Dr. Rowan Molnar | #DrRowanMolnar: Post surgery pain management

Modern pain medications and anaesthesia are designed to alleviate severe pain after surgery and help the body heal. Every patient is undoubtedly concerned about post surgical pain. While some pain and discomfort is inevitable post surgery, careful monitoring by the anaesthetist and well controlled pain medications can ensure a speedy healing and reduce the risk of complications.

Discuss pain control with your doctor

According to Dr. Rowan Molnar (#DrRowanMolnar), Staff Specialist Anaesthetist at Launceston General Hospital says it is extremely important for any patient to discuss post surgical pain relief and medications with their anaesthetist. This helps them prepare for more effective short and long term pain management. Most importantly it is vital to discuss any previous experiences with pain and pass on information of what types of pain relievers you have used in the past. This includes over the counter and prescription medications as well. Those who have chronic pain may be less sensitive to pain medication and must therefore play an active role in keeping their doctor informed so that a pain management plan can be implemented post surgery.

Balancing the benefits and risks

Dr. Rowan Molnar (#DrRowanMolnar) also stresses the importance of being straightforward when it comes to alcohol or drug use. Anyone patient who is to undergo surgery and is a recovering alcoholic or has a history of addiction must be honest with their doctor in order to reduce the risk of relapse and plan for maximum pain control. As a patient everyone has the right to relay their concerns about pain medications to their doctor. Pain management post surgery is about balancing the benefits and risks at each point during and after surgery.

Dr. Rowan Molnar | #DrRowanMolnar: What your anaesthesiologist must know before undergoing any surgery

The anaesthesiologist plays a vital role prior to surgery, during the procedure, and in a post surgical setting as well. They not only manage anaesthesia administered to a patient during surgery but are also responsible for monitoring all the critical life functions that are affected by the surgery. They are also skilled in immediately diagnosing and treating medical problems that may arise during and after surgery.

History of medications and lifestyle

While an anaesthetist takes on various tasks, according to Dr. Rowan Molnar (#DrRowanMolnar), Staff Specialist Anaesthetist at Launceston General Hospital in Tasmania, Australia and educator at several external organizations, it is vital for the anaesthesiologist concerned to be aware of the patient’s medical history, all types of medications taken, and lifestyle. Patients who have experienced adverse reactions to an anaesthetic in the past must be able to describe exactly what type of reaction they had and the specific symptoms. This proves vital in helping the anaesthesiologist decide in the right type of pain management plan before, during, and after surgery.

Drug use and allergies

Herbal supplements can also have an impact on the sedative effect of an anaesthetic, which is why Dr. Rowan Molnar (#DrRowanMolnar) recommends that patients tell their doctors about any type of herbal supplements they may have been or are currently taking. Patients are advised to stop taking any herbal supplements at least 3 weeks prior to surgery. In addition, make sure that your anaesthesiologist is aware of any food and drug allergies since some anaesthetic agents can trigger cross-allergies. Any history of drug abuse and use of prescription and over the counter medications must be made known to the anaesthesiologist since some medications may prolong bleeding and interfere with muscle relaxants administered during surgery.

Dr. Rowan Molnar (#DrRowanMolnar) – The relation between anaesthesia and states of consciousness

General anaesthesia has evolved significantly over time and has transformed surgery into something of a gentle slumber from a patient’s point of view. There are several new techniques being developed for imaging the brain and recording its electrical impulses during anaesthesia. Several studies aim at understanding the relationship between anaesthetics and consciousness and how it might interrupt consciousness.  Altered consciousness is a condition that occurs during general anaesthesia and when anyone falls asleep. However, an anaesthetic does allow the Dr. Rowan Molnar (#DrRowanMolnar) to safely manipulate consciousness safely. For the most part, an anaesthetist has one of the most critical tasks during and after surgery in keeping patients comfortable with the least amount of pain. Most patients experience a state of drowsiness similar to drunkenness prior to falling unconscious in the pre-surgery state.

Anaesthesia usually commences with an injection of drugs like protocol, which allows for a smooth and rapid transition to a state of unconsciousness. Following this, an inhaled anaesthetic is usually administered for better control of the depth of anaesthesia. Today, the list of anaesthetic agents range from complex steroids and other drugs to inert gases such as xenon. Brain imaging techniques are being used to track changes in blood flow to different areas of the brain to determine what areas of the brain are affected by anaesthetics. Dr. Rowan Molnar. (#DrRowanMolnar) has decades of global experience as a specialist Dr. Rowan Molnar (#DrRowanMolnar) in critical care and trauma medicine and is at the forefront of many clinical studies. In addition to holding various positions at major medical institutions in the USA and Australia he was also an Editorial Reviewer at Journal Anaesthesia and Intensive Care.

