Prática de Shadowing: Anesthesiology: Basics – Anesthesiology | Lecturio - Aprenda a falar inglês com vídeo
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Hello ladies and gentlemen.
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Here are a series of questions and answers to start you thinking about anesthesiology.
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I'll follow that with a short history of the specialty and a discussion on how anesthesiology has changed the world.
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A common question I'm asked and it's a reasonable question.
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I've been told that I will be asleep during my surgery.
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I don't think surgery could be performed on me if I were just asleep.
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Is general anesthesia the same as sleep?
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General anesthesia is not just deeper sleep.
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It's much better compared to a state of reversible coma.
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It's a type of coma that we can induce and we can reverse, and yes, we can reverse it,
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and you will wake up from your anesthetic.
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The second common question I'm asked is, I've been told that I will be paralyzed during my surgery.
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Isn't this dangerous?
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How will I breathe?
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This statement is often accompanied by my students with statements like, that's really gross and how would you do that to people?
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The answer is you may be paralyzed during your surgery
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if the surgeon requires muscle relaxation to complete the surgery successfully
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and safely or if the anesthesiologist must place a breathing tube in your trachea.
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The anesthesiologist is responsible for managing your breathing and will make sure that you have no memory for this whole experience.
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Third question that's commonly asked is, will I remember being operated upon?
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You will remember entering the operating room and being introduced to the team members
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that are going to be involved in your surgery.
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You will then be given an anesthetic, which will eliminate all memory of the surgical experience itself.
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And you will not be awakened, and you will not reform your memory until the surgery is completed.
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After the anesthetic is gone, won't I have a lot of pain?
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When anesthesia is properly delivered, the provider assures that pain prevention is an important aspect of the care.
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Before the end of surgery, the anesthesiologist will provide you with painkillers that will produce good pain relief when you wake up.
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In addition, the nurses in the recovery room will give you additional pain relief if you require it.
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So here's a definition from the Oxford Dictionary.
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It's not sleep.
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Surgery cannot be performed under conditions of normal sleep.
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Period.
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And the Oxford Dictionary says, An anesthetic that affects the whole body and it usually causes a loss of consciousness,
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i .e., he had an operation under general anesthesia.
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Anesthesia.
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The critical word here is a reversible drug -induced state of unconsciousness, which is characterized by a coma -like state under the control of the anesthetist,
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a term that is also known as anesthesiologist, depending on what part of the world you're in.
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It's often associated with muscle paralysis.
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It's always associated with profound amnesia for the surgical event.
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So how did anesthesia develop?
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Well, it's all thanks to the dentists.
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Doctors can't take any credit for it.
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Prior to 1846, there was no known way to provide anesthesia to those undergoing surgery.
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The whole process of surgery was extraordinarily painful, bloody and dirty.
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Surgeons were praised for the speed, not skill, in their sexful completions of operations.
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Surgical procedures were either very superficial, drainage of abscesses or removal of small skin lesions, or major amputations of limbs,
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caesarean section, all without any anesthesia.
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The Massachusetts General Hospital, at the time that this whole event occurs, was the busiest surgical site in North America.
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It provided surgical procedures to an average of five patients a week.
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After 1846, longer, more complex surgical procedures developed,
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and the field of surgery exploded.
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Now over 100 procedures are done at Massachusetts General Hospital a day,
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and new surgical procedures are being developed at a very rapid pace.
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So the first dentist we're going to talk about is Dr. Horace Wells.
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He's the real father of anesthesiology, although the term's been used on many individuals.
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Yes, he was a dentist.
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In 1844, he went to a party.
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It was a nitrous oxide party where people gathered and enjoyed themselves and breathed nitrous oxide,
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usually out of a big paper bag.
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And one of the things he noticed was a woman smashed her leg very hard against a bench
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and ended up with a large laceration on her leg, which should have been extremely painful.
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She had no sense of pain whatsoever from it.
