Anesthesiology

from Wikipedia, the free encyclopedia
Surgeons and anesthetists in Dresden (1956)
Training on the anesthesia simulator

The Anesthesiology , formerly Anesthesiology (to anesthesia and ancient Greek ἀναισθησία , insensibility ') as a medical specialty includes anesthesia ( general , regional , and local anesthesia ) including the maintenance of vital functions during surgical and diagnostic procedures as well as the intensive care medicine , the Emergency Medicine and pain . Palliative medicine has now been added as the “fifth pillar” . Due to its areas of activity, anesthesiology is characterized by a high degree of interdisciplinarity .

According to a definition by the American Board of Anesthesiology from the 1980s, anesthesiology includes , among other things:

  • bringing about freedom from pain during surgical, obstetric , therapeutic and diagnostic operations and caring for the patients affected by them,
  • the monitoring and the maintenance of homeostasis in the perioperative period as well as in critically ill, injured or otherwise seriously ill patients,
  • the diagnosis and treatment of painful syndromes ,
  • clinical management and training in cardiopulmonary resuscitation ,
  • assessing respiratory function and using ventilation therapy in all its forms,
  • the professional supervision and training of staff involved in anesthesia, ventilation and treatment of the critically ill,
  • basic research and clinical research to gain knowledge and improve patient well-being in relation to physiological functions and reactions to medication as well
  • administrative involvement in hospitals, medical training centers and outpatient facilities insofar as these are necessary for the implementation of these tasks.

The corresponding job title is anaesthesiologist , the specialist title is specialist in anesthesiology or anesthetist . The specialist works together with specialist nurses for intensive care and anesthesia or anesthesia technical assistants . “Anesthesia” is the service of an anesthetist; as a technical term, the term is incorrect jargon .

Areas of activity

In addition to the core areas of anesthesia and intensive care medicine, the specialist field of anesthesiology and intensive care medicine essentially includes emergency medicine, acute and chronic pain therapy and palliative medicine:

  • Anesthesia with preparation and implementation of general and regional anesthesia procedures , as well as immediate postoperative monitoring in the recovery room , so-called perioperative management. During surgical interventions, modern anesthesia is not only about "eliminating" pain and stress, but also about seamless monitoring of all body functions. Breathing, circulation, depth of anesthesia and often the degree of muscle relaxation are continuously measured and controlled by the anesthetist according to the requirements of the surgical phase.
  • Intensive Care on intensive therapy stations is used for intensive care and treatment of patients whose vital or organ functions are impaired in life-threatening manner or at risk and must be supported by intensive therapeutic methods or maintained. In intensive care medicine, seriously ill patients are treated medically by specialists in anesthesia and intensive care medicine in the context of life-threatening infections, after accidents, major surgical interventions and in the event of failure of vital organs for other causes.
  • Emergency medicine for recognizing threatening or occurring emergency situations , treating emergencies and restoring and maintaining acutely threatened vital functions . The broad spectrum of emergencies to be treated requires extensive knowledge of internal medicine , neurology , traumatological first aid, but also competence in completing child or obstetric assignments.
  • Pain therapy for chronic and acute pain (e.g. postoperatively). Acute pain, for example after injury or surgery, has a protective and alarm function for the human organism. Chronic pain has lost this protective function and can be associated with serious dysfunction of the body. Both acute and chronic pain must be treated adequately. In both cases, drug therapy, physiotherapy and psychological procedures (e.g. relaxation techniques, pain management strategies and psychotherapy ) as well as peripheral and central nerve blocks can help. Complementary medical methods can also be useful and applied.
  • As a result of the increasing aging of society, palliative medical alleviation of ailments is becoming increasingly important alongside curative medicine and complements classic pain therapy.
  • Working on the scientific environment of the subject

Specialist training

Further education in Germany

In Germany, anesthetists are specialists (specialist in anesthesiology and intensive care medicine, the exact name varies between the federal states). The first specialist in anesthesia in Germany was Werner Sauerwein from the Saarbrücken Bürgerhospital . He received his certification as a specialist on May 27, 1953. After a license has been granted , further training as a specialist is possible in one of the further training facilities approved by the state medical associations and lasts five years. It includes the processing of a catalog of 1,800 anesthetic procedures and a full-time employment of one year in an intensive care unit. Various additional training courses can be acquired in parallel to or following specialist training (e.g. additional qualifications in special intensive care medicine, emergency medicine and pain therapy). The Professional Association of German Anesthesiologists (BDA) and the German Society for Anesthesiology and Intensive Care Medicine (DGAI) provide information on specialist and additional training courses as well as an overview of training facilities . With the “Mein Pulsschlag” campaign for young professionals, they are specifically targeting young doctors who are interested in a career in anesthesiology.

