Практика Shadowing: Anesthesiology: Basics – Anesthesiology | Lecturio - Изучайте разговорный английский по видео

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Hello ladies and gentlemen.

Here are a series of questions and answers to start you thinking about anesthesiology.

I'll follow that with a short history of the specialty and a discussion on how anesthesiology has changed the world.

A common question I'm asked and it's a reasonable question.

I've been told that I will be asleep during my surgery.

I don't think surgery could be performed on me if I were just asleep.

Is general anesthesia the same as sleep?

General anesthesia is not just deeper sleep.

It's much better compared to a state of reversible coma.

It's a type of coma that we can induce and we can reverse, and yes, we can reverse it,

and you will wake up from your anesthetic.

The second common question I'm asked is, I've been told that I will be paralyzed during my surgery.

Isn't this dangerous?

How will I breathe?

This statement is often accompanied by my students with statements like, that's really gross and how would you do that to people?

The answer is you may be paralyzed during your surgery

if the surgeon requires muscle relaxation to complete the surgery successfully

and safely or if the anesthesiologist must place a breathing tube in your trachea.

The anesthesiologist is responsible for managing your breathing and will make sure that you have no memory for this whole experience.

Third question that's commonly asked is, will I remember being operated upon?

You will remember entering the operating room and being introduced to the team members

that are going to be involved in your surgery.

You will then be given an anesthetic, which will eliminate all memory of the surgical experience itself.

And you will not be awakened, and you will not reform your memory until the surgery is completed.

After the anesthetic is gone, won't I have a lot of pain?

When anesthesia is properly delivered, the provider assures that pain prevention is an important aspect of the care.

Before the end of surgery, the anesthesiologist will provide you with painkillers that will produce good pain relief when you wake up.

In addition, the nurses in the recovery room will give you additional pain relief if you require it.

So here's a definition from the Oxford Dictionary.

It's not sleep.

Surgery cannot be performed under conditions of normal sleep.

Period.

And the Oxford Dictionary says, An anesthetic that affects the whole body and it usually causes a loss of consciousness,

i .e., he had an operation under general anesthesia.

Anesthesia.

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,

a term that is also known as anesthesiologist, depending on what part of the world you're in.

It's often associated with muscle paralysis.

It's always associated with profound amnesia for the surgical event.

So how did anesthesia develop?

Well, it's all thanks to the dentists.

Doctors can't take any credit for it.

Prior to 1846, there was no known way to provide anesthesia to those undergoing surgery.

The whole process of surgery was extraordinarily painful, bloody and dirty.

Surgeons were praised for the speed, not skill, in their sexful completions of operations.

Surgical procedures were either very superficial, drainage of abscesses or removal of small skin lesions, or major amputations of limbs,

caesarean section, all without any anesthesia.

The Massachusetts General Hospital, at the time that this whole event occurs, was the busiest surgical site in North America.

It provided surgical procedures to an average of five patients a week.

After 1846, longer, more complex surgical procedures developed,

and the field of surgery exploded.

Now over 100 procedures are done at Massachusetts General Hospital a day,

and new surgical procedures are being developed at a very rapid pace.

So the first dentist we're going to talk about is Dr. Horace Wells.

He's the real father of anesthesiology, although the term's been used on many individuals.

Yes, he was a dentist.

In 1844, he went to a party.

It was a nitrous oxide party where people gathered and enjoyed themselves and breathed nitrous oxide,

usually out of a big paper bag.

And one of the things he noticed was a woman smashed her leg very hard against a bench

and ended up with a large laceration on her leg, which should have been extremely painful.

She had no sense of pain whatsoever from it.

And from this observation, he then went about using nitrous oxide in his dental practice.

He had his own tooth extracted under nitrous oxide anesthesia and had very little discomfort.

And in 1845, he demonstrated nitrous oxide for surgical anesthesia at the Massachusetts General Hospital.

