physician anaesthetists – pivotal to holistic...
TRANSCRIPT
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PHYSICIAN ANAESTHETISTS – PIVOTAL TO HOLISTIC HEALTHCARE DELIVERY IN GHANA
Robert Djagbletey Department of Anaesthesia
SMD/KBTH
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Outline
Introduction
Role of the Doctor Anaesthetist / Anaesthesiologist in the healthcare delivery
Perioperative care
Ambulatory surgery
Blood conservation
Resuscitation teams
Critical care units
Pain clinics
Conclusion
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Introduction
• The functions of the anaesthesiologist is not limited within the perimeter of the traditional operating theatre suites.
• Despite phenomenal growth, there is inadequate knowledge by the public, healthcare professionals and policy makers regarding the specialty, the scope of the functions of anaesthetists, as well as the pivotal role Anaesthesiologists play in the healthcare delivery system.
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History
History of anaesthesia can be trace as far back as biblical creation.
And the LORD God caused a deep
sleep to fall upon Adam, and he slept: and he took one of his ribs, and closed up the flesh instead thereof. Gen 2:21
First medical specialty
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History
• Modern anaesthesia begun with successful public demonstration of the effect of Ether 1846 by Dr. William Morton
Robinson DH, Toledo AH.Historical development of modern anesthesia. J Invest Surg. 2012;25(3):141-9.
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Introduction
Since then anaesthesia has been linked to “putting people to sleep and waking them up”
In a survey done in 2015 of 279 preoperative patients at KBTH , 45.5% who have heard of anaesthesia said it was all about “putting people to sleep and waking them up”
Less than 15% of responses correctly identified Anaesthesiologists roles outside the theatre.
A picture no different in many other countries
Hariharan S. Knowledge and Attitudes of Patients Towards Anesthesia and Anesthesiologists. A Review. Anestesia en México 2009; 21(3):174-178
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Roles of the Physician Anaesthetist
• The role of the Anaesthesiologist has transcended the barriers of the traditional operating theatre suites.
• Anaesthesiologists play very crucial roles in: Perioperative care
Ambulatory surgery
Blood conservation
Resuscitation teams
Critical care units
Emergency and trauma centres
Pain clinics
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Perioperative care
Anesthesiologists care for the surgical patient in the perioperative period
This involves:
Preoperative evaluation
Optimization of comorbidity
Formulation and execution of an anesthesia plan
Intraoperative anesthetic management
Post operative care
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• Provision of anaesthesia for all surgical sub-specialties
• Anaesthesia has been made safer by advances in science and technology
• New technology in airway devices, invasive monitoring and echocardiography has caused dramatic improvements in Neuroanaesthesia
Cardiothoracic anaesthesia
Maxillofacial anaesthesia
Complex spine surgery
Radical neck dissection
Liver surgery (including resection)
Plastic and reconstructive surgery.
Urman RD, Desai SP. History of anesthesia for ambulatory surgery. Current Opinion in Anaesthesiology;25(6) : 641–647
Perioperative care
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The Korle Bu story
0
10
20
30
40
50
60
70
2010 2013 2015
No. of Cases (x1000)
No. ofAnaesthesiologists
Number of Anaesthesiologists Vrs surgical cases done annually
Audit of M&M reports of Department of Anaesthesia KBTH
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Increased complexity of cases Radical neck dissection
Radical prostatectomy
Radical cystectomy
Brachytherapy for CAP
Liver resections
Whipple’s procedure
Spine fusion with instrumentation
Video Assisted Thoracoscopy (VATS)
Functional Endoscopic Sinus Surgery (FESS)
The Korle Bu story
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Ambulatory surgery
Day case surgery
Need for rapid recovery, requires experienced Anaesthesiologist
Patient selection of utmost importance
Cases include:
Paediatric / adult ambulatory surgical procedures
Imaging / interventional radiologic procedures
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Blood conservation
Perennial shortage of blood and blood products results in
Case cancellation Morbidity / mortality Increased length of hospital stay Increased cost
JW / Saviour church cases being done Open heart surgeries Craniotomies for brain tumours Phaeochromocytoma Major hip/knee arthroplasty Major gynaecological surgeries Caesarean section for major previa
National Blood Transfusion Service (NBTS), in its 2012 service data compilation
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Resuscitation
Vital members of Resuscitation teams
Adept with ACLS
Best chance of survival is arresting in the presence of an Anaesthesiologist
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Management of the critically ill Anaesthesiologists manage the
ICU
Monitoring of the critically ill
Airway maintenance
Support and management of major organ systems Respiratory Cardiovascular Renal Neurological
The GCPS Faculty of Anaesthesia is planning to introduce sub-specialty training in critical care medicine
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Transport of the critically ill
• Knowledge and required skills for managing critically ill
• Most suited to accompany such patients during transport
• Intra-facility for procedures
and investigations
• Inter-facility / international transport
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Specialty Number of cases
Neurosurgery 1320
General surgery 52
Orthopaedics & Trauma 61
Medical 45
Child Health 36
Plastics 22
Obst &Gynae 27
Others 36
Total 1599
Mortality 118
Audit of admissions and outcomes at KBTH ICU, 2011- 2013
1320 neurosurgeries were made possible
161 out of 279 (57.7%) of patients who without an ICU would have died were saved
The Korle Bu story
ICU Admissions: 2011-2013
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Pain management
Acute pain Post surgical Sickle cell crisis Labour analgesia Chronic pain Epidural steroid injection Nerve and plexus blocks KATH has a pain clinic KBTH yet to start
The GCPS Faculty of Anaesthesia is planning to introduce sub-specialty training in pain
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Conclusion A healthcare delivery service
which focuses on primary health without specialist services would be rudimentary.
With the springing up of several well equipped high level of care facilities the services of physician anaesthetists would be invaluable
The knowledge, skills
and versatility of the physician anaesthetist makes them able to play vital roles not only within but also outside the traditional operating theatres
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Conclusion The physician anaesthetist are involved in more ways
than one in reducing Morbidity
Mortality
Cost to the patient, facility and the nation as a whole
The role of the physician anaesthetist or anaesthesiologist facilitates and compliments those of various other specialties and is thus pivotal to holistic delivery of quality health care in Ghana.
A roadmap to ensure that the recent successes with respect to the growth of the Anaesthesia Specialty in Ghana is imperative to consolidated and further extend the to gains to maximise the benefits thereof to the national economy .
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Thank you
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References
• Robinson DH, Toledo AH.Historical development of modern anesthesia. J Invest Surg. 2012;25(3):141-9.
• Hariharan S. Knowledge and Attitudes of Patients Towards Anesthesia and Anesthesiologists. A Review. Anestesia en México 2009; 21(3):174-178.
• Urman RD, Desai SP. History of anesthesia for ambulatory surgery. Current Opinion in Anaesthesiology;25(6) : 641–647.
• Audit of M&M reports of Department of Anaesthesia KBTH (Unpublished)
• National Blood Transfusion Service (NBTS), in its 2012 service data compilation
• Audit of admissions and outcomes at KBTH ICU, 2011- 2013
• Amponsah G. History of anaesthesia in ghana (1): human resource development In anaesthesia. Post-graduate medical journal of Ghana;2(2):112-5.
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Conclusion • Physician Anaesthetists play a pivotal role in the holistic delivery of
quality healthcare.
• It is imperative that there should be a roadmap to ensure that the recent successes with respect to the growth of the Physician Anaesthesia Specialty is consolidated and further extended to formal sub-specialisation.
• This would maximise the benefit that such sub-specialisation would have on healthcare delivery in Ghana.