Anesthesiology: An Introduction For Medical Students

James Lamberg

What Do You Know?

Where Do Anesthesiologists Work? Who Do They Care For? What Do They Do? Common Misconceptions:
Just Push The White Stuff (propofol) A Very Narrow Sub-Specialty Just Put People To Sleep Too Competitive Boring
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Common Stereotype

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So What Do They Do?

Work In Every Area Of Medicine
OR, PACU, ICU, OB, Peds, Pain Clinic

Work With The Most Diverse Patient Population

Premature Infants To Geriatrics

Provide Medical Care & Critical Care

Prior To, During, And After Surgical Procedures

Work With Advanced Technology

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You Might Like Anesthesia If

You Enjoy Performing Procedures You Are Interested In Critical Care You Had Prior Experience (e.g. EMT) You Enjoyed:
Pharm, Physio, Cardiology, Pulmonology

You Like All Areas Of Medicine

You Can Specialize Though

You Like To See Immediate Results

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Ether Day October 16th, 1846

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Brief History
Pre-1800: Surgery Without Anesthesia 1846: First Ether Anesthetic 1884: Cocaine For Local Anesthesia 1921: Epidural Anesthesia Described 1942: Curare Clinical Trial Success 1960: Short Acting Opioids 1982: Transesophageal Echo 1983: Laryngeal Mask Airway
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Anesthesiology: An Introduction For Medical Students

In The Operating Room

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In The Operating Room

Pre-Anesthesia
History & Physical Exam Positioning & Patient Setup

Induction
Put Patient To Sleep Manage Airway Create Best Operating Conditions For The Surgery Team

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In The Operating Room

Maintenance
Anesthesia Machine Inhaled Anesthetics

Emergence
Safe Awakening Transfer To PACU

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In The Post-Anesthesia Care Unit

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In The Post-Anesthesia Care Unit

Reduce The Risk Of Post-Operative Complications (e.g. Stroke, MI) Reduce The Risk Of Post-Operative Nausea & Vomiting Reduce Post-Surgical Pain Safely Discharge Patients Home Or To Other Parts Of The Hospital

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In The Intensive Care Unit

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In The Intensive Care Unit

Founded Critical Care Medicine Overlapping Skills:
Airway Management Ventilator Management Analgesia & Sedation Management Of:
Respiratory Emergencies Cardiac Emergencies Common Critical Care Issues (e.g. sepsis)

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In The Pain Management Clinic

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In The Pain Management Clinic

Diagnosis Of Pain Treatment Of Pain
Pharmacologic Procedural
Injections Pumps Stimulators

Non-Pharmacologic
Biofeedback OMT
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Obstetric Anesthesia

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Obstetric Anesthesia
Risks To Mother & Fetus
Pharmacology Physiology

Pain Management Awake C-Sections Obstetric Emergencies

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Cardiothoracic Anesthesia

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Cardiothoracic Anesthesia
Cardiac Anesthesia
Cardiopulmonary Bypass
Multiple Vascular Lines

Transesophageal Echo
Performed By Anesthesiologist

Thoracic Anesthesia
Dual Lumen Tubes

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Neuro Anesthesia

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Neuro Anesthesia
Physiology Aneurysm Clipping Awake Craniotomy Lumbar CSF Drain Specific Disorders Electroconvulsive Therapy

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Pediatric Anesthesia

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Pediatric Anesthesia
Anatomical Differences Otolaryngology Congenital Heart Defects Gastrointestinal Disorders

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Trauma Anesthesia

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Trauma Anesthesia
Airway Management Transfusion Medicine Tension Pneumothorax

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Acute Pain Management

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Acute Pain Management

Local Anesthesia Neuraxial Anesthesia
Epidural Spinal Combined

Peripheral Blocks
Upper Extremity Lower Extremity

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Simulation

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What About Research?

CA-3 Research Track Advances In Safety & Technology Deaths Per 10,000 Anesthetics:
1950: 17.9 1975: 2.2 1980: 0.7 1989: 0.04

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Its Too Competitive For Me

ROAD: Radiology, Ophthalmology, Anesthesiology, Dermatology Freeman Book: Competitive
Not Very or Extremely Competitive

NRMP Match Data

Anesthesiology In The Middle

Academic Medicine (Mar 2009, Vol 84, #3): Competitive

Not Most or Lease Competitive
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Its Too Competitive For Me

Choosing A Medical Specialty by Freeman (2004) By Unmatched Rate:
Emergy Med 6.5% General Surgery 5.4% Anesthesiology 5.2% Ob/Gyn 4.3% Psychiatry 4.3% Neurology 3.0%
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Its Too Competitive For Me

NRMP Data 2008
Preferred Step 1 Score: 220

NRMP Data 2009

Preferred Step 1 Score: 222 Preferred Step 2 Score: 230 Similar To:
Internal Medicine, Pathology, General Surgery, Emergency Medicine, Pediatrics, Obstetrics & Gynecology, Neurology

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Its Too Competitive For Me

Academic Medicine (Mar 2009, Vol 84, #3), Selection Criteria for Residency: Results of a National Program Directors Survey.

Most Competitive: Plastics, Orthopedics, Otolaryngology, Ophthalmology, Radiology, Rad/Onc, Neurosurgery. Competitive: Emergency Medicine, Urology, Dermatology, General Surgery, Anesthesiology, Pediatrics, Ob/Gyn. Less Competitive: Psychiatry, Pathology, PM&R, Internal Medicine, Neurology, Family Medicine.
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Anesthesiology: An Introduction For Medical Students

Its Too Competitive For Me

Dispelling Myths
Medical Education Online (2005;10:17), Residency Selection Criteria: What Medical Students Perceive As Important. Academic Medicine (Mar 2009, Vol 84, #3), Selection Criteria for Residency: Results of a National Program Directors Survey. Academic Emergency Medicine (Jan 2002, Vol 7, #1), Selection Criteria for Emergency Medicine Residency Applicants.
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But Isnt It Boring?

Different Areas Of The Hospital Diverse Patient Population Lots Of Procedures

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The Best Medical Specialty?

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Thank You

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