Unfortunately, as you're going to learn in this course, nitrous oxide is not a strong anesthetic.

And it was a dismal failure.

And he was shamed before all the physicians in Massachusetts and the dentists.

Nitrous oxide provides good analgesia, good pain control, but cannot provide full anesthesia.

So the patient cried out during the surgery, Wells was humiliated, and he ultimately committed suicide.

This was a typical advertisement in those days for a laughing gas party, nitrous oxide party.

So you can see, laugh, sing, dance, speak, or fight, all those wonderful things you could do with nitrous oxide on board.

So the next dentist to come along was Dr. William Morton, also in Massachusetts.

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.

So the first described and known event in general anesthesia occurred on October 16, 1845.

Dr. Morton provided anesthesia to a young man having a tumor removed from his neck under ether anesthesia.

And the chief surgeon turned to the crowd in the room and said, in the very pompous way of that

Victorian era, gentlemen, this is no humbug.

And Morton's name was made.

Morton was a bit of a scamp,

unfortunately, and he tried to make more out of this than he was able to by coloring ether orange

and then trying to patent it as orange ether,

claiming it was superior to regular ether that had actually been around as a solvent and cleaning agent for centuries.

So this is a painting of that first event and this is from 1845 at the Massachusetts General.

This operating room is still in existence and you can visit it if you wish,

but you can see how very different the world was then than it is now.

All these people gathered around the operating room table wearing street clothes.

They may, in fact, be people right off the street because like public executions,

surgery was a popular spectator sport in the mid part of the 19th century.

You can see Morton holding his bottle of ether and the surgeon working on the young man's neck.

So that started general anesthesia for general surgery.

But it was important to move beyond that to other areas of need.

And the area that was likely to be missed in all of this was obstetrical anesthesia.

Partly this was due to the biases of the era that said,

you know, pain during labor was a required part of woman's recompense for original sin.

Well, there was a very powerful lady in existence in that era in Great Britain.

That was Queen Victoria.

And she wasn't willing to be punished for something that might have happened in the Garden of Eaton.

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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Лексика и советы по произношению к этому уроку

Этот урок разговорной практики построен на видео «Anesthesiology: Basics – Anesthesiology». Чаще всего повторяются слова: anesthesia, surgery, anesthetic, nitrous, oxide. В этом видео 148 предложений и 1942 слов для шедоуинга. Речь длится 13:33. Говорящий держит ровный темп — около 143 слов в минуту, удобный для шедоуинга. Только 79% слов входят в 3000 самых частых слов английского языка, поэтому лексика сложная.

Ключевая лексика этого видео

15 слов из видео, которые стоит выучить, с произношением и значением:

Слово	Произношение	Значение
oxide существительное	/ˈɑksaɪd/	о́кись, окси́д
surgical прилагательное	/ˈsɝd͡ʒɪkəl/	хирурги́ческий
lecture существительное	/ˈlɛk.t͡ʃə/	ле́кция, уро́к
procedure существительное	/pɹəˈsiː.d͡ʒə/	процеду́ра, ме́тод
mask существительное	/mæsk/	ма́ска, личи́на
breathe глагол	/bɹiːð/	дыша́ть
surgeon существительное	/ˈsɝd͡ʒən/	хиру́рг
dentist существительное	/ˈdɛntɪst/	зубно́й врач, данти́ст
spinal прилагательное	/spaɪ.nəl/	спинно́й, хребе́тный
aspect существительное	/ˈæspɛkt/	аспе́кт, вид
cocaine существительное	/koʊˈkeɪn/	кокаи́н
specialty существительное	/ˈspɛʃ.əl.ti/	специа́льность, специализа́ция
coma существительное	/ˈkoʊmə/	ко́ма
muscle существительное	/ˈmʌs.əl/	мы́шца, му́скул
asleep прилагательное	/əˈsliːp/	спя́щий, усну́вший

Фразовые глаголы, которые вы услышите

Слово	Произношение	Значение
come along глагол		сопровожда́ть, составля́ть компа́нию
wake up глагол	/ˌweɪk ˈʌp/	просыпа́ться, просну́ться

Фразы, которые стоит повторять

Короткие законченные фразы из видео, которые пригодятся в повседневном разговоре:

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?

