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Introduction to The Anaesthesiologyand
Reanimation
DR.,Dr. Hari Bagianto SpAnK.IC
Medical FacultyBrawijaya University
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Adam was put into sleep before Eve was created from his rib.
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The first Anesthesia(1846)
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Definition
An - esthesia = no pain
Re - Animate = Rescusitation
Anaesthesiology and Reanimationis
To alleviate Pain and Distress
To preserve life
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The Dying Process
Through all the body system :
Hypotension Hypo perfusion
Hypoxia Anoxia
Cell DeadOrgan Dead.
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Philosophy
To alleviate Pain and Distress
Artificial / IatrogenicTrauma
Critical Condition
Life Support
To preserve life
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Anaesthesia Episode
Artificial TraumaInform Consent (patient Right)
Pre-medication (alleviate Distress)Induction (Artificial
Coma)
Intubation (Artificial Apnoe)Relaxation (Artificial
Paralyze)
Maintenance/Bleeding (Haemodynamic Stability)The End of
Anesthesia
Recovery of all the System(Back to normal)
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To Preserve Life = Life Support
Normal
Accident / illness
Diagnostic / Initial Treatment
Definitive Therapy / Operation
Recovery
Intensive Care
Ward
Field
ED
O.R.
R.R.
ICU
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Anaesthesiology Fields
Emergency and Critical Care Medicine
Anaesthesiology
Pain Management
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Biphasic insult on the human body :
1. During surgery, there is trauma to tissuewhich produces a
barrage of nociceptive input
2. After surgery, there is an inflammatoryresponse which also
generating of noxious
input
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Redrawn with permissionfrom Kehlet H, Dahl JB.
The value of
"multimodal" or
"balanced analgesia" in
postoperative pain
treatment. Anesth Analg
1993;77:1049.
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POST OPERATIVEPAIN
MANAGEMENT
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Postoperative pain can affects all organ systems
andincludes:
Respiratory - reduced cough, atelectasis, sputumretention and
hypoxaemia
Cardiovascular - increased myocardial oxygenconsumption and
ischaemia
Gastrointestinal - decreased gastric emptying,reduced gut
motility and constipation
White PF., (2002) Anesth Analg ; 94:577-585
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Genitourinary - urinary retention
Neuroendocrine - hyperglycaemia, proteincatabolism and sodium
retention
Musculoskeletal - reduced mobility
Psychological - anxiety and fatigue
White PF., (2002) Anesth Analg ; 94:577-585
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Nevergive anaesthetic to the Patientwithout
capability to Preserve Life
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THANK YOU
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Disaster plan
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Disaster plan
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Disaster plan
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Disaster plan
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(BLS)
Layman
Police
Fire BrigadeSecurity Guard
Civil Defense
Scouts
Red Cross
(Paramedic)
118
EmergencyAmbulance
Service
E.D. I.C.U Ward
Access
Emergency
Telephone Number
110,113,118
Pre-Hospital Phase
Public
Health
Center
Rehabilitation
DISASTER
Hospital Phase
HOPE Emergency Nurse(BTLS, BCLS, BNLS, BPLS) Emergency
Physician(ATLS, ACLS, ANLS, APLS) Trauma Surgeon(ATLS, BSS, DSTC,
Peri OP CC)
DISASTER MANAGEMENT
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History in Indonesia
38
October1997
August1998
February2000
Emergency Medicine Specialist Team from Singapore
International Foundation starting to help development
Malang Trauma Service Center (MTSC)
at FKUB and Saiful Anwar Hospital Malang.
Build Emergency Dept System at Saiful Anwar Hospital
Preparing Medical EmergencyResidency
Malang Trauma Registry
15th July 2003 Starting Medical Emergency Residency
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Perform Residency Emergency Specialist
39
Professional Study Program 8 semester, focus on skill
andknowledge in prevention, diagnosis and management in
emergency situation.
Gen.Pract.
Basic SpecialistTraining:
4 semesters
Graduate as aMagister
AdvancedSpecialistTraining:
4 semesters Graduate as a
EmergencySpecialist
Emergency
Specialist
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F d f di f
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Fast responder for disaster forEast part of Indonesia
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