Anaesthesiologists: unseen heroes of OT

October 16 marked the anniversary of the first successful demonstration of ether anaesthesia at Massachusetts General Hospital in 1846, celebrated annually as World anaesthesia Day. The possibility of surgery without pain was considered one of the greatest contributions to humanity and the practice of medicine.

Transformations in the field of clinical anaesthesiology followed rapid advancements in medical technology and pharmacology, and a better understanding of human physiology and disease. Its complexity and diverse applications resulted in the creation of anaesthesiology as a distinct medical speciality, a much-coveted professional choice after graduation.

From the perspective of patients, however, there is apprehension about ‘going under anaesthesia’ and the anaesthesiologist remains an enigma. Lack of general information has resulted in common myths and misconceptions that cause unnecessary fears at the time of admission into hospital for surgery. Let us look at a few:

Are they doctors? Anaesthesiologists are not just doctors, but they are specialists like surgeons, orthopaedics, or gynecologists. They have undertaken the same number of years of study and training, and have comparable experience and authority. Today, there are even super-specialities like neuro-anaesthesia, cardiac anaesthesia, intensive care and paediatric anaesthesia.

When do we meet them? Patients may only remember the masked and capped head in the operation theatre, with the kindest eyes and voice, asking them to ‘count backwards from 10…’ In fact, the anaesthesiologist is one of the consultants who visit you before surgery to examine you, ask about your past medical history and evaluate your physical fitness for anaesthesia, and describe the plan along with some instructions.

What do anaesthesiologists do? Depending on your medical condition, general health and proposed surgery, anaesthesiologists will ensure that you experience no pain during surgery and the surgeon can operate efficiently. Under general anaesthesia, you will be unconscious, and will only be woken up after the surgery is over. In regional anaesthesia, the sensation is blocked only on the operated part of the body, but you will still be comfortable.

Will I wake up during the surgery? The anaesthetic drugs are titrated so that you will not be conscious during general anaesthesia. Studies reveal that less than 0.05% of patients wake up during surgery. Even when they do, it is possible for the anaesthetist to recognise and correct this situation.

Is it always ‘the anaesthesiologist’s fault’? Just as the risk of surgery is explained to you depending on the type of surgery and your physical condition, there is also risk associated with anaesthesia. Some risks can be minimised by simple measures like rehydration, controlling high blood sugars and blood pressure, and using medications. Risk can be higher in elderly, emergency surgeries, complicated surgeries and
very sick patients. This is always explained to the patient or relatives before consent is signed. Every care is taken to use appropriate anaesthetic drugs and monitor patients throughout. For this reason, blaming the anaesthesiologist for every death in the operating room would be grossly unfair.

Do they only work in the operation theatre? While most of the work happens in the operating room, emergency and intensive care is another medical discipline that requires the unique expertise of the anaesthesiologist. Here they are involved in resuscitation, artificial ventilation, invasive monitoring and medicating patients who are critically ill, terminally ill, or accident victims. Anaesthesiologists also work in pain clinics using medications and other procedures that relieve pain in chronic or terminally ill.

Is there anything patients can do? Always request to see your anaesthesiologist if you have a surgery planned and ask about the kind of anaesthesia, the procedure and the risks. Share information about your medical history, allergies and medicines you are taking, including previous operations and family medical history. Follow instructions carefully regarding fasting and medications before surgery.

Anaesthesiologist are the unseen, unsung heroes of the operating room, working with other surgical specialists for your well-being. Technology may have invaded the operating room in the form of high-tech monitors, anaesthesia delivery machines and ultrasound guidance, but the best protection for the patient is always an experienced anaesthesiologist; ever watchful and swiftly responsive. A patient fully awake after the operation, pain-free and comfortable, is ample reward.

(The writer is member, Indian Society of anaesthesiologists, Bengaluru)

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