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Want to become an Anesthesiologist?

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Brenda Tieu

on 16 June 2017

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Transcript of Want to become an Anesthesiologist?

Thank You!
Take grade 11 Chemistry!
Want to become an Anesthesiologist?
Job Description
In general an anesthesiologist is a medical doctor who cares for a patient before, during, and immediately after a surgical or medical procedure.

Their responsibility in the job is to
1. Administer proper anesthesia and monitor the patient for reactions and complications to ensure comfort and manage pain.
2. Carefully monitor the patient’s vital signs during the procedure making adjustments in anesthesia if necessary
3. Meet patients prior to the procedure to evaluate the patient’s condition and review their medical history
4. Explain the process of how the anesthesia works so the patient knows what to expect

Education Needed
In high school, a student would need to take math and science to prepare for success in university and medical school.

Most university students attend a four-year undergraduate program and enroll in a pre-medicine or another science-concentrated program.

There is no official degree required for admission to medical school. Some schools prefer graduates with a 4-year degree in natural sciences, which should include classes in physics, organic and inorganic chemistry, anatomy, and biology.

After attending university, it is required to attend four years of medical school where they spend the first two years learning basic sciences and the second two in clinical training.

After graduating from medical school, it is required to spend one year in an internship and three more years in a residency program.
Fellowships
Some anesthesiologists may participate in an additional one-year fellowship if there is an interest in practicing in a specific area of anesthesiology, such as critical care medicine, pain medicine, research or education.

Specialized elements of anesthesiology that are taught and practiced during a residency include:
- Chronic and acute pain management
- Preoperative patient evaluation
- Postoperative pain evaluation and control
- Intensive care pain management
- Pre-existing disease factors in surgical care

A Day in the Life of a General Anesthesiologist
Derek Mitchell
On a typical weekday morning he wakes up at around 5:45 AM and
takes a quick drive to campus.
While walking through the hospital parking lot he reviews his cases in his head.
Mitchell changes into scrubs, grabs a cap, and heads to his scheduled OR (operating room)
then does an anesthesia machine check and gets all the equipment and drugs ready.
It takes 20 to 40 minutes to set up the room depending on the complexity of the procedure.
Once the OR is ready, he attends a morning lecture from 6:30 to 7:00 AM.
Mitchell then meets his patient in the pre-anesthesia area and reviews their history, medications, and allergies then discusses the anesthetic plan.
Afterwards, he takes the patient to the OR by 7:30AM.
His attending let's him have a 15 minute morning break and a lunch break in the afternoon
Cases end between 3:30 to 5:00 PM.
When the room is finished, he takes 30-45 minutes to check the next day’s schedule and do a preoperative evaluation on the patients and completes their chart.
Then Mitchell discusses the patient and anesthetic plan with his attending.
Finally, he goes home and has enough free time in the evening to spend time with family, study for an hour, and get enough sleep for the next day.

Fun Facts
Anesthesiologists work in tradition surgical settings in a hospital or medical centre, dental offices, outpatient surgical centres, labor and delivery units by administering epidural (epidural anesthesia is the most popular method of pain relief during labor), pain management clinics, critical and intensive care units, teaching, and research.

Anesthesiologists can receive and experience a high level of social interaction with patients and their families, and enjoy a great amount of companionship with their partners on the medical team.

Commonly Used General Anesthetic
Halothane
Molecular Formula:
C2HBrClF3

Word Equation:
1-chloro-1,2,2-trifluoro-ethane + bromine gas → halothane

Balanced Chemical Equation:
C₂F₃ClH₂ + Br₂ → C₂HBrClF₃

Structural Equation:
How is this reaction used in anesthesiology?
Anesthesia administered intravenously and through inhalation. It affects the entire body causing total unconsciousness.

Halothane is a general inhalation anesthetic used for induction and maintenance of general anesthesia.

Halothane is used for:
- reducing blood pressure
- frequently decreasing the pulse rate
- decreasing respiration.
- inducing muscle relaxation
- reducing pains sensitivity by altering tissue excitability by decreasing the extent of gap junction mediated cell-cell coupling and altering the activity of the channels that underlie the action potential.

