Department of Anesthesiology

Comprehensive discipline

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anaesthesia Discipline is a comprehensive discipline, which contains multidisciplinary knowledge. The scope is very wide, not only to meet the requirements of surgery, but also to participate in the rescue work of various departments, gynaecological painless delivery, Painless abortion wait.

Chinese name: Department of Anesthesiology

Type: Comprehensive discipline
Application: Painless delivery in gynecology, Painless abortion

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Does it belong to the medical technology department

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Department of Anesthesiology

More than once, I saw some hospitals posting recruitment Anesthesiologist Medical information, plus generous treatment for highly educated anesthesiologists. At the same time, anesthesiologists are included in the recruitment category Medical Technology Department 。 Slightly Insights % of anesthesiologists will ask such a question. Since the treatment is so generous, why do you know nothing about the basic position of the anesthesia department, and how can you talk about advocating talents?

Of course, it should be recognized that modern anesthesia has a short history in China, and has just begun anesthesiology Undergraduate education It was only in the 1980s. However, the cause of anesthesia in China has developed rapidly, and the work of anesthesiologists has gradually been recognized. In 1989, China Ministry of Health Documents were issued to clarify that the anesthesia department belongs to the secondary discipline and clinical First level discipline (Document No. 12). But our hospital managers know nothing about it. Are they really unable to distinguish between clinical departments and medical technology departments? The anesthesiologist conducts the operation inside and outside the operating room Tracheal intubation , solve the patient Hypoventilation And hypoxia; Participation in the treatment of hypotension Shock treatment ； Implement various nerve blocks to solve pain problems; Treatment during operation Arrhythmia And various critical diseases, participate in severe surveillance and recovery. They focus on maintaining the safety of patients' surgery, and their scope of anesthesia work has gone far beyond relieving the pain of patients' surgery alone. Is this series of work they are engaged in just a medical skill?

Anesthesiologist

At present, even in many countries Grade III Grade A Hospital There are still many units that list the anesthesia department as a medical technology department. It has to be said that there is job discrimination in the medical industry Grass roots hospitals This is even more true. For a long time, in the eyes of some medical staff and even hospital managers, anesthesiologists are simply engaged in various operations, which is no big deal. Therefore, under the control of this concept, they believe that; The anesthesiologist should honestly make profits for the hospital, cooperate well with the operation and make no major mistakes. As a result, the anesthesia department is listed as a tool for hospitals to make money, and the construction of academic research in the department of anesthesia is not paid attention to at all. Anesthesiologists are engaged in high-risk I didn't enjoy my clinical work clinician I remember what happened in China in 2003 atypical pneumonia , many anesthesiologists went to Fight against SARS The first line of the war made great contributions to the victory of the war without gunsmoke, some even sacrificed their lives. They hold the licensed doctors who have been acquired through hard study qualification However, they were placed in the position of medical technology work for no reason, and thus suffered unfair treatment. Therefore, it is necessary to change the ideas of people, especially hospital managers, and eliminate discrimination against the work of anesthesiologists as soon as possible. Only in this way can we mobilize their enthusiasm, so that they can give full play to their intelligence economic performance Double harvest creates favorable conditions.

Scope of work of anesthesiologist

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Anesthesiologist

Ensure that the patient can accept it smoothly under painless and safe conditions surgical treatment , is the basic task of anesthesia clinic, but it is only part of modern anesthesia discipline job content 。 Anesthesia work also includes preparation and treatment before and after anesthesia, monitoring and treatment of critical patients, emergency resuscitation, pain treatment and other work. Scope of work From operating room to ward, outpatient, emergency room and other places, from clinical medicine to teaching scientific research 。 With the increasing scope of work, Task Increasingly heavy. 1. Clinical anesthesia work

In order to do a good job in clinical anesthesia, anesthesia must be mastered Basic theory And skilled application of various anesthesia techniques, but also familiar with the characteristics of various surgical conditions. In each case of anesthesia, the following specific work must be carried out.

a、 Preparation before anesthesia work

It is mainly to understand the condition, make a correct estimate, determine the anesthesia plan based on the condition, and select the most appropriate anesthesia method and drug. Sufficient estimate During anesthesia operation Possible In order to prevent problems before they occur, make full preparations and preventive measure And formulate solutions for possible problems.

b、 Work during anesthesia

Anesthesia shall be carried out according to the anesthesia operation procedures to obtain the best anesthesia effect, so as to make the patient feel painless, quiet, memory free Adverse reactions Complete the operation. At the same time, create good conditions for the operation, and try to meet the special requirements of some operations (such as Muscle relaxation , low temperature hypotension Etc.). Do a good job Surgical anesthesia Process monitoring, including circulation, respiration Water electrolyte , body temperature and other functions continuous monitoring , and write Anesthesia records 。 Make effective treatment according to the change of anesthesia process, such as maintenance Hemodynamics The stability and progress of Respiratory management Etc.

c、 Work after anesthesia

Send the patient back to the ward after anesthesia (or anesthesia Recovery room ）, make shift handover. According to different conditions and operations, do a good job in various post anesthesia treatments, including continuous monitoring of patients to prevent complication To deal with the accident in time, assist the clinical department to treat the complications and make the patient recover as soon as possible. Keep records of follow-up and summary after anesthesia.

