PHYSICIAN ANAESTHETISTS – PIVOTAL TO HOLISTIC HEALTHCARE DELIVERY IN GHANA

Robert Djagbletey Department of Anaesthesia

SMD/KBTH

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

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.

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

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.

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

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

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

• 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

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

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

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

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

Resuscitation

Vital members of Resuscitation teams

Adept with ACLS

Best chance of survival is arresting in the presence of an Anaesthesiologist

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

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

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

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

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

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 .

Thank you

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.

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.