Title : 

Bius pesakit perlu kepakaran

News : BIUS. Ramai yang takut bila mendengarkan perkataan itu. Belum lagi
sebut "bedah". 
Bius dan bedah - kedua-duanya menggambarkan seseorang yang bertugas di
dewan pembedahan (OT) dengan pakaian menutupi kepala, hidung dan mulut.
Sesetengahnya menganggap, dibius tidak ubah seperti menghampiri pengalaman
mati yang tidak mati.
Mereka takut tidak bangun untuk selama-lamanya. Sayangnya, mereka juga takut
untuk bertanya doktor lebih lanjut tentang perkara ini.
Bagi yang sudah melaluinya, mereka mendakwa tersedar dan mendengar butir-
butir percakapan doktor dengan jururawat semasa menjalani pembedahan.
"Bagi pakar bius, perkara begitu tidak menjadi sesuatu yang pelik kerana
sesetengah prosedur memerlukan pesakit sedar seketika dalam proses
pembedahan bagi menilai keberkesanannya," kata Dr. Mahamarowi Omar.
Kesihatan berpeluang menemu bual beliau yang merupakan seorang pakar di
bidang berkenaan dari HUSM bagi memberikan gambaran sebenar mengenai
anestesiologi atau istilah kebanyakannya, pembiusan.
Ketika artikel ini disiarkan, beliau baru sahaja berlepas ke Australia semalam bagi
meneruskan latihan lanjutannya dalam bidang ICU yang dijangka berakhir
September ini.

Siapakah itu pakar bius?

Pakar anestetisia atau semakin popular dikenali sebagai anesthesiologist adalah

gelaran yang diberikan kepada doktor pakar dalam bidang pembiusan. 
Mereka bertanggungjawab memastikan pesakit tidak berasa sakit dan selamat,
semasa mahupun selepas pembedahan. 

Apakah bidang tugas pakar pembiusan?

Umumnya, ia terbahagi kepada empat:

1. Membius pesakit yang memerlukan pembedahan sama ada pembedahan
kecemasan atau elektif. 
2. Menjaga serta merawat pesakit kritikal di ICU yang memerlukan alat sokong
hayat seperti mesin pernafasan dan alat-alat pemantauan khusus atau berterusan,
serta memerlukan ubat-ubatan tertentu yang tidak mungkin digunakan di wad-
wad biasa. 
3. Merawat pesakit yang mengalami kesakitan akut atau kronik akibat
pembedahan atau trauma atau, kesakitan semasa kelahiran dan juga akibat
kesakitan kanser yang berpanjangan.
4. Sebagai resusitator (bagi memulihkan kembali seseorang yang kelihatan telah
mati) kepada pesakit yang mengalami serangan cardiorespiratory.

Bagaimanakah pembiusan dijalankan?

Tugas sebagai doktor pembiusan selalunya bermula sehari sebelum waktu

pembedahan di mana pakar bius wajib melawat para pesakit yang memerlukan
pembedahan. Tugasan ini dikenali sebagai Pre-operative assessment (Preop). 

Apakah objektifnya? 

Untuk memastikan para pesakit yang akan menjalani pembedahan selamat,

semasa dan juga selepas pembedahan. Lawatan ini amat penting dan mesti
dijalankan oleh doktor yang akan memberi pembiusan.
Adalah menyalahi etika kedoktoran sekiranya doktor memberi pembiusan tanpa
terlebih dahulu melawat atau memeriksa pesakit. 
Dengan lawatan sedemikian, doktor akan dapat mengetahui sejarah pesakit secara
menyeluruh dan tepat.
Ini termasuk mengambil tahu ubat-ubatan yang digunakan oleh pesakit kerana
sesetengahnya mungkin mempunyai kesan interaksi yang bahaya dengan ubat
pembiusan.
Pakar bius juga akan mendapat gambaran menyeluruh status pesakit di samping
membuat keputusan yang tepat berkenaan kaedah pembiusan sesuai untuk
pesakit tersebut.
Pesakit yang tenat tetapi memerlukan pembedahan akan dirawat terlebih dahulu
untuk memastikan tahap kesihatan pesakit sebelum pembedahan.
Lawatan sebelum pembedahan juga membolehkan doktor bius mempreskripsi
ubat-ubatan tertentu untuk pesakit.
Selain itu, ia memberikan gambaran sebenar tahap kesihatan pesakit serta
memohon kebenaran pesakit tentang apa-apa prosedur yang mungkin dilakukan
semasa berada di dewan bedah.
Tujuan utamanya adalah untuk mengurangkan ketegangan, keresahan atau
kesakitan pesakit dan memudahkan proses pembiusan pada hari berikutnya.
Jelas sekali, selain perubatan, pakar bius memerlukan pengetahuan mendalam
tentang bidang farmakologi.

