthesia simply means ‘loss of sensation’, which is what anaesthetic medications are designed to achieve. A mixture of medications are combined to either put a patient to sleep or numb the pain in a specific area so that surgery can be carried out without the patient experiencing any pain.
General anaesthetic
This is the term used to refer to the type of anaesthetic that makes a patient completely unconscious so that they are not aware of the procedure and so will feel no pain. This type of anaesthetic is administered via injection or gas which puts the patient to sleep and is used for serious, complex or lengthy procedures.
Regional/local anaesthetic
This type of anaesthetic is used for minor surgery or procedures where the patient does not need to be unconscious but do need to feel no pain. This anaesthetic is given for a specific area of the body and is only intended to numb that area.
There are different types of regional anaesthetic:
* Epidural – type of regional anaesthetic that is used to numb the lower half of the body and is usually used during labour and childbirth
* Spinal – regional anaesthetic that is used to numb the lower half of the thoracic region,abdominal region and lower limbs.
Role of Anaesthetist as Intensivist
As an outgrowth of the ICU, critical care units are now found in all major medical facilities throughout the world. Anesthesiologists are uniquely qualified to coordinate the care of patients in the intensive care unit because of their extensive training in clinical physiology/pharmacology and resuscitation. Some anesthesiologists pursue advanced fellowship training to subspecialize in critical care medicine in both adult and pediatric hospitals. In the ICU, they direct the complete medical care for the sickest patients. The role of the anesthesiologist in this setting includes the provision of medical assessment and diagnosis, respiratory and cardiovascular support and infection control.
Anesthesiologists also possess the medical knowledge and technical expertise to deal with many emergency and trauma situations. They provide airway management, cardiac and pulmonary resuscitation, advanced life support and pain control, all of which are essential skills to the intensivist. As consultants, they play an active role in stabilizing and preparing the patient for emergency surgery.
The ventilatory support of very sick patients from all specialities are being looked after by the anaesthetist not only making them haemodynamically stable by various drugs,providing transparental nutrition in coma patients and weaning them off gradually as the patient shows signs of recovery.
(The author is Head of Department, Cardiothoracic Anaesthesia, Superspeciality Hospital, GMC Jammu)
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