How does this reaction benefit society?
Reduces intraoperative (during operation) patient awareness and recall
Allows proper muscle relaxation for prolonged periods of time
Facilitates complete control of the airway, breathing, and circulation
General anesthetics can be used in cases of sensitivity to local anesthetic agent
Can be administered without moving the patient
Can be adapted easily to procedures of unpredictable duration or extent
Can be administered rapidly and is reversible

Specialized Equipment Used
Anesthesia Machine - Boyle's Machine
The machine is named after Henry Boyle, the British anesthesiologist, who in 1917 invented the machine’s original concept.

It is a special medical device that consists of a ventilator, suction unit, and a patient monitoring device and is used primarily for supporting anesthesia administration to the patients.

Properties of Halothane
Appearance:
Volatile clear colourless liquid with a characteristic chloroform-like odour and a sweet burning taste.
Density or Vapour measure:
243 mmHg
Melting point:
-118°C
Boiling point:
49-50°C
Freezing point:
-118°C
Water solubility:
Slightly soluble 0.01-0.1g/100mL at 18°C
Physical and Chemical Properties
Connections Between Structures and Properties
- Chemically bonded between carbon atoms - hydrocarbon
- Can bond up to four other atoms
- Halothane is considered straight chained

Relevent Units in Anesthesiology
Length:
millimeters (mm), centimeters (cm), meters (m), inches (in)

Volume:
millilitres (mL), litres (L)

Mass:
grams (g), kilograms (kg), pounds (lbs)

Temperature:
degrees celsius (℃), degrees fahrenheit (℉)

Time:
seconds (sec), minutes (min), hours (h)

Pressure:
pascal (Pa = 1 Newton per square meter) 1 atm = 760 torr = 101.325 kPa

Blood pressure:
systolic/diastolic mmHG (millimeter of mercury, not an SI unit)

Concentration:
Molarity (moles/litre)

Examples of What and How Substances are Measured
The body may have risks to anesthetics depending on the patient’s body mass index (BMI). The BMI is the relationship between the height and weight expressed by a number. The height can be measured in feet and inches (standard) or in centimeters (metric). Weight can be measured in pounds (standard) or kilograms (metric). It is used to determine if a person is at a healthy weight for their height. If the BMI is ranged from 20 to 25 then it is considered to be a healthy weight. Any less than 20 is considered underweight, any more than 25 is considered overweight, and above 30 is obese. If a patient has a BMI of over 30, there can be a higher risk of surgical and anaesthetic complication.
Also, if the anesthesiologist measured the body mass
index incorrectly it could result in many complications.
Body Mass Index Measurement
Examples of What and How Substances are Measured
Temperature of the Patient
Anesthesiologists monitor the temperature of the patient during operation using Boyle’s machine (anesthesia machine). The human thermoregulatory system maintains core body temperature near 37 degrees C. Thermoregulatory is a process that allows the body to maintain its core internal temperature. All thermoregulation mechanisms are designed to return the body to homeostasis (a stable equilibrium). This homeostasis is accomplished by thermoregulatory defense mechanisms such as vasoconstriction (constriction of blood vessels increasing blood pressure), vasodilatation (the dilatation of blood vessels, which decreases blood pressure) and shivering or sweating. Thermoregulation is impaired during general anesthesia. Suppression of thermoregulatory defense mechanisms during general anesthesia is dose dependant and mostly results in perioperative hypothermia.
What if the temperature measurement was
measured inaccurately?
Several adverse effects of hypothermia have been identified, including an increase in postoperative wound infection, perioperative coagulopathy and an increase of postoperative morbid cardiac events. Perioperative hypothermia can be avoided by warming patients actively during general anesthesia. Fever is a controlled increase of core body temperature. Various causes of perioperative fever are given. Fever is usually attenuated by general anesthesia. Typically, patients develop a fever of greater magnitude in the postoperative phase. Postoperative fever is fairly common. The incidence of fever varies with type and duration of surgery, patient's age, surgical site and preoperative inflammation.
Examples of What and How Substances are Measured
Blood Pressure
Invasive blood pressure is measured with a catheter called an arterial line placed inside an artery usually in the wrist. Majority of surgeries are done with non invasive blood pressure measured with a cuff. Every two to five minutes while the patient is under anesthesia the blood pressure is measured to ensure if changes are detected as quickly as possible. Anesthesiologists monitor the blood pressure of the patient with an electrocardiogram (EKG or ECG) monitor. Three to five electrode stickers are placed on the chest to read the electrical conduction through the heart, which determines the heart rate and rhythm. Changes in the levels of blood electrolytes might also have a characteristic appearance on the EKG. If blockages exist in the coronary arteries that supply blood to the heart, the EKG pattern will show changes.
Most importantly, an anesthesiologist measures the dosages of medicine that the patient needs during the surgery while monitoring them. They are the ones who use the machine to administer the doses of anesthesia to the patient. (An anesthesiologist does not make the anesthetic but they are the ones responsible for measuring and administering it on the patient) There is a risk of inducing a coma on the patient, brain damage, or even death if dosages of anesthesia is not measured correctly.
Examples of What and How Substances are Measured
Concentration of Anesthetic
Cause and Effect
What are the implications of inaccurate measurements?
Symptoms of the patient during the surgery. A patient’s heart pressure and rate on the monitor can determine if the patient is unconscious or about to become conscious again. It can also determine if there is any complications in the circulatory system. If a patient is considered overweight but the body mass index measurements were incorrect, it may cause complications within the surgery. This is because patients who are overweight have a higher risk of complications than those who are considered to be at a healthy weight. Patients that are considered overweight sometimes have to go to a specialist to help them in losing weight before going into surgery.