Further education in Austria

The training lasts six years, whereby it is necessary to complete six months of internal medicine , six months of surgery and one year of intensive medicine within this period . It must be completed with the practical and theoretical specialist examination. The professional title is specialist in anesthesiology and intensive care medicine . The ÖGARI provides information for young anesthesiologists who are facing their board examination.

Further education in Switzerland

In Switzerland, training to become an anesthetist takes five years, divided into four to four and a half years of subject-specific and six to twelve months of non-subject-specific training (intensive care medicine). A two-day course in emergency medicine is also required. The further training is concluded with an examination, which includes an oral and a written part (written examination of the European Society of Anaesthesiology ). A Swiss or recognized foreign doctor's diploma is required to take the exam . The title of specialist in anesthesiology is awarded upon successful completion of further training and exams .

Further education in the USA

The further training consists of a total of four years, of which one year must be completed in a different subject. After further training you are board eligible and after passing the written and oral examination you can call yourself board certified according to the American Board of Anesthesiology (ABA) or the American Osteopathic Board of Anesthesiology (AOBA). Since 1999 the certificates are only valid for ten years. Afterwards, in one year of fellowship, a subspecialty certification in pain medicine, pediatric anesthesiology, cardiovascular anesthesiology and critical care medicine can be acquired.

Further education in other countries

In England, continuing education is supervised by the Royal College of Anesthetists. The training lasts at least seven years. In Australia and New Zealand, continuing education is overseen by the Australian and New Zealand College of Anesthetists.

A comprehensive European (and thus supranational) qualification can be proven with the examination of the European Society of Anaesthesiology, the abbreviation of which can be used in almost all countries after the name ( DESA = Diploma of the European Society of Anaesthesiology , formerly DEAA = Diploma of the European Academy of Anaesthesiology ). This diploma, awarded by a private association, is not recognized by the German state medical associations as a specialist qualification.

history

Anesthetist, pictured on the right (1922)

Anesthesiology has its roots in anesthesia, which is why the development of anesthesia is described in excerpts below.

On March 30, 1842, the first ethereal anesthesia was applied by Crawford Williamson Long . A few years later, on October 16, 1846, the first successful public ether anesthesia was performed by the dentist William Thomas Green Morton in Boston, who after his success devoted himself entirely to anesthesiology. Hermann Askan Demme performed the first ether anesthesia in German-speaking countries on January 23, 1847 in Bern.

In Germany, the first successful ether anesthesia was applied on January 24, 1847 by Heinrich Eduard Weikert and Carl Friedrich Eduard Obenaus in Leipzig . On the same day, Johann Ferdinand Heyfelder in Erlangen also made use of this new medical technology, but did not achieve sufficient anesthesia.

From 1847 the doctor John Snow worked exclusively as an anesthetist in London hospitals. Further specialists for anesthesia and thus pioneers of anesthesiology were there in England since the 19th century (the Society of Anesthetists was founded there in 1893). One of the first anesthesia specialists in Germany was Ernst von der Porten from Hamburg.

Carrying out anesthesia from 1846 was initially (and in some cases remained until after 1970) primarily the task of surgeons and specially trained nurses. Surgical pioneers of anesthesia in Germany included Arthur Läwen (1910) and Albert Lezius (1950). After the importance of anesthesia increased sharply after the war, the German Society for Anesthesiology and Intensive Care Medicine (DGAI) was founded on April 10, 1953 . Only a few weeks later, on May 27, 1953, the first specialist in anesthesia completed his training.

The anesthesiological activities performed during anesthesia or after an operation under anesthesia include, among other things, the administration of blood and blood products that may be necessary to maintain the body's functions. Since 1914, for the first time by the Belgian Albert Hustin (1882–1967), blood made incoagulable by citrate ( citrated blood ) has been used for blood transfusion . In the case of postoperative intensive medical treatment, dialysis treatment may also be necessary, which is also indicated and, if necessary, carried out in the context of the anesthesiological professional field.

