Anesthesiology Orientation

1. Billynda L. McAdoo, M.D. EMORY UNIVERSITY Assistant Professor Director of Medical Student Education Department of Anesthesiology Emory University Hospital Anesthesiology Orientation

2. Objectives • After attending this lecture, the audience should: • Have a better understanding of the scope of the practice of anesthesiology • Understand basic concepts of airway evaluation • Understand basic components of airway management

3. Outline • Anesthesiology • Definition • Different Forms • Airway Evaluation • Airway Management

4. Anesthesiology • The practice of rendering patients insensible to pain during surgery or obstetric delivery.

5. Definition of the Practice of Anesthesiology1 • Assessment of, consultation for, and preparation of, patients for anesthesia. • Relief and prevention of pain during and following surgical, obstetric, therapeutic, and diagnostic procedures. • Monitoring and maintenance of normal physiology during the perioperative period. • Management of critically ill patients. • Diagnosis and treatment of acute, chronic, and cancer-related pain. • 1From the American Board of Anesthesiology Booklet of Information, January 2003.

6. Definition of the Practice of Anesthesiology1 (cont.) • Clinical management and teaching of cardiac and pulmonary resuscitation. • Evaluation of respiratory function and application of respiratory therapy. • Conduct of clinical, translational, and basic science research. • Supervision, teaching, and evaluation of the performance of both medical and paramedical personnel involved in perioperative care. • Administrative involvement in health care facilities, organizations, and medical schools necessary to implement these responsibilities • 1From the American Board of Anesthesiology Booklet of Information, January 2003.

7. What does an anesthesiologist do? • As physicians, anesthesiologists are responsible for administering anesthesia to relieve pain and for managing vital life functions, including breathing, heart rhythm and blood pressure, during surgery. After surgery, they maintain the patient in a comfortable state during the recovery, and are involved in the provision of critical care medicine in the intensive care unit.

8. Options for Anesthesia • General Anesthesia • Regional Anesthesia • Monitored Anesthesia Care (MAC)

9. Preoperative Evaluation of Patients • Preoperative History • Patient Problems (PMH, PSurgH, Meds, Allergies) • Planned Procedure • Review of Organ Systems • Physical Examination • Laboratory Evaluation • Review of Diagnostic Studies • Informed Consent

10. ASA Physical Status Classification

11. Airway Evaluation and Management • Expert airway management is an essential skill for an anesthesiologist. • Patient safety depends on a thorough understanding of: • the anatomy of the upper respiratory tract • necessary equipment • techniques and complications of laryngoscopy, intubation, and extubation

12. Airway Evaluation • Mallampati Classification • Mouth Opening • Thyromental Distance • Neck ROM

13. Airway Management - Equipment • Oral and Nasal Airways • Mask • Laryngoscopes • Macintosh • Miller • Glidescope • Fiberoptic Scope

14. Airway Management • Proper Positioning • “Sniff Position” – alignment of oropharynx, pharynx, and larynx • Mask Ventilation • Intubation • LMA Insertion

15. Conclusion • The practice of anesthesiology has expanded well beyond rendering patients insensible to pain during surgery or obstetric delivery. • The specialty is unique in that it requires a working familiarity with most other specialties, including surgery and its subspecialties, internal medicine, pediatrics, and obstetrics as well as clinical pharmacology, applied physiology, and biomedical technology.