Dr. Rowan Molnar Australia (#DrRowanMolnar): on the Benefits of a Pain Management Training Program

Pain is something that every physician has to deal with on a regular basis, as this is something that many patients complain of. Lower back pain is common today and demands the need for better pain management techniques. Specialist training is available to physicians in order to assist patients cope with pain in a better way. On completion of the training program, a physician will be able to expand his or her practice to include the sub specialty services of pain management. A physician will also be able to perform all the injection procedures such as Facet injection, Trigger Point injections, Para vertebral Facet injection, and injection of Sacroiliac, Shoulder, Hip, and Knee. Dr. Rowan Molnar (#DrRowanMolnar) has always been an active advocate of pain management training programs.

Participants will be able to evaluate and develop treatment by using injection techniques for patients with chronic lumbosacral pain. They will also be able to evaluate patients with large joint pain and develop an effective injection therapy treatment plan. By using image guidance, they will be able to use various needle placement techniques. Physicians will also learn appropriate dosages of supplies and solutions and learn how to order them. Dr. Rowan Molnar (#DrRowanMolnar) has specific expertise in anaesthesia and pain management. As a senior specialist anaesthetist he has over 25 years experience extensive clinical experience in anaesthesia at a tertiary referral hospital level, which includes various positions held at Massachusetts General Hospital Boston,  Harvard University and associations and training with John Hopkins Medical Centre in Baltimore, and the University of California. He is currently working as a senior specialist anaesthetist and Director of Anaesthesia at a major Australian Government Project in Papua New Guinea.

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Dr Rowan Molnar (#DrRowanMolnar):Aviation route administration and Anaesthesia

Block of the upper aviation route is normal in anaesthesia, which is created by the loss of muscle tone. The restricted fragment known as the hypo pharynx is defenceless amid anaesthesia and sedation. Distinguishing high hazard patients is crucial notwithstanding looking for a background marked by upper aviation route bargain. As per Dr. Rowan Molnar (#DrRowanMolnar), right now the Staff Pro Anaesthetist at Launceston General Clinic, Tasmania with broad clinical involvement in anaesthesia at a tertiary referral doctor's facility level, elements, for example, corpulence, manipular subsidence, and nasal obstacles or simply a couple hazard zones that must be distinguished. Such conditions make intubation troublesome and build powerlessness to upper aviation route block amid anaesthesia or slumber.

Significance of danger recognizable proof

Dr. Rowan Molnar (#DrRowanMolnar), who is likewise Head of Order, Anaesthesia, at College of Tasmania Clinical School says that hazard distinguishing proof and alert are the keys to aviation route administration even while the utilization of helps, for example, the laryngeal veil aviation route is started. The aviation route must be secured before regulating anaesthesia when uncertainty exists. Furthermore, it is crucial for each anaesthetist of arrangement for fizzled intubation or fizzled ventilation. For anaesthetists, one of the real markers of the conceivable conduct of the upper aviation route is the conduct of the upper aviation route amid slumber.

Patient components

Amid slumber and anaesthesia, upper aviation route check increments because of narrowing of the pharynx and the expanded weight around it. Elements outside the pharynx incorporate narrowing of skeletal limits, and the sidelong pharyngeal fat cushions in fat patients, loss of footing on the pharynx and diminishment in lung volumes because of corpulence. There are essentially three reasons why a tight aviation route is powerless against breakdown. A little span of bend and more prominent extending power is obliged to keep up satisfactory pressure on the mass of the aviation route to avert breakdown as per Laplace's law. On the off chance that the bore is little indisputably the adjustment in gauge is less preceding aviation route conclusion. Propensities, for example, smoking, liquor utilization, resting pills, and certain meds can likewise have an impact on muscle tone and aviation route bore. Tracheal intubation is the standard method for control of the aviation route in which the lower aviation route and areas where the trading of gas happens in the lungs are specifically gotten too.