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And from this observation, he then went about using nitrous oxide in his dental practice.
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He had his own tooth extracted under nitrous oxide anesthesia and had very little discomfort.
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And in 1845, he demonstrated nitrous oxide for surgical anesthesia at the Massachusetts General Hospital.
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Unfortunately, as you're going to learn in this course, nitrous oxide is not a strong anesthetic.
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And it was a dismal failure.
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And he was shamed before all the physicians in Massachusetts and the dentists.
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Nitrous oxide provides good analgesia, good pain control, but cannot provide full anesthesia.
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So the patient cried out during the surgery, Wells was humiliated, and he ultimately committed suicide.
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This was a typical advertisement in those days for a laughing gas party, nitrous oxide party.
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So you can see, laugh, sing, dance, speak, or fight, all those wonderful things you could do with nitrous oxide on board.
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So the next dentist to come along was Dr. William Morton, also in Massachusetts.
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He had actually been predated by Dr. Crawford Long in Great Britain, who did do surgery under ether anesthesia, but didn't bother publishing his results.
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So the first described and known event in general anesthesia occurred on October 16, 1845.
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Dr. Morton provided anesthesia to a young man having a tumor removed from his neck under ether anesthesia.
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And the chief surgeon turned to the crowd in the room and said, in the very pompous way of that
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Victorian era, gentlemen, this is no humbug.
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And Morton's name was made.
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Morton was a bit of a scamp,
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unfortunately, and he tried to make more out of this than he was able to by coloring ether orange
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and then trying to patent it as orange ether,
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claiming it was superior to regular ether that had actually been around as a solvent and cleaning agent for centuries.
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So this is a painting of that first event and this is from 1845 at the Massachusetts General.
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This operating room is still in existence and you can visit it if you wish,
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but you can see how very different the world was then than it is now.
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All these people gathered around the operating room table wearing street clothes.
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They may, in fact, be people right off the street because like public executions,
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surgery was a popular spectator sport in the mid part of the 19th century.
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You can see Morton holding his bottle of ether and the surgeon working on the young man's neck.
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So that started general anesthesia for general surgery.
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But it was important to move beyond that to other areas of need.
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And the area that was likely to be missed in all of this was obstetrical anesthesia.
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Partly this was due to the biases of the era that said,
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you know, pain during labor was a required part of woman's recompense for original sin.
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Well, there was a very powerful lady in existence in that era in Great Britain.
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That was Queen Victoria.
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And she wasn't willing to be punished for something that might have happened in the Garden of Eaton.
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And with her eighth child, she had 11, I believe, she asked Dr. John Snow,
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who was the first practicing anesthesiologist in Great Britain, to provide her with anesthesia.
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Snow's an interesting man.
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And for those of you who are aware of the London pump cholera story,
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it's the same John Snow who discovered that pump and was able to prevent cholera from spreading in London.
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And so in a way, he's the father of epidemiology, and he's also one of the fathers of anesthesiology.
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Very amazing man.
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Anyway, after she delivered her baby, Queen Victoria said, Dr. Snow gave the blessed chloroform, and the effect was soothing,
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quieting, and delightful beyond measure.
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And from that moment forward, obstetrical anesthesia had a solid place in medicine.
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So this is what it looked like to start with.
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This is a bottle of ether and a Schimmelbush mask.
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And the mask is basically just a wire mask that you laid some gauze over,
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and you poured ether directly on the gauze and put the mask
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and gauze over the patient's face and they breathe the vapor.
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This is a modern anesthetic machine, a little bit fancier than the Schimmel -Busch mask,
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much more sophisticated, full of very complex warning systems and monitoring systems, which we'll discuss in more detail in a later lecture.
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Other forms of anesthesia that have developed include regional anesthesia, which developed as local anesthetics were created,
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and one of the first people involved in this story was Sigmund Freud, who thought that cocaine would be both a useful medication
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and felt that it would be particularly useful in the treatment of depression.
