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The Role of Anesthesiologist in Pain Manajement
Husni Tanra
Department ofAnesthesiology, IC and Pain Management
Faculty of Medicine Hasanuddin UniversityMakassar
Anesthesia was the first
applied science in the world
Before Eva was created from
Adam’s rib, he was put into sleep
Prof. HyodoJapan
First Ether Anesthesia in 1846 at Massachusetts HospitalWilliam T, Morton (left) holding globe inhalerJohn C Warren the SurgeonGilber Abbot the Patient
The feat earned Morton the epitaph in Massachusetts
• The Inventor of anesthetic inhalation
• By whom pain in surgery was annulled
• Since whom science has control of PAIN• Before whom, surgery as agony
What is Anesthesiology?
Anesthesiology is the practice of medicine dedicated to the pain relief and total care of the surgical patient before, during and after surgery.
Who is Anesthesiologist?
Anesthesiologists is a physician who focus on surgical patient and pain relief.
( perioperative pain management doctor)
Two main role of anesthesiologistsare:
1. Life Saving
(we r master in CPR)
2. Alleviate suffering
(pain relief)
The main role of Anesthesiologist
History of Pain Managementand Critical Care Medicine
First Anesthesiologist who practice pain management in US. Founder the Society for Pain Practice Management (SPPM). One of the leader of Intervention Pain Management.
Steven D. WALDMAN
ANESTHESIOLOGIST is a superman DoctorIS NOT JUST IN THE OPERATING ROOM
• Operating roomhospital
surgicenter
• Labor & delivery suite
• Other procedural areas
• Intensive care unit (ICU)
• PACU
• Pain management
acute pain
chronic/ cancer pain
o Emergency Medicine
• “Code Blue” team
• Respiratory therapy
• Administration
operating room
hospital
medical school
• Education
health professionals
public
• Research
• ManagersCopyright © 2003 American Society of Anesthesiologists. All rights reserved
The Ideal Anesthesiologist
Who is Anesthesiologist?
• Anesthesiologist Is a suprman phycisian, not only in OR but also ........
• Anesthesiology, best job in America.
• Their salary of;
Anesthesiologist earn $ 292.000/year
Obgy doctor $ 222.000/year
Psychiatrist $ 177.000/year
GREAT Z’S 2009
Why it has to be an anesthesiologist in Pain Clinic?
• We are working with various analgesic drugs in our daily basis;
1. Common analgesic (paracetamol)
2. Non-opioid analgesic (NSAIDs)
3. Opioid analgesic
4. Local anesthetic
5. We had been trained in regional blocks, cenrally or peripherally. So we are mastering in pain pathway.
Why Anesthesiologist for PM?
• Our experiences in OT, made us to get use in peripheral as well as neuroaxial block
This is the Basic interventionpain management
Peripheral Neural blockade
Neuraxial Blockade
Epidural BlockMultipurpose weapon for;
• Epidural Anesthesia
• Post operative pain relief
• Treatment of chronic pain (LBP, symphaticpain, etc).
• Cancer pain, if oral or iv is failed.
Acute pain (Management of post operative pain at APS):
Epidural for Postoperative Pain management.
Caudal Block in Pediatric
Caudal Block in Pediatric
Before Caudal Block
After Caudal Block
Caudal Block in Adult
Epiduroscopy( Minor Surgery)
EpiduroscopyMinor Surgery
Epiduroscopy(Minor Surgery)
STELLATE GANGLION BLOCK
at pain - clinic
Chronic pain in Pain clinic
Stellate Ganglion Block
Indication of SGB:
1. Reflex SymphaticDystrophy (RSD)
2. Phantom Limb Pain
3. Herpes Zooster
4. Raynaud’s Syndrome
5. Facial Palsy
Epidural steroid for radicular painAt pain-clinic
Chronic Pain
Femoral Block for Post Herpetic neuralgiadone in pain-clinic
Femoral Block for Post Herpetic neuralgia.
done in pain-clinic
Anesthesiology residents learn pain management in Onomichi Hospital, Japan
Historyry of Intervention Pain Management?
Interventional pain management have been developing new technique since 1960 by John Bonica.
This tehnique was previously the role of Anesthesiologists, but now is opened to many other spesialists ( neurosurgeons, orthopaedics, rehabilitation medicine, and so on).
American Society of Interventional Pain Physicians (ASIPP),
Imaging techniques have become a part of this new techniques.
KepMenkes 779/Menkes/Sk/VIII/2008 ttgstandar pelayanan anestesiologi dan
reanimasi di rumah sakit
Why it has to be an anesthesiologist in Pain Clinic?
• We are working with various analgesic drugs in our daily basis;
1. Has been trained at least 4 years in
2. using Analgesic Opioid, Non- opiod as well as Adjuvan drugs, inlude Local anesthetics.
3. We had been trained in regional blocks, cenrally or peripherally. So we are mastering in pain pathway.
4. We are mastering in CPR, cause this is our daily activity In Operating teatre
54
We Anesthesiologists are diserve to
work in pain clinic, because pain
management is a part of our
competence.
Husni Tanra
In conclution, I want to say that;
55
If we don’t want to do it,
somebody else will
Eddy Rahardjo
• Be a good Anesthesiologist
Not only providing good and safe anesthesia in OT, but alsoProviding pain management
jangan mau disebut sebagaiDokter Bius (Bihos)
Thank you very much
For your attention
Memory picture with Prof. John Bonica in Seattle, US. January 1988
Makassar 23 Oktober 2013.
atas perhatian dan pengertiaannya.