'Anesthetists are unsung heroes of the OT, intensive care'

The field of anesthesiology has been receiving unfair negative publicity in recent months following a series of reports of death in the operating room allegedly due to errors linked to anesthesia. The accusations and allegations tossed around were premature and unproven.

The President of the Indian Society of Anesthesiologists, Bangalore Chapter, issued an early statement that death in the operating theatre cannot always be blamed on the Anesthesiologist and the cause should be properly investigated. He cautioned against approaching the press in such an eventuality as it could do more harm than good. Around two lakh patients are anesthetised in Bangalore city alone every year and negative incidents are extremely rare. The allegation of anesthesia overdose has not been proved as yet in any of the three cases reported in the media.

In the hands of qualified doctors in well-equipped hospitals, administration of anesthesia is reasonably safe. The international standards of safe practice adopted by the World Federation of Anesthesiologists in 1992 is accepted and followed by the fraternity worldwide. The role of precaution and care in anesthesia is emphasised during the years of training and practice.

The risk of any complication due to anesthesia, estimated to be around 0.3 per cent, is minimised by thorough prior evaluation of every patient, optimisation of his physical condition, careful titration of anesthetics administered and continuous monitoring. Critically ill patients have a higher risk, between 9.4 per cent and 57 per cent under anesthesia, but the surgery may be undertaken when it is life saving. It is never easy to discuss and explain risk to patients preparing for surgery, or their relatives, but this is done in every case and written consent obtained.

Most patients are apprehensive about anesthesia as it involves loss of consciousness and control, viewed as a dreaded necessity for any surgical procedure. This is understandable but largely unwarranted, as state-of-the-art anesthesia today is tailored, smooth and atraumatic. When the case is elective, there is time for the anesthetist to gain the confidence of the patient and allay his anxieties. This is especially important in the case of children. However, in most cases, only one visit may be possible before surgery.

A thorough assessment and preparation of the patient plays a critical role in the successful outcome. Patients are graded according to the American Society of Anesthesiologists (ASA) rating of physical condition prior to surgery. It is not in the patient’s interest to conceal any previous medical history including allergies and drug reactions from their anesthetist during this evaluation.

As a vital part of the team in the Operating Theatre, the anesthesiologist, along with the surgeon, decides on the best possible anesthetic for the patient. Anesthesia is broadly categorised into two types - regional and general. In regional anesthesia, which includes Spinal and Epidural anesthesia, pain sensation at the operation site is blocked, and the patient is sedated. In general anesthesia, the patient is rendered unconscious during the surgical procedure.
Actual incidence
The complex anesthetic delivery apparatus and monitoring equipment is systematically checked before every surgery, a vital step in risk mitigation that is often likened to a pilot’s cockpit review. As with aviation, the possibility of accidents is high but the actual incidence is very low in the hands of a qualified, committed expert.
 In earlier days coca, alcohol and opium, among other drugs, were routinely used to reduce surgical pain. It was the work of Sir Humphrey Davy on ‘Laughing gas’ and that of the Father of Anesthesiology, John Snow using ether and chloroform, which resulted in the emergence of this new specialty of medicine in the early years of the last century. The quest to provide the most comfort to the patient and the best operating conditions for the surgeon led to the discovery and refinement of anesthetic drugs and procedures that, along with monitoring equipment, form part of the complex armamentarium of the anesthesiologist today.

Modern, safe and reliable anesthetic techniques makes possible complex and life-saving surgical procedures in cases of multiple traumas, cardiac and neurosurgery. It also enables surgery on the eye and ear as well as time-consuming reconstruction and microsurgery. The surgical heroics involved in separation of conjoined twins could not be attempted if not for safe anesthesia.

Today, the field of anesthesiology has super-specialties like pediatric, cardiac and neuro-anesthesiology and its consultants are in charge of intensive care units, pain clinics and emergency medicine departments of all major hospitals. The training and research in this field is rigorous and intensive with the primary focus on patient safety and complete recovery from anesthesia. Working behind the scenes in a complex, high stress profession, anesthetists are unsung heroes of the operation theatre and intensive care arena.

The recent negative publicity is most unfortunate and misleading as this specialty is a vital component of even the most basic surgical practice today. Further, it can create a fear psychosis in the minds of patients that is unwarranted and can compromise health if it ends in refusal to undergo anesthesia for life-saving surgical treatment.
(The writer is a senior anesthesiologist and medical ethicist)