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And unfortunately, Sigmund Freud had to withdraw this belief in a later period because one of his best friends,
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who was a very famous American surgeon, became addicted to cocaine and died from its use.
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In any case, the use of cocaine and other simple local anesthetics led to the development of spinal and epidural anesthesia.
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And we can now provide complete loss of sensation to many parts of the body, and particularly the limbs, for surgery.
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Spinal anesthesia is the commonest form of anesthesia for cesarean sections,
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for instance, whereas epidural anesthesia is useful for pain relief during labor or after certain types of surgery.
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Spinal anesthesia is often used for surgery of the legs.
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With modern ultrasound equipment, it is now possible to pass a needle directly to a nerve without perforating the nerve
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or hitting blood vessels under direct vision using ultrasound.
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And this has revolutionized the use of regional anesthesia over the last 5 to 10 years.
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Anesthesia is an extremely safe medical specialty.
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It's one of the safest interventions in modern medicine.
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My practice started in 1980.
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At that time, people used to die on the operating room table.
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In 2014, it's extraordinarily rare for this to happen.
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In developed countries, the mortality rate from general anesthesia is usually stated to be around 1 in 10 ,000
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or maybe as high as 1 in 20 ,000.
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The rate is much lower, however, in young, healthy individuals.
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Also in developed countries, the rate of permanent neurologic damage from spinal or epidural anesthesia is less than 1 in 100 ,000.
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So in a career, most anesthesiologists will never see this happen.
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So our lecture series is going to be laid out like this.
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An introductory lecture, which you're hearing now, a lecture on physiologic aspects of anesthesia, drugs used in anesthesia, and anesthetic systems.
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We'll then move into the more clinical aspects of the specialty and talk about general anesthesia, regional anesthesia, emergencies in the operating room,
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intensive care of patients, pain management, and anesthesia for special populations such such as the pregnant patient,
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children, thoracic anesthesia, neuroanesthesia.
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And then at the very end, we'll summarize everything and we'll have a short discussion about anesthesia and its use in other medical disciplines,
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and the future of anesthesia, and some of the opportunities for young anesthesiologists opening into the future.
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So in this lecture, we've summarized the history of anesthesiology
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and given you a bit of an overview of what general anesthesia and regional anesthesia look like.
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We're going to go into a great more detail in the subsequent lectures, and I hope you join us for those.
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Vocabulário e dicas de fala para esta lição
Esta aula de conversação usa o vídeo “Anesthesiology: Basics – Anesthesiology”. As palavras que mais se repetem: anesthesia, surgery, anesthetic, nitrous, oxide. Este vídeo tem 148 frases e 1942 palavras para praticar shadowing. A fala dura 13:33. O falante mantém um ritmo estável de cerca de 143 palavras por minuto, confortável para o shadowing. Apenas 79% das palavras estão entre as 3.000 mais comuns do inglês, por isso o vocabulário é exigente.
Vocabulário principal deste vídeo
15 palavras do vídeo que vale a pena aprender, com pronúncia e significado:
| Palavra | Pronúncia | Significado |
|---|---|---|
| oxide substantivo | /ˈɑksaɪd/ | óxido |
| surgical adjetivo | /ˈsɝd͡ʒɪkəl/ | cirúrgico |
| lecture substantivo | /ˈlɛk.t͡ʃə/ | conferência, palestra |
| procedure substantivo | /pɹəˈsiː.d͡ʒə/ | procedimento |
| mask substantivo | /mæsk/ | máscara |
| breathe verbo | /bɹiːð/ | respirar |
| surgeon substantivo | /ˈsɝd͡ʒən/ | cirurgião |
| dentist substantivo | /ˈdɛntɪst/ | dentista |
| spinal adjetivo | /spaɪ.nəl/ | espinal, espinhal |
| aspect substantivo | /ˈæspɛkt/ | aspeto, aspecto |
| cocaine substantivo | /koʊˈkeɪn/ | cocaína |
| specialty substantivo | /ˈspɛʃ.əl.ti/ | especialidade |
| coma substantivo | /ˈkoʊmə/ | coma |
| muscle substantivo | /ˈmʌs.əl/ | músculo |
| reverse substantivo | /ɹɪˈvɝs/ | contrário |
Phrasal verbs que você vai ouvir
| Palavra | Pronúncia | Significado |
|---|---|---|
| wake up verbo | /ˌweɪk ˈʌp/ | acordar, despertar |
Frases que vale a pena repetir
Frases curtas e completas do vídeo que você pode usar na conversa do dia a dia:
- How will I breathe?