Apakah teknik pembiusan yang biasa dilakukan?

Umumnya, terdapat dua jenis teknik pembiusan iaitu:

1. Pembiusan umum (GA): 
Pemberian bius yang menyebabkan pesakit tidak sedarkan diri dan tidak berasa
sakit semasa pembedahan.
Kaedah utama dan sesuai bagi kebanyakan kes pembedahan ini amat rumit dan
memerlukan kepakaran, kecekapan serta pengetahuan yang mendalam.
Untuk membius seseorang pesakit, sekurang-kurangnya memerlukan lima hingga
enam jenis ubat bius.
Ia termasuklah ubat penahan kesakitan, ubat yang menyebabkan pesakit tidak
sedarkan diri selama beberapa ketika, ubat yang melumpuhkan pesakit supaya
pesakit tidak bergerak semasa pembedahan dan ubat untuk pemulihan selepas
pembedahan. 
Ubat-ubatan ini mempunyai kesan terhadap sistem pernafasan, jantung, otak,
buah pinggang, hati dan juga sistem otot-otot badan.
Ia hanya boleh diperoleh di OT dan ICU dan hanya boleh digunakan oleh doktor-
doktor terlatih di dalam bidangnya sahaja.
Terdapat dua kaedah pemberian ubat pembiusan umum:
1. Melalui suntikan terus ke dalam saluran darah - teknik ini menyebabkan pesakit
terlena dengan cepat atau
2. Memberi gas-gas pembiusan melalui sedutan pernafasan paru-paru dengan
menggunakan topeng gas. Kaedah begini amat sesuai untuk kanak-kanak.
Proses permulaan pembiusan dan pemulihan merupakan langkah yang amat
kritikal dan bahaya. Analoginya samalah seperti seorang juruterbang yang
memandu kapal terbang di mana peringkat yang paling bahaya ialah semasa
berlepas dan semasa mendarat.
Oleh itu, kecekapan dan kemahiran yang tinggi amat mustahak kerana sedikit
kelalaian sahaja semasa proses pembiusan boleh membawa mudarat yang besar
kepada pesakit. 
2. Pembiusan separuh atau setempat:
Seperti namanya, pembiusan setempat yang semakin popular ini adalah
pemberian suntikan ubat bius pada kawasan yang hendak dibedah contohnya,
tangan atau kaki.
Semasa pembedahan, pesakit berada di dalam keadaan sedar, boleh bercakap,
mendengar dan kalau mahu boleh melihat sendiri bagaimana pembedahan
dijalankan tanpa berasa sakit.
Terdapat beberapa teknik setempat yang selalu didengar seperti kaedah epidural,
spinal dan yang paling popular di kalangan wanita yang bakal bersalin melalui
kaedah pembedahan irisan Caesarean.
Walau bagaimanapun, teknik pembiusan setempat bukan terhad kepada
pembiusan epidural atau spinal sahaja.
Terdapat banyak kaedah lain seperti pembiusan kepada kanak-kanak yang mahu
berkhatan di mana pembiusan hanya disuntik pada alat kelamin.
Begitu jugalah, pembuangan keputihan pada selaput mata (katarak) memerlukan
pembiusan diberikan pada bahagian mata sahaja. 
Kaedah pembiusan setempat memerlukan sejenis ubat yang dikenali sebagai
"Local Anaesthetic".
Jika dibandingkan dengan pembiusan umum, pembiusan setempat hanya
memerlukan sejenis ubat sahaja.
Pembiusan secara setempat lebih selamat namun sekalipun nampak mudah, tidak
bermakna ia senang dilakukan. 
Walaupun peratusannya amat sedikit, terdapat juga kesan sampingan seperti
tekanan darah menurun secara mendadak, sakit kepala, sakit belakang,
pembiusan tidak menjadi atau tidak sepenuhnya, kelumpuhan pada sistem
pernafasan atau reaksi alahan kepada ubat tersebut.
Oleh itu pembiusan separuh atau setempat memerlukan kemahiran, kecekapan
dan kemahiran yang tinggi dan doktor yang melakukan pembiusan ini biasanya
sudah menjalani latihan yang secukupnya. 

