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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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Từ vựng và ghi chú luyện nói cho bài học này
Bài luyện nói này dựa trên video “Anesthesiology: Basics – Anesthesiology”. Những từ được nhắc lại nhiều nhất trong bài: anesthesia, surgery, anesthetic, nitrous, oxide. Video này có 148 câu và 1942 từ để luyện shadowing. Phần lời nói dài 13:33. Người nói giữ tốc độ đều, khoảng 143 từ mỗi phút, vừa sức để nói đuổi theo. Chỉ 79% số từ nằm trong 3.000 từ tiếng Anh thông dụng nhất, nên từ vựng khá khó.
Từ vựng quan trọng trong video
15 từ đáng học trong video, kèm phiên âm và nghĩa:
| Từ | Phiên âm | Nghĩa |
|---|---|---|
| oxide danh từ | /ˈɑksaɪd/ | oxyt, oxit |
| lecture danh từ | /ˈlɛk.t͡ʃə/ | bài giảng |
| procedure danh từ | /pɹəˈsiː.d͡ʒə/ | phương pháp |
| mask danh từ | /mæsk/ | mặt nạ |
| breathe động từ | /bɹiːð/ | thở, hô hấp |
| surgeon danh từ | /ˈsɝd͡ʒən/ | bác sĩ phẫu thuật |
| dentist danh từ | /ˈdɛntɪst/ | nha sĩ, bác sĩ nha khoa |
| specialty danh từ | /ˈspɛʃ.əl.ti/ | đặc sản |
| coma danh từ | /ˈkoʊmə/ | hôn mê |
| muscle danh từ | /ˈmʌs.əl/ | cơ, bắp thịt |
| painful tính từ | /ˈpeɪn.fl̩/ | đau đớn |
| pump danh từ | /pʌmp/ | bơm |
| nerve danh từ | /nɝv/ | thần kinh |
| limb danh từ | /lɪm/ | chi, but see chân tay |
| ultrasound danh từ | /ʌl.tɹə.saʊnd/ | siêu âm |
Cụm động từ bạn sẽ nghe
| Từ | Phiên âm | Nghĩa |
|---|---|---|
| wake up động từ | /ˌweɪk ˈʌp/ | thức dậy, dậy lên |
Những câu đáng luyện lại
Các câu ngắn, trọn ý trong video mà bạn có thể dùng lại khi giao tiếp hằng ngày:
- 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?
Ngữ pháp trong video
Những cấu trúc người nói dùng nhiều nhất, kèm đúng cụm từ trong video:
| Cấu trúc | Trong video |
|---|---|
| Câu bị động be + quá khứ phân từ — nhấn vào việc xảy ra, không phải người làm | I've been told · could be performed · is often accompanied |
| Thì hiện tại hoàn thành have/has + quá khứ phân từ — việc đã xảy ra nhưng còn liên quan đến hiện tại | has changed · I've been told · term's been |
| Mệnh đề quan hệ who / which + mệnh đề — thêm thông tin về người hoặc vật | anesthetic, which will · unconsciousness, which is |
Phát âm cần chú ý
Người nói dùng 21 dạng rút gọn, ví dụ we'll, you're, I'm. Hãy nói theo dạng ngắn đúng như bạn nghe.
- Âm “th”: breathe /bɹiːð/, gather /ˈɡæðɚ/, bother /ˈbɑðɚ/, eighth /eɪtθ/, tooth /tuθ/
- Âm “sh” và “zh”: specialty /ˈspɛʃ.əl.ti/, execution /ˌɛk.sɪˈkjuː.ʃən/, prevention /pɹɪˈvɛnʃən/, intervention /ɪntɚˈvɛnʃən/, completion /kəmˈpliː.ʃən/
- Từ dài — đặt trọng âm cho đúng: superior /sʊˈpɪɹ.i.ɚ/, successfully /səkˈsɛs.fə.li/, execution /ˌɛk.sɪˈkjuː.ʃən/, intervention /ɪntɚˈvɛnʃən/, eliminate /ɪˈlɪm.ɪ.neɪt/
Những âm người Việt thường gặp khó:
- Cụm phụ âm cuối — đọc đủ từng âm, đừng nuốt âm cuối: mask /mæsk/, dentist /ˈdɛntɪst/, aspect /ˈæspɛkt/, pump /pʌmp/, ultrasound /ʌl.tɹə.saʊnd/
- Âm /tʃ/, /dʒ/ và /ʒ/ — tiếng Việt không có, đừng đọc thành “ch” hay “gi”: surgical /ˈsɝd͡ʒɪkəl/, lecture /ˈlɛk.t͡ʃə/, procedure /pɹəˈsiː.d͡ʒə/, surgeon /ˈsɝd͡ʒən/, gentleman /ˈd͡ʒɛn.təl.mən/
- Âm /æ/ — mở miệng rộng hơn âm “e”: mask /mæsk/, aspect /ˈæspɛkt/, gather /ˈɡæðɚ/, whereas /(h)wɛɹˈæz/, rapid /ˈɹæp.ɪd/
Cách luyện với video này
- Nghe hết video một lần, chưa cần nói, và ghi lại những từ bạn chưa biết.
- Nói đuổi từng câu ở tốc độ bình thường, lặp lại mỗi câu đến khi nhịp của bạn khớp với người nói.
- Ghi âm giọng mình rồi so với bản gốc, chú ý các từ như oxide, lecture, procedure.
Phương Pháp Shadowing Là Gì?
Shadowing là kỹ thuật học ngôn ngữ có cơ sở khoa học, ban đầu được phát triển cho chương trình đào tạo phiên dịch viên chuyên nghiệp và được phổ biến rộng rãi bởi nhà đa ngôn ngữ học Dr. Alexander Arguelles. Nguyên lý cốt lõi đơn giản nhưng cực kỳ hiệu quả: bạn nghe tiếng Anh của người bản xứ và lặp lại to ngay lập tức — như một "cái bóng" (shadow) đuổi theo người nói với độ trễ chỉ 1–2 giây. Khác với luyện ngữ pháp hay học từ vựng bị động, Shadowing buộc não bộ và cơ miệng phải đồng thời xử lý và tái tạo ngôn ngữ thực tế. Các nghiên cứu khoa học xác nhận phương pháp này cải thiện đáng kể phát âm, ngữ điệu, nhịp điệu, nối âm, kỹ năng nghe và độ lưu loát khi nói — đặc biệt hiệu quả cho người luyện IELTS Speaking và muốn giao tiếp tiếng Anh tự nhiên như người bản ngữ.