One of the first journals for anesthesiology appeared with Current Researches in Anesthesia and Analgesia from 1922 in the USA. In 1928 the first German-language specialist journal for anesthesia was published, The Pain, and in the same year Anesthesia and Anesthesia . The two journals were merged in 1929 on pain, anesthesia and anesthesia , the first German-language anesthesiological organ. In France appeared Anesthésie et analgesia for the first time in 1935. In 1940, the first edition of was published in the United States Anesthesiology and in England in 1945 Anesthesia . The journal Der Anaesthesist , published in Germany, Austria and Switzerland, has been published since 1952.

A step on the way to modern intensive care and intensive medicine as pillars of anesthesiology was the first treatment center for poisoning at the Bispebjerg Hospital in Copenhagen in 1949 . Intensive care and emergency medicine, which is also used by anesthetists during and after surgical interventions, includes maintaining the patient's circulation and regulating the blood pressure. Artificial or controlled lowering of blood pressure, such as controlled hypotension during neurosurgical operations, was carried out in 1950 by Hale Enderby in England with hexamethonium , in 1951 by the Swiss F. Gross and HJ Bein with the ganglion blocker azumethonium ( pendiomid ) and by Stanley J. Sarnoff in the USA with trimethaphane ( Arfonad ). Also in 1951, P. Huguenard and H. Laborit in France published their concept of artificial hibernation (bringing about an "artificial hibernation" to suppress the body's reactions with drugs and reduce the oxygen demand of intensive care patients). The first intensive care unit designed as a ventilation station was set up in Denmark in 1952 for artificial ventilation of patients suffering from a poliomyelitis epidemic.

The first chair and the first institute for anesthesiology in the German-speaking area was established in 1959 in Innsbruck by Bruno Haid. In 1960, an associate chair for anesthesiology was established with Rudolf Frey at the University of Mainz . Six years later, Karl Horatz received the first German professorship in the subject at the University Medical Center Hamburg-Eppendorf . With Peter Lawin he initiated intensive care medicine in Germany. After the Second World War, Otto Mayrhofer-Krammel in Austria and Werner Hügin in Switzerland were among the pioneers of the field.

The practice-oriented anesthesia textbooks that are widely used in the German-speaking world include the 1974 Compendium of Anesthesiology by Johannes Eichler (1920–1998) and the Anesthesiology Clinic Guide published by M. Reinhard and R. Schäfer in 1993 .

The first world congress for anesthesiology took place in 1955 in Scheveningen, the Netherlands, where the World Federation of Anesthesia Societies (WFSA) was founded, the second in 1960 in Toronto in Canada, the third in 1964 in São Paulo and the fourth in 1968 in London. The 1st European Congress of Anaesthesiology was held in Vienna in 1962, the second in Copenhagen in 1966 and the third in Prague in 1970. World Anesthesia Day has been taking place in Germany every October since 2012. Doctors and clinics provide information on specific topics in the field with campaigns and events around this day. The main topics of World Anesthesia Day 2015 were the two pillars of “ anesthesia ” and “ emergency medicine ”.

In 1967 the World Federation of Societies of Anesthesiologists (WFSA) opened the first international anesthesia training center in Caracas / Venezuela.

One of the pillars of anesthesiology is emergency medicine and, in particular, the use of cardiopulmonary resuscitation procedures . The external heart massage as a method of resuscitation was in 1960 by electrical engineer William B. Kouwenhoven developed with the medical James R. Jew and GG Knickerbocker in the US.

Anesthesiologists are also strongly represented at the “Week of Resuscitation”, which has been part of the “Save a life. 100 Pro Reanimation ”takes place every year in September with the support of the Federal Ministry of Health . The aim of this campaign and the action week is to increase the lay resuscitation rate in Germany .

See also: History of Dental Anesthesia

museum

On the grounds of the Bonn University Clinics , one of the few museums on this subject was opened in 2000 on 300 m².

literature

  • G. Benad, M. Schädlich: Outline of anesthesiology . VEB Verlag Volk und Gesundheit Berlin, 1989, ISBN 3-333-00063-6 .
  • Rudolf Frey , Otto Mayrhofer , with the support of Thomas E. Keys and John S. Lundy: Important dates from the history of anesthesia. In: R. Frey, Werner Hügin , O. Mayrhofer (Ed.): Textbook of anesthesiology and resuscitation. Springer, Heidelberg / Basel / Vienna 1955; 2nd, revised and expanded edition. With the collaboration of H. Benzer. Springer-Verlag, Berlin / Heidelberg / New York 1971. ISBN 3-540-05196-1 , pp. 13-16.
  • Michael Heck, Michael Fresenius: Anesthesiology revision course. Preparation for the anesthesiological specialist examination and the European diploma in anesthesiology. 3rd, completely revised edition. Springer, Berlin / Heidelberg / New York et al. 2001, ISBN 3-540-67331-8 .
  • Christoph Weißer: Anaesthesiology. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. De Gruyter, Berlin 2005, ISBN 3-11-015714-4 , p. 55.