2. Anesthesia recovery room and strengthened monitoring Treatment Room work

With the increase of complex anesthesia and surgery for critical and difficult patients, the end of surgery does not mean that Anesthetic effect The disappearance and main physiological function In addition, the disorder of circulation, respiration, metabolism and other functions that had occurred during the operation anesthesia could not be completely corrected, so there was still a risk of complications after anesthesia. Due to the development of anesthesia, monitoring technology After anesthesia surgery, patients still need to go through Professional training The doctors and nurses of the hospital carefully treated and nursed the patients to recover as soon as possible. about general anesthesia The patient should be fully conscious Nerve block anesthesia Patient part Sensorimotor The function should be completely restored to normal, and the patient's important physiological functions such as circulation, respiration, liver and kidney should be restored to normal and stable state 。 Patients with anesthesia complications should be actively treated. Therefore, the anesthesia recovery room and the strengthened monitoring and treatment room are playing an increasingly important role in the recovery of anesthesia patients, the monitoring of critical patients, the prevention and treatment of anesthesia complications, and are important components of modern anesthesia departments. Its establishment and perfection is one of the important signs to measure the advancement of modern hospitals.

3. First aid resuscitation

Department of Anesthesiology

Anesthesiologists make full use of their professional knowledge and skills, including Applied Physiology 、 Pathophysiology and Clinical pharmacology Of Theoretical knowledge , endotracheal intubation, artificial ventilation methods, various measures to maintain circulatory function and restore cardiac activity, protection central nervous system Functional Cryotherapy , as well as monitoring technology and medication And other aspects of experience play an important role in emergency resuscitation. Therefore, first aid and resuscitation have become modern Anesthesiology It is also one of the important tasks of anesthesia specialty.

4. Pain treatment

For various diseases and trauma Causative urgency Chronic pain The use of analgesic drugs and nerve block and other techniques mastered by the anesthesia specialty to set up pain treatment clinics or wards can achieve good results. At the same time, it can also diagnose and treat some Terminal blood vessel Obstacle dominated vascular disease And nerve paralysis or spastic disease, etc Postoperative analgesia , painless delivery and late stage Cancerous pain It has also achieved good results and has been gradually applied in clinical anesthesia.

Role in modern medicine

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Most people believe that anesthesiologists are doctors who relieve pain and make patients unconscious through drug treatment. However, few people realize that the tasks of anesthesiologists in the operating room are more important than ensuring the comfort of patients during surgery and anesthesia convalescence Monitor and diagnose changes in vital functions caused by various factors (anesthesia, surgery, primary diseases, etc.), and treat them accordingly to ensure Perioperative period Patient safety.

Anesthesiologists need extensive knowledge to be competent for this job, and they need to have pathophysiology, pharmacology, internal medicine Surgery , women and children, anesthesia, etc clinical medicine Multidisciplinary knowledge. As an anesthesiologist, it is important to relieve patients' pain and manage patients Vital signs , including respiration, heart rate, blood pressure, heart nervous system , liver and kidney function, etc.

The anesthesiologist treats the medical problems of patients in the perioperative period (during the operation, before the operation and after the operation). The anesthesiologist judges the patient's condition before operation, and considers individual difference According to this, a treatment plan was formulated, and advanced instruments were used to monitor the patient's life function during the operation. Anesthesiologists must rely on various complex and precise instruments to make accurate diagnosis of the disease and maintain the life of patients, some of which are already very fragile.

At the end of the operation, the patient will be sent to the recovery room or intensive care （ ICU ）The patient shall be sent back to the ward after recovering from anesthesia. In addition to the operating room, the scope of work of the anesthesiologist includes intensive care, pain treatment, etc.

What is the job of an anesthesiologist?

Anesthesiologists are also called Physician Not only are you proficient in various anesthesia techniques to ensure the patient's painless operation and smooth operation, but also you can use advanced instruments to monitor the patient's life function at any time. If you find that there are problems threatening the patient's life due to surgery, anesthesia or the patient's original disease, you can take various Treatment measures To maintain the stability of the patient's life function and ensure the patient's safety.

Generally speaking, the clinical anesthesiologist is responsible for: 1 Joint decision Whether the patient can withstand surgical anesthesia; 2. Decide which anesthesia and monitoring measures to adopt; 3. Anesthesia for patients; 4. Try to ensure the safety of patients throughout the operation; 5. After the operation Patient safety Recover smoothly; 6. Postoperative pain treatment; 7. Treatment of chronic pain.

