Why You Should Be An Anaesthetist

1. Why You Should Be An Anaesthetist

2. AND HOW TO BE ONE

3. “Corpus curare spiritumque” • "To care for the body and its breath of life"

4. WHAT EXACTLY ARE WE TALKING ABOUT?

7. 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.

8. Oliver Wendell Holmes • ”Reversible lack of awareness,"

9. 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.

10. Thomas Green Morton: • a public demonstration of ether anaesthesia in Boston, Massachusetts, on October 16, 1846.

11. Types of Anaesthesia • Procedural sedation • Conscious sedation • Local anaesthesia • Regional anaesthesia • General anaesthesia

13. Yes, We Are Real Doctors

15. You Get To See Good Shit

17. You Get To Play With Very Cool Drugs

19. Local Anaesthetics • Cocaine • (isolated 1859), • used by Inca Americans for trephination (spit). • Eye surgery 1884 • Spinal anaesthesia 1898 • Procaine (1905) • Lignocaine (1943) • Bupivicaine • Ropivicaine

21. 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.

22. Inhalational Anaesthetic Agents • Isoflurane • Sevoflurane • Desflurane • (Halothane) • (Xenon – 80%) • (Nitrogen - >4bar)

23. Intravenous Anaethetic Agents • Benzodiazepines • Midazolam • Barbiturates • Sodium thiopental • Ketamine • Etomidate • Propofol

24. Propofol • “Milk of human kindness”, “white magic”, “Michael Jackson juice” • Anaesthetic • Sedative • Antiepileptic • Amnestic • Antiemetic • Antipruritic

26. As lamented by Fallopius: “when soporifics are weak, they are useless, and when strong, they kill.”

27. Propofol • Adverse effects: • Apnoea • Hypotension • Negative inotropy • Vasodilatation • Pain on injection • Myoclonus • Priapism • Addiction

28. Ketamine • “Special K”, related to PCP • Anaesthetic • Analgesia, antineuropathic • Bronchodilator • Hallucinogen • More cardiovascularly stable • “Preserves airway reflexes”

29. Ketamine • Adverse effects: • Hallucination/dysphoria • Tachycardia/myocardial ischaemia • Increased salivation • Increased ICP • Addiction • Irritable bladder

30. Muscle Relaxants • Depolarising: • Suxamethonium • Non-depolarising: • Vecuronium • Rocuronium • Pancuronium • Atracurium • Cisatracurium • Mivacurium

32. Analgesics • Opioids • Alfentanil • Fentanyl • Remifentanil • Morphine • Methadone • Endone • Oxycontin • Buprenorphine

33. Analgesics • Anti-neuropathics • TCAs (nortriptyline) • Antiepileptics (gabapentin) • Antiarrhythmics (flecainide, lignocaine) • Ketamine • Others • Clonidine • Clonazepam • Simples

34. Vasoactives • Metaraminol, ephedrine • Noradrenaline, adrenaline • GTN • Dopamine, dobutamine • Milrinone

35. Others • Blood, platelets, FFP, cryoprecipitate • Recombinant factor VII

36. Equipment

49. You Run Theatre