Rawatan penjagaan pesakit yang bagaimanakah diperlukan semasa pembedahan?

Apa jua teknik bius yang digunakan, pesakit yang sedang dibedah hendaklah
dijaga dengan sepenuh perhatian, pada setiap masa.
Malah, adalah menjadi kesalahan pakar bius meninggalkan pesakit semasa dalam
pembiusan walaupun seminit kerana dalam tempoh beberapa saat pun sebarang
kemungkinan boleh berlaku.
Setiap pesakit mesti dipantau tekanan darah, tahap oksigen, nadi, suhu badan dan
paras gulanya setiap masa dengan menggunakan peralatan canggih dan terkini.
Apa-apa sahaja yang berlaku terhadap pesakit serta-merta akan dikesan dan
tindakan sewajarnya diambil dengan segera.
Apatah lagi jika pembiusan yang melibatkan pesakit yang teruk seperti kecederaan
di kepala, pendarahan dalam perut atau dada, pesakit yang datang dengan
pelbagai kecederaan atau pesakit yang dibius mengalami jangkitan kuman yang
serius.
Mereka ini memerlukan penjagaan yang lebih rapi, di bawah perhatian dua atau
lebih pakar bius di bawah pemantauan yang lebih invasif.
Pendarahan yang teruk semasa pembedahan besar memerlukan kecekapan dan
kemahiran yang tinggi daripada pakar bius.
Oleh itu, pakar bius bertanggungjawab untuk memastikan cecair tubuh sama ada
 darah atau cairan garam sentiasa diganti mengikut keperluan pesakit setiap
ketika. 
Begitu juga dengan fungsi organ-organ seperti buah pinggang, hati dan lain-lain,
dijaga dan diawasi dengan teliti.
Dr. Mahamarowi akan terus membincangkan beberapa persoalan menarik lain
yang sering bermain di fikiran orang ramai tentang bius.
Antaranya, kenapakah pesakit diwajibkan berpuasa sebelum dibedah, adakah tidur
selepas dibius sama dengan tidur biasa, apakah bius itu menyakitkan, apakah
kemungkinan yang ada jika ubat bius gagal berfungsi dan sejauh manakah bius
benar-benar selamat?
Career: Anesthesiologists

Even the most routine surgeries can be risky when a patient undergoes anesthesia. In some cases, irregularities in
blood pressure or heart rate during surgery can lead to grave consequences. Imagine how important it is to
administer just the right dose of medication to an infant whose organs are still underdeveloped or cannot speak to
tell you that he's in pain.

It’s the job of the anesthesiologist to take these factors into consideration and to monitor a patient's pulse,
temperature, and other vital signs throughout surgery. 

Anesthesiologists work with other doctors to give patients medication that relieves pain during surgery. They also
monitor patients' vital functions throughout an operation.

Did You Know?

 If you want to specialize in critical care or pain medicine, you'll need to take on
extra training.
Are You Ready To...?

 Spend years studying and training, and a lifetime keeping up with advances in
your field

 Concentrate intently for long periods

 Make sure patients are safe and pain-free

 Work for long hours in an operating room

 Balance heavy workloads with your personal life

It Helps to Be...
Self-motivated and able to work long hours under pressure. It also helps to be a strong decision-maker and a good
communicator. Anesthesiologists must be especially calm and cooperative since they work so closely with a team
during surgery -- always a potentially tense situation.

Make High School Count

 Take plenty of challenging math and science courses, including AP courses in

biology, chemistry, physics, and calculus.

 Enhance your communication skills through English composition, speech, and

drama classes.

 Sign up for psychology to learn about human nature and explore the mind-
body connection.

 Volunteer at a health clinic, a hospital, a women’s clinic, or an elder-care

facility.