What is the anesthesiologist doing during the operation? Anesthesiologists work like pilot Work. Aircraft takeoff and landing are equivalent to Anesthesia induction And recovery, used in flight Autopilot Is equivalent to narcotic , muscle relaxants and mechanical respiration. During the operation, the anesthesiologist must continuously observe the patient, and the information obtained through eyes, ears, and hands must be constantly entered central nervous system After analyzing and thinking over the monitoring data to form some detailed and complex judgment results, drug (including anesthetic, muscle relaxant, liquid and hemostatics Make some adjustments to maintain the physiological function of the patient as stable as possible, and implement emergency resuscitation in case of emergency.

Hand: A finger placed at the pulse beat is equivalent to several monitors. It can provide Pulse rate And whether there is arrhythmia. Helps maintain contact between anesthesiologists and patients. The feeling of the patient's skin is important: dry and warm skin indicates good clinical condition; Cold and damp skin indicates shock during operation. By compression or Massage skin , Note blood capillary The refilling time can be used to know whether the tissue perfusion is appropriate.

Eyes: The following observations can be made.

(1) Skin: Cyanosis Or pink indicates improper breathing or other reasons; Paleness and sweating suggest bleeding or shock.

(2) Head and neck: eye movement indicates shallow anesthesia; Pupil dilation (with atropine Although it was expanded later, it suggested that deep anesthesia Ganglion blockers Role of, acute hypoxia and/or respiration Circulatory failure 。

(3) Chest: Chest movement indicates that air enters the lungs. Is bilateral expansion symmetrical? If the patient is Spontaneous respiration , Respiratory rhythm The change of respiratory depth is accompanied by the change of respiratory depth. Tracheal traction indication Muscle relaxant The role of "has not completely disappeared; Lower thorax intercostal muscle Retract, prompt Airway obstruction 。

(4) Abdomen: at Laparotomy Middle, observe the operation to determine whether muscle relaxation is appropriate? Is the patient nervous? Is there a lot of bleeding? Suction bottle How much blood is in it? What is the degree of peritoneal contamination? (This is related to postoperative shock)

(5) Apparatus: rotor Current meter Is proper airflow indicated? Measuring cylinder Is the capacity of? Is the vaporizer properly installed? Is there any anesthetic in the vaporizer? breathing Valve Need adjustment? Is the breathing bag properly inflated? If used Soda lime What color is soda lime? Is soda lime invalid? inspect respirator Devices: inflation pressure, inflation rate, whether there is negative pressure. Can the ventilator expand the chest? Is the connection appropriate? Is the air flow rate appropriate? Check the quantity and speed of intravenous infusion; In case of blood transfusion, check the blood bottle number and the patient's number to ensure that the blood transfusion is correct for the patient.

(6) Physiological monitoring: measure pulse and blood pressure, and record every 5 minutes; If you use a heart monitor, you can also take the readings on the monitor or the flashing values on the pulse monitor. During the whole operation, the blood loss must be recorded.

(7) Is the operation performed as planned or changed? surgeon What unexpected difficulties did you encounter? Did you lose a lot of blood? If using tourniquet Is the pressure appropriate?

Ear: During the operation, anesthesiologists almost unconsciously listen to the voice of exhaling valve gas with their ears, and even small changes can be heard quickly; Ventilator noise and Rhythmic occurrence Changes can also be detected immediately. Even when talking, the pilot of the aircraft can also notice the change of the pitch and rhythm of the engine skillfully and quickly. Frequently used in anesthesia Stethoscope ， Precordial region It is necessary to place a stethoscope to monitor the breathing and heart rate of children. It can also be used to measure blood pressure and record it. Spontaneous respiration The nature of can provide information, Laryngospasm Suggest light anesthesia; Stopping breathing after exhalation indicates shallow anesthesia, while stopping breathing after inspiration indicates deep anesthesia, with abdominal muscles slack. The heart pulse monitor can send Audio signal However, this monitor can be interfered by temperature or other electronic instruments. If someone trips the wire or lead, the signal can be interrupted suddenly.

The ear must also be able to tolerate noise and irrelevant conversation. These noises can distract attention and cause excitement. The anesthesiologist has the right to ask for silence and even ask the staff to stop their activities. Some surgeons like whistling. When anesthesia induction is carried out in the anesthesia room, whistling is never allowed.

It should be a rule to keep quiet in the anesthesia room, and conversation is strictly prohibited. At a certain stage of anesthesia induction, patients can even hear whispers. During the operation, the surgeon is allowed to speak to the anesthesiologist. When the surgeon is performing a delicate operation, the anesthesiologist should be careful not to talk to avoid disturbing him. However, during the lengthy operation, a few words or even jokes can relax people's spirit and temporarily relieve their persistent concentration.

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