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What is an Anesthesiologist ?

An anesthesiologist is a physician who has completed four years of undergraduate education (college), four years of medical school and at least four years of residency training. The anesthesiologist is a physician specialist responsible for the anesthetic care, life support and pain management for patients undergoing surgery, childbirth and various medical procedures. Additionally, anesthesiologists are involved in the management of critically ill patients and patients with chronic pain syndromes. Upon completion of specialty training, the anesthesiologist becomes eligible for board certification by the American Board of Anesthesiology.

Anesthetic Agent

There are 2 kind of anesthetic induction agents, inhalation and intravenous agents. The inhalation agents are halothan, sevoflurane, enflurane, isoflurane, and desflurane. For induction, we usually use sevoflurane, that rapid onset for induction and halothan (but this agent is hepatotoxic, so the use of this agent should not repeated until minimally 6 month). The others are not common for induction because they are irritant for the airway, and slow onset. Isoflurane is the best for use in neuroanesthesia, because of the neuroprotectif feature and less toxic on renal system. Enflurane has epileptogenic effect, so it must be avoid for use on epileptic patients. The intravenous agents are barbiturat (pentothal), propofol, etomidat, ketamin, and benzodiasepin (midazolam). The features of them are same except ketamin because it has simpatetic effect, not depressed the cardiovascular system, and has broncodilator feature. Pentothal has neuroprotectif feature, so it is the best for use in neuroanesthesia. Propofol has rapid onset and short duration, but must be careful to use it because can depress cardiovasculer system. Etomidat and benzodiazepin are more safe in patient with cardiovascular compromized, but benzodiazepin has slower onset.

How to prepare patient undergoing anesthetized ?

1. Look general condition. Good, or bad, and the consciousness. Ask history of asthma, allergies, hypertension, diabetes mellitus, convulsion, prolong therapy of tuberculosis.
2. Examine “the ABCD” Airway: clear or unclear (any discharge, debris, blood, etc) Breathing: respiratory rate, pattern of breathing, additional sounds (wheezing, ronchi) Circulation: blood pressure, heart rate (regularity, quality), additional heart sounds Dissability: consciousness (GCS), pupil light reflex, pupil diameter, pupil isokor/anisokor
3. Do appropriate supporting examines: laboratorium, X-ray photos, CT Scan, etc.
4. Assess the patient condition with ASA criteria
5. Is the surgery being elective or emergency ? Be careful in emergency patient. All emergencies patient is full stomach, so they need special tecnique, such as rapid induction/intubation, do Sellick manuever, set the nasogastric tube.
6. There is no best anesthetic agent/technique but only best anestetician. Good luck

How to perform intubation ?

1. Prepare the instruments: endotracheal tube (ET), laryngoscope, tapes, stetoscope, spuit cuff, suction unit.
2. Check the light of laryngoscope.
3. Perform triple manuevers: jaw trust, neck extension, chin lift
4. Get the laryngoscope left handled, open the mouth, start from the right edge of mouth until middle tongue get the blade of laryngoscope until find eppiglottis and than plica vocalis under the epiglottis. If there is any debris, than suction
5. Enter the ET to the laryng.
6. Check the pulmo sound with stetoscope, right and left must be the same. If harder than another pull out until have the same sound.
7. Fixation the ET with cuffing the ballon, plaster the ET pipe on the mouth.
8. Connect to the breathing equipment If you have any question, or advise, please do not hesitate to contact me at this comment below

Let’s anesthetize..

Terdapat tiga teknik anestesi: 1. General anestesi (anestesi umum). Termasuk di sini adalah teknik TIVA atau total intravena anestesi, face mask atau anestesi dengan sungkup muka, LMA atau dengan pemasangan laryngeal mask airway, dan intubasi yaitu anestesi dengan memasang endotracheal tube. 2. Regional anestesi. Termasuk di sini adalah teknik subarachnoid block (SAB atau spinal anestesi) yaitu anestesi dengan memasukkan obat anestesi lokal ke ruang subarachnoid segmen vertebra yang dikehendaki, epidural anestesi yaitu dengan memasukkan obat anestesi lokal ke ruang epidural di vertebra yang dikehendaki, dan blok regional. 3. Anestesi lokal, yaitu memberikan obat anestesi lokal secara infiltrasi di sekitar daerah yang akan dilakukan pembedahan. Penggunaan teknik-teknik di atas tergantung dari lokasi pembedahan dan kondisi pasien yang akan dilakukan pembedahan. Agen atau obat yang digunakan dalam anestesi dapat dikelompokkan menjadi 1. Obat premedikasi, misalnya: anti muntah, anti nyeri, antisialogogue, sedasi, dll 2. Obat induksi (dapat juga untuk obat pemeliharaan anestesi), yaitu obat yang digunakan untuk membuat pasien dari keadaan sadar menjadi tertidur/tidak sadar. Dapat dibagi menjadi obat inhalasi (misalnya halotan, isofluran, enfluran dan sevofluran) dan intravena. (misalnya: propofol, ketamin, tiopenthal, midazolam, dan etomidat) 3. Pelumpuh otot, yang dibagi menjadi golongan depolarisasi (misalnya: suksinilkolin) dan nondepolarisasi (misalnya atracurium, rocuronium, vecuronium, dll) 4. Analgetik. Dibagi golongan: opioid (misalnya fentanil, petidin), gas (N2O), dan NSAID. 5. Untuk anestesi regional dan blok dipakai obat anestesi lokal seperti lidokain, bupivacain dan ropivacain. Tentu saja keterangan di atas hanya secara garis besar saja. Untuk lebih detilnya dapat dilihat pada textbook anestesi: Clinical anestesi dari Morgan, Anesthesia procedure of general hospital of Massachuset (Benar nggak ya ngejanya ?), dan jangan lupa boleh kirim e-mail atau tanggapan atau pertanyaan. Klik aja di comment, insya 4JJI dijawab.