Web links

Commons : Anaesthesiology  - collection of images, videos and audio files
Wiktionary: Anesthesiology  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Analogous definition of the German Medical Association in the (model) advanced training regulations of May 2003 in the version of March 28, 2008 ( Memento of September 18, 2010 in the Internet Archive )
  2. ^ Richard J. Kitz, Leroy D. Vandam: A History and the Scope of Anesthetic Practice. In: Ronald D. Miller (Ed.): Anesthesia. 3 volumes, Churchill Livingstone, New York / Edinburgh / London / Melbourne 1981, 2nd edition ibid. 1986, ISBN 0-443-08328-2 , Volume 1, pp. 3–25, here: pp. 15 f.
  3. ^ ÖGARI - Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine. (No longer available online.) In: www.oegari.at. Archived from the original on July 8, 2016 ; Retrieved July 8, 2016 .
  4. ↑ Schüttler, 50 Years of the German Society for Anaesthesiology and Intensive Care Medicine, p. 87
  5. ↑ Professional Association of German Anesthetists V. . Retrieved February 19, 2015.
  6. ↑ German Society for Anaesthesiology and Intensive Care Medicine V. . Retrieved February 19, 2015.
  7. ↑ Information page of the BDA on the youth campaign "Mein Pulsschlag" . Retrieved February 19, 2015.
  8. ^ ÖGARI - Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine. In: www.oegari.at. Retrieved July 8, 2016 .
  9. ↑ Swiss Institute for Medical Further Education SIWF : Further education program specialist in anesthesiology from January 1, 2013 ( Memento from May 18, 2015 in the Internet Archive ). Retrieved May 7, 2015.
  10. ↑ Further training regulations (WBO). (PDF; 143 KB) June 21, 2000 (last revision: September 28, 2017). In: fmh.ch. SIWF, accessed on September 2, 2018 .
  11. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 14.
  12. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 15.
  13. ^ Jörg Vienken : Calcium and Citrate. Control variables for blood coagulation in dialysis . In: Spectrum of Dialysis. June 30, 2017.
  14. ↑ Carl Joseph Gauß , Hermann Wieland, Ernst von der Porten, B. Behrens (editor): The pain. German journal for anesthesia and anesthesia. At the same time the central organ for anesthesia and anesthesia. Volume 1. Wilh. Kurt Kabitzsch Univ.-Verlagbuchhandlung, Würzburg 1928.
  15. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 15.
  16. ^ Roche Lexicon Medicine: Artificial Hibernation .
  17. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 15.
  18. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 15.
  19. ^ Meinolfus Strätling, A. Schneeweiß, Peter Schmucker: Medical University of Lübeck: Clinic for Anesthesiology. In: Jürgen Schüttler (Ed.): 50 Years of the German Society for Anaesthesiology and Intensive Care Medicine: Tradition and Innovation. Springer, Berlin / Heidelberg / New York 2003, ISBN 3-540-00057-7 , pp. 479-486, here: pp. 481 and 484.
  20. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 15 f.
  21. ↑ Further information on World Anesthesia Day: Service pages from BDA and DGAI . Retrieved February 19, 2015.
  22. ↑ Further information on the subject of anesthesia: information page of the BDA . Retrieved February 19, 2015.
  23. ^ WFSA: website .
  24. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 16.
  25. ^ Rudolf Frey, Otto Mayrhofer: Important dates from the history of anesthesia. 1971, p. 16.
  26. ↑ Website for the campaign by the Federal Ministry of Health: “Save a life. 100 per resuscitation " . Retrieved February 19, 2015.
  27. ↑ Eckart Roloff and Karin Henke-Wendt: Against pain and for saving lives. (Horst Stoeckel Museum for the History of Anesthesiology) In: Visit your doctor or pharmacist. A tour through Germany's museums for medicine and pharmacy. Volume 1, Northern Germany. Verlag S. Hirzel, Stuttgart 2015, pp. 114–116, ISBN 978-3-7776-2510-2 .
  28. ↑ What is and why an anesthesia museum? In: anaesthesia-museum.uni-bonn.de. Retrieved August 2, 2018 .