 Explore summer study programs like the University of Massachusetts’ High

School Health Careers Program or the Health Careers Opportunity Program at
the University of Montana.
Did You Know?
 In addition to passing the U.S. Medical Licensing Examination, you'll need to take
certification exams given by the American Board of Anesthesiology.
Outlook
Government economists expect jobs for doctors, including anesthesiologists, to grow much faster than the average
for all careers through 2018. They also predict the retirement of many experienced doctors. Open positions should
outnumber applicants, especially in rural and low-income areas.

A growing and aging population means that more people will need more medical services. Changes in health care
coverage and advances in technology, however, could limit demand.

Compensation
The U.S. Bureau of Labor Statistics estimates that anesthesiologists earned an average of $197,570 in 2008.

Subjects.
Take chemistry, organic chemistry, or physics to prepare for getting into med school.
Take biochemistry, anatomy and physiology, genetics, cell biology, microbiology,
medical ethics or statistics to build a foundation for actual med school courses.
Becoming an Anesthesiologist

Education Needed

Even before entering college, those interested in a career in anesthesiology need to think about the
kinds of classes taken in high school. Classes with a math and science concentration certainly go a
long way in preparing a future anesthesiologist for success in college and medical school.

As with other physician specialties, all future anesthesiologists need to attend a four-year
undergraduate program and most will enroll in a pre-medicine or another science-concentrated
program, though it is not required.

Following graduation, prospective anesthesiologists are required to attend four years of medical
school where they generally spend the first two years building on basic sciences and the second two
in clinical training.

Additional Anesthesiologist Training

Upon graduation from medical school, an anesthesiologist must spend one year in an internship and
three more years in a residency program. There are approximately 160 anesthesiology medical
residency programs throughout the United States and Canada.

During residency training, anesthesiologists work toward obtaining certification from the American
Society of Anesthesiologists or the American Board of Anesthesiology.

Some anesthesiologists may participate in an additional one-year fellowship if there is an interest in

practicing in a specific area of anesthesiology, such as critical care medicine, pain medicine,
research or education.
 Step 1: Prepare in High School
o Although medical schools don't usually look at your high school transcript when making admissions
decisions, you can use these years to build a good foundation for your future career. 3
1. The National Institutes of Health recommends that students planning on becoming anesthesiologists
take biology, mathematics, English, chemistry, and physics in high school.4
2. Take advanced placement or college level math and science courses if possible. 5
3. Volunteer in a medical office, or take advantage of a job shadowing program. 5

 Step 2: Obtain Your Bachelor's Degree
o Medical schools generally require a four-year college degree. They also want to see you maintain a high
GPA throughout college.

Selecting a College
o The Association of American Medical Colleges has some suggestions that will help you select a school
that will prepare you well for medical school.6

1. Select a college with a reputation for high academic standards, particularly in science. 6
2. Make sure the science department has up-to-date laboratory facilities. 6
3. The school should offer all of the courses that medical schools require for admission. 6
4. A pre-med or pre-health advising program can help make sure you're prepared for med school. These
programs can identify internship opportunities, as well as help you manage the medical school application process. 6
5. Investigate the college's medical school acceptance rate.6
o If you are a strong student, and certain you wish to pursue a medical career, you may want to apply to
colleges that offer a combined program granting both an undergraduate and a medical degree in six years rather than
eight.4 There are also programs that admit you to medical school at the same time you are admitted to an undergraduate
program. These programs are only available to the most qualified students.

While Earning Your Bachelor's Degree

o Admission to one of the United States' 146 medical schools is highly competitive, so you'll need to begin
preparing for acceptance as early as possible in your college career. 4
1. Most colleges don't offer pre-med majors; students anticipating medical school generally major in math or
science.
2. Medical schools also require courses in the social sciences and humanities. 4
3. Maintain a high GPA. 3.0 is generally the minimum required for medical school admission. 7
4. Participate in extracurricular opportunities that allow you to develop and demonstrate leadership skills. 6
5. Take advantage of opportunities to volunteer in medical situations, or job shadow a doctor, to gain
experience and strengthen your medical school application.
6. Prepare for and take the Medical College Admission Test (MCAT) during your junior year of college. 7
7. Begin applying to medical schools near the end of your junior year.
 Step 3: Attend Medical School
o The four years you spend in medical school will lay the foundation for the actual anesthesia training you'll
receive when you enter a residency after graduation.
1. The first two years of medical school will be spent in the classroom and the lab learning topics such as:
1. Pharmacology
2. Anatomy
3. Biochemistry
4. Physiology
5. Psychology
6. Microbiology
7. Pathology
8. Immunology
9. Histology
10. Medical ethics8
 2. The first half of medical school also provides training in how to take medical histories, examine patients,
and diagnose illness.4
3. During the second half of medical school you'll begin to use some of what you studied in the first half on
clinical rotations in various medical specialties.8
4. In your second and fourth years, you'll take medical licensing exams. 9
 Step 4: Complete an Anesthesiology Residency
o Intensive training in anesthesiology begins after you graduate from medical school. You'll learn to be an
anesthesiologist during your residency, which usually takes four years to complete. 10

