Role of Anesthesiologists in Critical Care – Jammu and Kashmir latest news | Tourism

Dr. Satya Dev Gupta
The terminology of Anesthesia and Anesthetist has remained as an enigmatic discourse for the general public and of course those at the helm. They were aloof from the vivid importance and implications of this highly technical specialty, until the deadly mass Covid-19 pandemic laid down its fearsome claws of death upon the unfortunate global population residing in countries highly developed, developing, backward and poor. The people who had fallen prey to this disaster needed oxygen therapy by experts well versed in high skill advanced treatments. These experts are the anesthesiologist or anesthesiologist and experts in pulmonary medicine.
Anesthesia physicians can work wonders as their services are utilized and they are at the forefront as an emergency physician, resuscitator, treating long-term pain pathology and providing supportive conditions. painless labor to term pregnant women.
It is a paradox that most patients when they are admitted to the hospital for surgery like to choose the specialist surgeon of their choice and do not care to know the anesthesiologist to whom they sacrifice their life for the performing the surgery.
Advent of painless surgery
The specialty of anesthesia was originally intended to provide an environment for painless surgery. This was introduced on October 16, 1846 by dentist William T. G. Morton of Boston at his first public demonstration at Massachusetts General Hospital using sulfuric ether (diethyl be) on Edward Gilbert Abbott for an operation by a prominent surgeon John Colin Warren Professor of anatomy and surgery at Harvard Medical School in Boston. Reports of these operations where the patients were rendered insane by the administration of ether appeared in Boston newspapers, medical journals, and other personal correspondence. This event of discovery spread far and wide in Europe and the rest of the world.

world anesthesia day

The other heroically advanced development came in the form of the use of muscle relaxants (muscle blocking drugs). Henry Dale in 1933 studied the transmission of nerve impulses to muscle through a neurotransmitter named acetylcholine and further research on drugs capable of blocking this transmission and paralyzing the muscle was eventually developed by Harold Griffith and Johnson. This drug was d-tubocurare. Now the basic requirement for surgical procedures, i.e. sleep or absence of senses (hypnosis), pain-free condition (analgesia) and muscle relaxation (muscle blockers) was possible. In 1878, Macewen was the first to introduce the technique of passing a tube through a trachea (endotracheal incubation for anesthesia) to isolate the trachea for good ventilation and avoid aspiration of debris. Now, with the advent of muscle relaxants, this procedure is easily done.
LOCAL AND REGIONAL ANESTHESIA
By name, local and regional anesthesia produces numbness and relaxation of a part and region of the body by interrupting the conduction of nerve impulses. This technique was first introduced by William Stewart Halsted in 1885 through a self-experiment by injecting cocaine near a nerve trunk. He succeeded in his experiment but found himself trapped in cocaine addiction. He took 2 years to recover from his jaw.
Later, new safe drugs were introduced which changed the scenario. Local blocks, nerve blocks, regional, spinal and epidural anesthesia were the results.
BIRTH OF THE INTENSIVE CARE UNIT
The breakthroughs came in 1952 in Denmark when the polio epidemic engulfed that country’s children and Copenhagen was the epicenter of one of the worst polio outbreaks the world had ever seen. Bjørn Aage Ibsen, an anesthetist had a radical idea. His idea was to blow air directly into the lungs to expand them with a bellows (Ambu bag) and then allow the body to relax and passively exhale. He proposed the use of the tracheotomy: an incision in the neck, through which a tube enters the trachea and delivers oxygen to the lungs. This type of breathing is called positive pressure ventilation. Mortality, which was 87%, fell to 31%. This adventure gave birth to mechanical ventilation, ventilators, a new concept of ANESTHESIA, and intensive services.
ANESTHESIOLOGY AND CRITICAL CARE
Anesthesiologists take care of patients who have serious infections and trauma, or groups of patients who are assigned for major surgery, whether cardiac, thoracic, neuro, gastrointestinal, organ transplant, etc. . preoperatively, perioperatively and postoperatively. operative period.
In intensive care, the anesthetist works as an intensivist, that is, an intensive care doctor who manages the entire treatment and coordinates with other specialists as needed. Intensivists are familiar with all the technical know-how of other visiting experts and serve around the clock for patients required to stay in intensive care for a few hours to several months together.
In intensive care, patients have central, peripheral or both intravenous lines for the administration of fluids and a set of electronic gadgets to monitor vital parameters like (a) ECG, electrical activity of the heart (b) blood pressure (c) blood oxygen saturation (d) Respiratory rate (e) Heart rate (f) Temperature (g) further complex vital elements instrumentation to measure cardiac output, contractility, peripheral vascular resistance and some opportunities to assess brain function. Sometimes patients are put on ventilators to help maintain respiratory functions.
The anesthesiologist working in critical care medicine plays a central role in maintaining the well-being of admitted patients. They supervise the intensive care team and coordinate with relevant surgeons, doctors, physiotherapists, etc.
BOOST SECURITY
Shortly after the inventory of anesthesia in 1846, there was a chain of development after development aimed at improving and advancing patient safety. The upgrading of technology, especially in the last decades, especially in the electronic field, has led to an improvement in the monitoring of the subject’s vital signs not only in the operating room or nursing sectors. but also in the discipline of emergency medical services. It gave an impetus to the anesthetist on duty to standardize the monitoring system concerning hemodynamics of blood flow, pressure, cardiac electrical activity (ECG), functions, respiratory well-being (oxygenation status ), urine output, core temperature, degrees of neuro-muscular block, etc. With the advancement of modern technologies, new standards of safety and patients have emerged.
Those are:
* AIMS (Anesthesia Information Management System)
* AL (Artificial Intelligence)
* WHD (Portable Home Devices)
With the help of artificial intelligence and the use of modern sensors, the safety of patients during the operation, in the intensive care sectors and in the emergency medical services is better than before and the future saves the significant result where mortality will be zero.
(The author is Ex – HOD, Intensive Care and Anesthesia Unit)

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