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Anesthesiology:An IntroductionFor Medical
Students
James Lamberg
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What Do You Know?
Where Do Anesthesiologists Work?
Who Do They Care For?
What Do They Do? Common Misconceptions:
Just Push The White Stuff (propofol)
A Very Narrow Sub-Specialty
Just Put People To Sleep
Too Competitive
Boring
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Common Stereotype
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So What Do They Do?
Work In Every Area Of Medicine
OR, PACU, ICU, OB, Peds, Pain Clinic
Work With The Most Diverse PatientPopulation
Premature Infants To Geriatrics
Provide Medical Care & Critical Care
Prior To, During, And After SurgicalProcedures
Work With Advanced Technology
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You Might Like Anesthesia If
You Enjoy Performing Procedures
You Are Interested In Critical Care
You Had Prior Experience (e.g. EMT)
You Enjoyed:
Pharm, Physio, Cardiology, Pulmonology
You Like All Areas Of Medicine
You Can Specialize Though You Like To See Immediate Results
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Ether Day October 16th, 1846
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Brief History
Pre-1800: Surgery Without Anesthesia
1846: First Ether Anesthetic
1884: Cocaine For Local Anesthesia 1921: Epidural Anesthesia Described
1942: Curare Clinical Trial Success
1960: Short Acting Opioids 1982: Transesophageal Echo
1983: Laryngeal Mask Airway
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In The Operating Room
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In The Operating Room
Pre-Anesthesia
History & Physical Exam
Positioning & Patient Setup
Induction
Put Patient To Sleep
Manage Airway
Create Best Operating Conditions ForThe Surgery Team
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In The Operating Room
Maintenance
Anesthesia Machine
Inhaled Anesthetics
Emergence
Safe Awakening
Transfer To PACU
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In The Post-Anesthesia Care Unit
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In The Post-Anesthesia Care Unit
Reduce The Risk Of Post-OperativeComplications (e.g. Stroke, MI)
Reduce The Risk Of Post-OperativeNausea & Vomiting
Reduce Post-Surgical Pain
Safely Discharge Patients Home Or
To Other Parts Of The Hospital
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In The Intensive Care Unit
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In The Intensive Care Unit
Founded Critical Care Medicine
Overlapping Skills:
Airway Management
Ventilator Management
Analgesia & Sedation
Management Of:
Respiratory Emergencies Cardiac Emergencies
Common Critical Care Issues (e.g. sepsis)
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In The Pain Management Clinic
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In The Pain Management Clinic
Diagnosis Of Pain
Treatment Of Pain
Pharmacologic
Procedural Injections
Pumps
Stimulators Non-Pharmacologic
Biofeedback
OMT
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Obstetric Anesthesia
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Obstetric Anesthesia
Risks To Mother & Fetus
Pharmacology
Physiology
Pain Management
Awake C-Sections
Obstetric Emergencies
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Cardiothoracic Anesthesia
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Cardiothoracic Anesthesia
Cardiac Anesthesia
Cardiopulmonary Bypass Multiple Vascular Lines
Transesophageal Echo Performed By Anesthesiologist
Thoracic Anesthesia
Dual Lumen Tubes
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Neuro Anesthesia
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Neuro Anesthesia
Physiology
Aneurysm Clipping
Awake Craniotomy
Lumbar CSF Drain
Specific Disorders
Electroconvulsive
Therapy
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Pediatric Anesthesia
Anatomical Differences
Otolaryngology
Congenital Heart Defects
Gastrointestinal Disorders
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Trauma Anesthesia
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Trauma Anesthesia
Airway Management
Transfusion Medicine
Tension Pneumothorax
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Acute Pain Management
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Acute Pain Management
Local Anesthesia
Neuraxial Anesthesia
Epidural
Spinal
Combined
Peripheral Blocks
Upper Extremity Lower Extremity
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Simulation
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What About Research?
CA-3 Research Track
Advances In Safety & Technology
Deaths Per 10,000 Anesthetics:
1950: 17.9
1975: 2.2
1980: 0.7
1989: 0.04
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Its Too Competitive For Me
ROAD: Radiology, Ophthalmology,Anesthesiology, Dermatology
Freeman Book: Competitive Not Very orExtremely Competitive
NRMP Match Data
Anesthesiology In The Middle
Academic Medicine (Mar 2009, Vol84, #3): Competitive Not Most orLease Competitive
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Its Too Competitive For Me
Choosing A Medical Specialty byFreeman (2004)
By Unmatched Rate: Emergy Med 6.5%
General Surgery 5.4%
Anesthesiology 5.2%
Ob/Gyn 4.3%
Psychiatry 4.3%
Neurology 3.0%
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Its Too Competitive For Me
NRMP Data 2008
Preferred Step 1 Score: 220
NRMP Data 2009 Preferred Step 1 Score: 222
Preferred Step 2 Score: 230
Similar To:
Internal Medicine, Pathology, GeneralSurgery, Emergency Medicine, Pediatrics,Obstetrics & Gynecology, Neurology
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Its Too Competitive For Me
Academic Medicine (Mar 2009, Vol 84,#3), Selection Criteria for Residency:Results of a National ProgramDirectors Survey.
Most Competitive: Plastics, Orthopedics,Otolaryngology, Ophthalmology,Radiology, Rad/Onc, Neurosurgery.
Competitive: Emergency Medicine,Urology, Dermatology, General Surgery,Anesthesiology, Pediatrics, Ob/Gyn.
Less Competitive: Psychiatry, Pathology,PM&R, Internal Medicine, Neurology,Family Medicine.
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Its Too Competitive For Me
Dispelling Myths Medical Education Online (2005;10:17),
Residency Selection Criteria: WhatMedical Students Perceive As Important.
Academic Medicine (Mar 2009, Vol 84,#3), Selection Criteria for Residency:Results of a National Program DirectorsSurvey.
Academic Emergency Medicine (Jan2002, Vol 7, #1), Selection Criteria forEmergency Medicine ResidencyApplicants.
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But Isnt It Boring?
Different Areas Of The Hospital
Diverse Patient Population
Lots Of Procedures
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The Best Medical Specialty?
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Thank You