What could be learned from a scenario in which inaccurate measurements were made?
The anesthesiologist will have to learn from their mistake to never make the same events occur again. For example, if he or she was not monitoring the patient, then he or she would not know when to put another dosage of anesthesia to keep the patient asleep.
What safety measures should be implemented in order to reduce the possibility of error?
There are not many safety measure that can be implemented before going into surgery. This is because the dosage that a patient needs cannot solely be based on calculations. The patient’s body may react to the anesthesia differently than other patients. Therefore, the only safety measure that can be implemented is to always be watching the patient in case of any changes. If there are any changes to the patient then the dosages of anesthesia will be changes as well, when more dosages are administered every few minutes.
Environmental Issue
What is the problem?
They have a contribution to global climate change and the environmental
Anesthesia providers have a responsibility to minimize unnecessary atmospheric pollution by utilizing techniques that can lessen any adverse effects of these gases on the environment.
Most of the organic anesthetic gases remain for a long time in the atmosphere, where they have the potential to act as greenhouse gases.

There is a possibility for leakage of the anesthetic gases in the operating room when anesthetic techniques or the anesthesia machine delivery system is flawed.
An example of this is applying the face mask on the patient during the induction of the general anesthesia. Gas seepage around the mask is unavoidable. If there is a poorly fitted mask on a patient, the risks of gas seepage is larger, especially with pediatric patients
While refilling the vaporizer in the anesthesia machine, spillage of the liquid inhalational anesthetic can contaminate the workplace.

The major atmospheric effects that may arise from emission of volatile anesthetics are their contributions to ozone depletion in the stratosphere and to greenhouse warming in the troposphere
All volatile anesthetics are halogenated chlorofluorocarbons (halothane is a chlorofluorocarbon) which are potentially damaging to the earth's ozone layer
They also contribute to global warming. The bromide-containing agent halothane is the most destructive against ozone

What effects does this compound have on the environment (air/water quality)?
Environmental Issue
Is there a protocol for waste disposal?
Scavenging systems are designed to collect gases and vapors that are vented from the breathing circuit.
The gases are then redirected to a safe area, directly exhausted outside of the facility, or a dedicated Waste Anesthetic Gases (WAG) disposal system

Environmental Solution
What is being done to lessen the harmful impacts on human health and the environment?
Implementing preventive practices and simple strategies can promote the safest and most healthy environment.
Simple knowledge-based decisions and preventive strategies that may minimize deleterious effects of these gases on the environment.
Health care facilities that use anesthetic gases are accountable for ensuring that all anesthesia equipment is effective and routinely maintained
The development of new methods of capturing anesthetic gases for reuse, rather than releasing them into the atmosphere, can reduce the environmental impact.
Researchers have developed a recycling system, called the Dynamic Gas Scavenging System, which collects and reuses 99% of anesthetic gases without chemically altering them in the process.
Could we reduce the amount used?
Environmental Solution
Could we modify the chemical components?
Isoflurane and enflurane (which contains only chloride and fluoride ion substitutions) have a lesser impact on the ozone.
Isoflurane
Enflurane
Alternatives
If there is a possibility that intravenous anesthetics can be used, then there will be less of a chance that the air will be polluted.
Unfortunately, the aqueous substances may be released into the hospital sewage system if not dealt with cautiously.

Are there safer and greener alternatives?
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