Грамматика в этом видео

Конструкции, которые говорящий использует чаще всего, с точными словами из видео:

Конструкция	В видео
Пассивный залог be + причастие прошедшего времени — важно, что происходит, а не кто это делает	I've been told · could be performed · is often accompanied
Present Perfect have/has + причастие прошедшего времени — прошлое действие, важное сейчас	has changed · I've been told · term's been
Придаточные определительные who / which + предложение — уточнение о человеке или предмете	anesthetic, which will · unconsciousness, which is

Произношение, на которое стоит обратить внимание

Говорящий использует 21 сокращённых и редуцированных форм, например we'll, you're, I'm. Произносите их коротко, так, как слышите.

Звуки «th»: breathe /bɹiːð/, gather /ˈɡæðɚ/, bother /ˈbɑðɚ/, eighth /eɪtθ/, tooth /tuθ/
Звуки «sh» и «zh»: specialty /ˈspɛʃ.əl.ti/, execution /ˌɛk.sɪˈkjuː.ʃən/, prevention /pɹɪˈvɛnʃən/, intervention /ɪntɚˈvɛnʃən/, completion /kəmˈpliː.ʃən/
Длинные слова — следите за ударением: superior /sʊˈpɪɹ.i.ɚ/, successfully /səkˈsɛs.fə.li/, execution /ˌɛk.sɪˈkjuː.ʃən/, intervention /ɪntɚˈvɛnʃən/, eliminate /ɪˈlɪm.ɪ.neɪt/

Звуки, трудные для русскоязычных:

/w/ — губы округлены, это не /v/: wire /ˈwaɪɚ/, whereas /(h)wɛɹˈæz/, subsequent /ˈsʌbsɪkwənt/, withdraw /wɪðˈdɹɔ/, whatsoever /ˌ(h)wʌtsoʊˈɛvɚ/
/h/ — лёгкий выдох, а не русское «х»: whereas /(h)wɛɹˈæz/, whatsoever /ˌ(h)wʌtsoʊˈɛvɚ/, humiliate /hjuːˈmɪliˌeɪt/
Звонкие согласные в конце слова — не оглушайте их: oxide /ˈɑksaɪd/, nerve /nɝv/, ultrasound /ʌl.tɹə.saʊnd/, whereas /(h)wɛɹˈæz/, rapid /ˈɹæp.ɪd/

Как заниматься с этим видео

Прослушайте всё видео один раз молча и выпишите незнакомые слова.
Повторяйте предложение за предложением на обычной скорости, пока ваш ритм не совпадёт с ритмом говорящего.
Запишите себя и сравните с оригиналом, обращая внимание на такие слова, как oxide, surgical, lecture.

Что такое техника Shadowing?

Shadowing — это научно обоснованная техника изучения языка, изначально разработанная для подготовки профессиональных переводчиков и популяризированная полиглотом доктором Александром Аргуэльесом. Метод прост, но эффективен: вы слушаете аудио на английском от носителей языка и немедленно повторяете вслух — как тень, следующая за говорящим с задержкой в 1–2 секунды. В отличие от пассивного прослушивания или грамматических упражнений, Shadowing заставляет мозг и мышцы рта одновременно обрабатывать и воспроизводить реальные речевые паттерны. Исследования показывают, что это значительно улучшает точность произношения, интонацию, ритм, связную речь, понимание на слух и беглость речи — что делает его одним из самых эффективных методов для подготовки к IELTS Speaking и реального общения на английском.

Техника шедоуинга: читать полное пошаговое руководство →

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