1. The Clinical Base Year is the first year of an anesthesiology residency.

1. It includes at least six months of diagnosis and treatment of patients with a variety of medical
and surgical problems, only one month of which may involve the administration of anesthesia. 10
2. The other six months of the Clinical Base Year must include rotations in both critical care and
emergency medicine, each lasting one to two months.10
2. The following 36 months (the CA-1, CA-2, and CA-3 Years) provide clinical training in anesthesia. 2
1. The first two years after the Clinical Base Year (CA-1 and CA-2) consist of basic anesthesia
training and sub-specialty rotations.10
2. Subspecialty rotations may include:
1. Obstetric anesthesia
2. Pediatric anesthesia
3. Cardiac anesthesia
4. Anesthesia for thoracic and vascular surgery
5. Neuroanesthesia
6. Ambulatory anesthesia
7. Acute pain management
8. Chronic pain management
9. Post-anesthesia care10
3. CA-3 involves increasing levels of responsibility and independent patient care. 10

Selecting Your Residency

o The Accreditation Council on Graduate Medical Education, which is responsible for accrediting all
medical residency programs, has a database that you can search to find accredited anesthesiology residency programs.11
1. Are you looking for a program associated with a teaching hospital, or would a community hospital
program meet your needs?
2. Do you have location preferences or constraints?
3. What level of commitment does the program require? Some programs still demand 80 hours a week from
their residents, while others have instituted part-time residencies to accommodate doctors with young children. 12
o After completing their residency and board certification exam, anesthesiologists may either begin
practicing or continue on for additional training in an anesthesia sub-specialty. In 2005, anesthesiologists in the United
States had a median income of approximately $260,000 a year. 1

Tips on Becoming an Anesthesiologist

 Take advanced-placement math and science in high school
 Obtain a bachelor's degree

1. Consider majoring in science during college
 Select a college with a good record of getting students into medical school
 Take the MCATs after your junior year of college
 Maintain a high GPA in college
Website yang digunakan :
http://bmspm.net/afterspm.htm

http://careers.stateuniversity.com/pages/467/Anesthesiologist.html

http://www.studymalaysia.com/what/index.php?studyfield=13&elevel=&ckeyword=medicine

http://www.goftp.com/qna/How_many_credits_do_you_need_to_become_an_anesthesiologist-qna680652.html

http://www.malaysia-scholarship.com/Latest_Malaysia_Scholarship_for_Malaysians.html

http://findyouruniversity.info/

http://www.health-medicine-wellness.com/NSU,_Nova_Southeastern_Universi.html

http://education-portal.com/articles/Top_Schools_with_Anesthesiologist_Assistance_Programs.html

http://search.yahoo.com/search;_ylt=A0oGdXdz1w1N21QARhdXNyoA;_ylc=X1MDMjc2NjY3OQRfcgMyBGFvAzAEZ
nIDeWZwLXQtNzAxBGhvc3RwdmlkA0pOWTZhVW9HZFRETnhGX2VUT1V6VHdCdlA5bm9WRTBOMTNNQUJpYWIEbl
9ncHMDMARuX3ZwcwMwBG9yaWdpbgNzcnAEcXVlcnkDYmlybWluZ2hhbSBhcyBhbmVzdGhlc2lvbG9naXN0BHNhb
wMxBHZ0ZXN0aWQDVklQMDI2?p=birmingham+as+anesthesiologist&fr2=sb-top&fr=yfp-t-
701&fp_ip=my&rd=r1&meta=vc%3Dmy