- Third question that's commonly asked is, will I remember being operated upon?
- After the anesthetic is gone, won't I have a lot of pain?
Gramática neste vídeo
As estruturas que o falante mais usa, com as palavras exatas do vídeo:
| Estrutura | No vídeo |
|---|---|
| Voz passiva be + particípio passado — o foco está no que acontece, não em quem faz | I've been told · could be performed · is often accompanied |
| Present perfect have/has + particípio passado — uma ação passada que ainda importa agora | has changed · I've been told · term's been |
| Orações relativas who / which + oração — informação extra sobre uma pessoa ou coisa | anesthetic, which will · unconsciousness, which is |
Pronúncia para ficar de olho
O falante usa 21 contrações e formas reduzidas, como we'll, you're, I'm. Diga-as na forma curta, do jeito que você ouve.
- Os sons de “th”: breathe /bɹiːð/, gather /ˈɡæðɚ/, bother /ˈbɑðɚ/, eighth /eɪtθ/, tooth /tuθ/
- Os sons de “sh” e “zh”: specialty /ˈspɛʃ.əl.ti/, execution /ˌɛk.sɪˈkjuː.ʃən/, prevention /pɹɪˈvɛnʃən/, intervention /ɪntɚˈvɛnʃən/, completion /kəmˈpliː.ʃən/
- Palavras longas — acerte a sílaba tônica: superior /sʊˈpɪɹ.i.ɚ/, successfully /səkˈsɛs.fə.li/, execution /ˌɛk.sɪˈkjuː.ʃən/, intervention /ɪntɚˈvɛnʃən/, eliminate /ɪˈlɪm.ɪ.neɪt/
Sons difíceis para falantes de português:
- Consoante final — sem acrescentar um “i” depois: oxide /ˈɑksaɪd/, mask /mæsk/, dentist /ˈdɛntɪst/, aspect /ˈæspɛkt/, asleep /əˈsliːp/
- /l/ final — a língua toca o céu da boca, não vira “u”: surgical /ˈsɝd͡ʒɪkəl/, spinal /spaɪ.nəl/, muscle /ˈmʌs.əl/, skill /skɪl/, removal /ɹɪˈmuː.vəl/
- /h/ — um sopro suave, diferente do “r”: whereas /(h)wɛɹˈæz/, whatsoever /ˌ(h)wʌtsoʊˈɛvɚ/, humiliate /hjuːˈmɪliˌeɪt/
Como praticar com este vídeo
- Ouça o vídeo inteiro uma vez sem falar e anote as palavras que você não conhece.
- Faça shadowing frase por frase na velocidade normal, repetindo cada uma até o seu ritmo ficar igual ao do falante.
- Grave a sua voz e compare com o original, prestando atenção a palavras como oxide, surgical, lecture.
O que é a Técnica de Shadowing?
Shadowing é uma técnica de aprendizado de idiomas com base científica, originalmente desenvolvida para o treinamento de intérpretes profissionais. O método é simples, mas poderoso: você ouve áudio em inglês nativo e repete imediatamente em voz alta — como uma sombra seguindo o falante com 1-2 segundos de atraso. Pesquisas mostram melhora significativa na precisão da pronúncia, entonação, ritmo, sons conectados, compreensão auditiva e fluência na fala.