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Dr. Rowan Molnar (#DrRowanMolnar) -Simulation and Anaesthesia

The very basis of anaesthesia training is based on the duration and quality of clinical experience. It is important for budding anaesthetists to be exposed to a range of interventions. While basic training works for routine cases, anaesthetists have to be well prepared to carry out multiple tasks in the case of uncommon and life-threatening events. According to Dr. Rowan Molnar (#DrRowanMolnar), a senior specialist anaesthetist at Launceston General Hospital, Tasmania, simulation training is one of the best ways to prepare anaesthetists through standard scenario building and reflective training.

The use of technology to train anaesthetists

During simulation training, it is easy to address a number of non-technical aspects of the daily activities of anaesthetists. Dr. Rowan Molnar (#DrRowanMolnar), who is dedicated to medical education at all levels, particularly in the implementation of simulation based teaching, and armed with a Master’s of Science in Health Professional Education (Simulation Major), Harvard University is of the opinion that the technology can be used most effectively to assess competence levels as well. A model of the human airway is used to teach airway skills while a mannequin is used to perform various tasks including endotracheal intubation. Mannequin patients used in simulation centres are backed by software-based physiology to make the situation as realistic as possible. According to Dr. Rowan Molnar (#DrRowanMolnar), learners can feel the changes in airway and breathing during simulation training. A typical simulation usually involves a patient management situation where a learner is briefed about a patient condition and is asked to conduct an anaesthetic.

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Dr. Rowan Molnar (#DrRowanMolnar): Meeting the Challenges of Anaesthesia through Simulation Training

MPSs or mannequin patient simulators have evolved rapidly with the advent of inexpensive personal computers and software capabilities. Dr. Rowan Molnar (#DrRowanMolnar), a teacher of Simulation at various organisations and former Medical Education Director at St. Vincent's Simulation Centre - St. Vincent’s Hospital, says that patient simulators play an integral role in helping students, anaesthesiology trainees, and nurse anaesthetists learn to cope with complex clinical problems that may arise, including difficult management.

The multiple benefits of simulation training for learners

Patient simulation is one of the best ways for students to learn about complex scenarios malignant hyperthermia, intravenous air embolism, vaporiser leaks, contaminated oxygen supply, and other malfunctions in the delivery of anaesthesia. Dr. Rowan Molnar (#DrRowanMolnar) stresses the fact that simulation training offers distinct advantages where students learn to identify and correct rare and complex clinical problems. For the most part, this training can potentially be a life saver for many patients.  One of the biggest benefits of simulation training according to Dr. Rowan Molnar (#DrRowanMolnar) is that the training can be finetuned to the needs of the learner and not the patient. They are able to focus on specific components of a procedure or the procedure as a whole. Learners also have the opportunity to explore the various pros and limits of each technique and learn from failures, which isn’t possible in a clinical setting. In addition, there is more scope for formative and summative assessments due to the development of an increasing range of metrics. Most importantly, patient simulation training provides a platform for the entire healthcare team to learn and practice important clinical, leadership and interpersonal skills. 

Dr. Rowan Molnar: Pelvic laparoscopy and anaesthesia

Pelvic laparoscopy has undergone massive changes in terms of instrumentation and techniques, which has made it a popular procedure over laparotomy.  The technique is known to offer better visualisation of the pelvic viscera. The patient’s arms are placed at the side for the surgeon to have easy access after the induction of general anaesthesia.

Anaesthetic technique

According to Dr. Rowan Molnar, a Staff Specialist Anaesthetist Launceston General Hospital, Tasmania, Australia it is essential for the anaesthetic technique used in laparoscopy to compensate for physiological disturbances. Premedication is decided on by the anaesthetist and is used to reduce any anxiety felt by the patient. An intravenous cannula is introduced in the hand or forearm vein with an extension attached to the tubing for easy introduction of injections. Induction is performed with anaesthetics where the tip of a short cuffed tube is secured beyond the larynx. The anaesthetist uses agents such as nitrous oxide and oxygen anaesthesia which is supplemented with short acting narcotic analgesics to induce muscle relaxation.

In pelvic laparoscopy, ventilation is controlled by a respirometer which monitors tidal and minute volumes, and is used to adjust ventilation. Following the administration of anaesthesia, the patient’s legs are secured on stirrups and the feet dropped off the table. After the procedure, patients require to spend time in the recovery area until the effects of anaesthesia wear off. Outpatients are usually discharged the same day as the procedure depending on the type of anaesthesia given once vital signs such as blood pressure, pulse and breathing are stable.

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