Introduction to Anesthesia
With Brian Warriner, MD
Introduction to Anesthesia (aka Anesthesiology)
What is anesthesia?
• Question:
I have been told that I will be asleep during my surgery.
Will having general anesthesia make me feel the same as
when I am sleeping?
• Answer:
General anesthesia induces a state that is not just a slightly
deeper form of normal sleep. This state is much better than
placing a patient in a reversible coma.
Introduction to Anesthesia (aka Anesthesiology)
What is anesthesia?
• Question:
I have been told that I will be paralyzed during my surgery.
Is this dangerous? How will I breathe?
• Answer:
You may be paralyzed if muscle relaxations are required or
if a breathing tube needs to be placed in the trachea.
The anesthesiologist is responsible for managing the
breathing.
Introduction to Anesthesia (aka Anesthesiology)
What is anesthesia?
• Question:
Will I remember being operated on?
• Answer:
You will remember entering the operating room (OR) and
being introduced to the OR team.
Being under anesthesia will eliminate all memory of the
surgical experience itself.
Introduction to Anesthesia (aka Anesthesiology)
What is anesthesia?
• Question:
After the anesthetic has worn off, will I have
a lot of pain?
• Answer:
When anesthetics are properly delivered, pain prevention
is an important aspect of the care.
Before the end of surgery, pain killers, which will produce
good pain relief, will be given.
If required, the patient will be given more pain killers.
Introduction to Anesthesia
Being under anesthesia is not like sleeping!
Surgery cannot be performed under conditions of
normal sleep.
Oxford Dictionary definition:
An anesthetic that affects the whole body and
usually causes a loss of consciousness: He had the
What Is operation under general anesthetic.
General
Anesthesia? A reversible drug-induced state of
unconsciousness, which is characterized by a
coma-like state under the control of an anesthetist
(aka: anesthesiologist).
Introduction to Anesthesia
Being under anesthesia is not like sleeping!
Surgery cannot be performed under conditions of
normal sleep.
Oxford Dictionary definition:
Often associated with muscle paralysis.
What Is Always associated with profound amnesia for the
General surgical event.
Anesthesia?
History of Anesthesia
all thanks to the dentists!
1844 Before 1846, there was no way to provide anesthesia
1845 to those undergoing surgery.
1846
Surgery was extraordinarily painful, bloody, and dirty.
Surgeons were praised for their speed, not their skill, in
successfully completing an operation.
1853
The Massachusetts General Hospital (MGH) provided
1890 surgical procedures to an average of 5 people per week:
~260 people per year.
x100 Now, over 100 procedures are done per day at MGH:
36,000+ people per year.
2000s
History of Anesthesia
all thanks to the dentists!
1844 Horace Wells the real father of anesthesiology
1845
• Dentist
1846
• 1844 Wells attended a party and
observed that party participants who
breathed nitrous oxide did not seem
1853 to suffer pain when injured.
• 1844 Wells had a tooth extracted
under nitrous oxide anesthesia.
1890
• January 1845 demonstration of
nitrous oxide for surgical anesthesia
at Massachusetts General Hospital a
dismal failure.
2000s
History of Anesthesia
1844
1845
1846
"The effect of the Gas is to make
those who inhale it either laugh,
sing, dance, speak or fight
1853 according to the leading trait of
their character.
They seem to retain
1890 consciousness enough not to say
or do that which they would have
occasion to regret.
2000s
History of Anesthesia
all thanks to the dentists!
1844 William Morton
1845
• October 16, 1845 William Morton
1846
(another dentist) successfully
demonstrated the use of ether for
excision of a neck tumor at
Massachusetts General Hospital
1853
•
1890 ether
2000s
First Surgical Anesthetic
Morton at Massachusetts General
1844
1845
1846
1853
1890
2000s
History of Anesthesia
Physicians enter the history
1844 John Snow and Obstetrical Anesthesia
1845
• April 7, 1853 Queen Victoria
1846
received chloroform during the birth of
her 8th child.
• Dr. John Snow administered the drug
1853 he was the "father of anesthesia" and
the "father of
1890
2000s
History of Anesthesia
Early Developments
1844
1845
1846
1853 Ether and
Schimmelbusch
mask (early
anesthetic machine)
1890
2000s
History of Anesthesia
Modern Developments
1844 A modern anesthetic
1845 machine
1846
1853
1890
2000s
Other Forms of Anesthesia
1. First development of local anesthetic drugs
cocaine was the first (Sigmund Freud was an
early proponent of cocaine for many treatments).
2. This led to spinal and epidural anesthesia.
3. Regional anesthesia can provide complete loss
of sensation to many parts of the body and is
Regional particularly useful for limb surgery.
Anesthesia
Other Forms of Anesthesia
4.
4. Spinal anesthesia is the common form for
cesarean section, whereas epidural anesthesia
is useful for pain relief during labor or after
surgery.
5. Spinal anesthesia is also often used for surgery
of the legs.
Regional 6. Ultrasound equipment has led to the modern
Anesthesia practice of ultrasound-guided regional
anesthesia, primarily for treatment of
postoperative pain.
Anesthesia Safety
One of the safest interventions in modern medicine
1980 2014
My practice started in 1980. By 2014, death in the OR had
At that time, people still died become a very unusual event.
on the OR table.
Anesthesia Safety
One of the safest interventions in modern medicine
1:10,000 Mortality rate from general anesthesia
in developed countries.
• Rate is much lower for young, healthy
individuals.
< 1:100,000 Rate of permanent neurological
damage from spinal and epidural
anesthesia in developed countries.
• Will probably not be experienced in
career.
Introduction to Anesthesia
1 Introductory Lecture
2 Physiologic Effects of Anesthesia
3 Drugs Used in Anesthesia
4 Anesthetic Systems
5 General Anesthesia
Course Structure 6 Regional Anesthesia
7 Emergencies
8 Intensive Care
9 Pain Management
10 Anesthesia for Pregnant Patients, Children and the Elderly
11 Anesthesia and Other Medical Discplines
