Definition and Overview
Anaesthesiology is the branch of medicine that specializes in minimizing pain and keeping the patient in a stable condition both during and after surgical procedures.
It is used in conjunction with almost all other branches of medicine as long as surgery and pain are involved. It may be used in diagnostic procedures, abdominal and brain surgeries, obstetrics, and so on. It plays a crucial role so that the surgery may be performed safely and with the least possible amount of discomfort for the patient.
The two most common types of anaesthetics used are local and general anaesthesia. Local anaesthesia prevents the patient from feeling any pain in a specific part or region of the body, whereas general anaesthesia places the patient in a state of controlled unconsciousness, rendering him unable to feel pain, and also paralyzing his muscles so that he will not be able to move for. The anaesthesia is usually administered in liquid form and is injected into the veins, but can also be administered in gas form that the patient breathes in through a special type of mask. These agents take effect almost immediately, and can cause a patient to lose consciousness within a minute.
The Responsibilities of Anaesthesiologists
It is the anaesthesiologist's responsibility to ensure the well-being and safety of the patient at all stages of surgery. More specifically, they are responsible for:
- Providing pain relief to allow surgery to be performed
- Assessing the risk of complications during surgery
- Identifying conditions or factors that may cause surgical complications
- Managing pain and stress during surgical procedures
- Ensuring the stability of the patient
- Providing the patient with life support during surgery
- Providing immediate postoperative care for the patient
- Assessing all medications that the patient is currently taking to prevent dangerous interactions with the anaesthetic agents
- Managing the side effects of anaesthetic agents
- Informing patients about the risks of anaesthesia
- Advising the patients about the possible side effects they may experience as the anaesthesia wears off
For most of the surgery, the anaesthesiologist will not play an active role in the procedure, but will constantly monitor the patient's condition and will stay with the patient until the surgery is over. Before the procedure ends, the anaesthesiologist typically gives the patient a fresh round of pain relievers to keep him comfortable upon regaining consciousness.
When should you see an Anaesthesiologist?
Patients should meet with an anesthesiologist in the following situations:
- When there is a medical emergency
- Before undergoing a surgical procedure
- Before undergoing a dental procedure
- Before childbirth, if the patient opts for painless childbirth
- For the treatment of acute and chronic pain
Anaesthesiologists are considered as medical physicians specializing in pain control. They are required to complete a four-year pre-medicine undergraduate program, followed by a medical degree and specialized training in anaesthesiology. Nowadays, they can be found working in varied settings. Aside from the traditional hospital or medical center, they also work in pain management clinics, outpatient surgery centers, dental clinics, labor and delivery centers, and intensive care units.
During a consultation with an anaesthesiologist, the physician will first evaluate the patient, and upon consulting with the surgical team who will perform the procedure, will then create a customized anaesthetic plan for the patient. This determines the most appropriate type of anaesthetic for the patient, the choices being local, general, epidural, spinal, or nerve blocks, and also the correct dosage to be administered. The evaluation is the most important part of the process, as it is during this stage that the anaesthesiologist reviews the patient's medical history, including his personal and family history of allergic reactions to pain relievers and anaesthetic agents.
The anaesthesiologist will also use the consultation to explain the different side effects and risks of anaesthesia, which include:
- A feeling of coldness accompanied by shivering
- Temporary memory loss
- Temporary effects on the patient's concentration
- Slowed reflexes
- Bladder problems
- Sore throat
Meanwhile, the possible risks and complications of anaesthetic agents may include:
- Inherited reactions, sometimes causing breathing problems
- Severe allergic reactions, or anaphylaxis
- Regaining consciousness during the surgery – This happens very rarely as patients are closely monitored during procedures and may be given more anaesthetics if required.
The risk of serious complications is higher in the following instances:
- During emergency surgery
- When the patient has a serious medical illness
- If the patient is a smoker
- If the patient is overweight or obese
Given these risks, it is normal for patients to receive instructions prior to undergoing surgery in order to prevent any complications and interactions due to the use of anaesthetic agents. Patients are usually advised to refrain from drinking alcohol and to stop smoking several weeks before their scheduled operation, and to lose weight if necessary.
American Society of Anesthesiologists. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013;118:291-307. PMID 23364567 www.ncbi.nlm.nih.gov/pubmed/23364567.
Malhotra V, Mack PF. Quality of care and patient safety. In: Miller RD, Pardo MC, eds. Basics of Anesthesia. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 47.