It is almost impossible to imagine today’s healthcare without surgery. Equally impossible is to imagine surgery without anaesthesia.
In modern era, the knowledge of patients and public is very limited about anaesthesiology and anaesthesiologist. Role of anaesthesiologist is very important during any kind of surgery. When patient goes to hospital, he will inquire about the surgeon for his surgery, but who will anaesthetize and look after the patient before, during and after the operation? Patient does not know though his life is in hands of anaesthesiologist. It is the role of anaesthesiologist to anaesthetize and take care of the patient. So, whenever patient consults surgeon for his surgery, he must enquire about his anaesthesiologist from him.
Indian Society of Anaesthesiologists, the national parent body also instructed the members all over India to arrange public awareness programs, that will make the public aware of the importance of our subject, us and our role. Press and media can also help.
People have lot of doubts, misbeliefs, misconceptions and apprehensions about the subject. So, presenting this text for public awareness about anaesthesiology and anaesthesiologist.
On October 16, 1846 Dr. William TG Morton used ether for anaesthesia for the first time. He is known as the father of anaesthesiology and every year on the same day, whole world celebrate as World Anaesthesia Day.
Today anaesthesiology is a fast growing speciality. There is lot of modernization and development to keep the patients safe during anaesthesia.
The mortality rate due to anaesthesia is 1 in 10,000 in developing countries and 1 in 2,00,000 in developed countries. In future there will be further decline in this mortality rate.
Lets try and answer some basic queries
WHAT IS ANAESTHESIOLOGY?
Anaesthesia related knowledge and information is called anaesthesiology.
WHAT IS ANAESTHESIA?
Controlled unconsciousness is called anaesthesia. There is triad of anaesthesia i.e. sleep, pain relief and relaxation, so that surgeon can operate with ease. This is also called balanced anaesthesia.
Many factors influence the effects of the drugs used to provide anaesthesia i.e. age, weight, pregnancy, race, alcohol, tobacco, medication etc.
The anaesthesia technique is used depending upon the part of the body to be operated. The patient is thoroughly examined for high blood pressure, diabetes, any other disease related to kidney, liver, heart, respiratory system, nervous system etc., so that anaesthesia technique is chosen accordingly and so are different types of drugs and quantity used during anaesthesia.
Side by side during operating period, different monitors are used to examine and control the activities of all parts of the body, so that patients remain safe during and after anaesthesia.
Patient should be empty stomach for 3 to 4 hours before operation,so that he may not vomit during surgery/anaesthesia.
By anaesthesia technique, any one part of the body or whole body is anaesthetized.
Drugs used for anaesthesia are usually safe but some times adverse effects and serious complications can occur. One drug can act differently in different patients. So, it is very difficult to predict about the out come of anaesthesia.
WHO IS ANAESTHESIOLOGIST?
The medical person who administers anaesthesia is called anaesthesiologist. After passing MBBS one has to undergo 2 to 3 years course for securing DA (Diploma) or MS/MD (Degree) respectively. Such qualified doctor is called Anaesthesiologist. Many anaesthesiologists are now called super specialists by working for 6 months or more in specific field of anaesthesiology i.e. cardio-vascular throracic, neuro, paediatric, pain relief etc. etc.
Inspite of qualified anaesthesiologist, the anaesthetic morbidity and mortality cannot be stopped, reduced and prevented completely but in most cases it can be handled and prevented. Hence anaesthesiology is difficult and dangerous speciality.
The anaesthesiologist assesses the risk of the patient undergoing surgery/ anaesthesia and optimizes the patient’s condtion before, during and after surgery/anaesthesia.
TYPES OF ANAESTHESIA
Nerves carrying the impulses are blocked locally, is called local anaesthesia. In this method the anaesthetic drug is usually injected into the tissues to numb the specific part of the body.
Nerves carrying the impulses are blocked at the level of spinal cord, is called regional anaesthesia. There are many types of regional anaesthesia but two methods are very popular-
Spinal Anaesthesia & Epidural Anaesthesia
In both the methods, the anaesthetic drug is injected with great exactness in the appropriate area of the back resulting in loss of sensation in the lower parts of the body.
During local and regional anaesthesia, the patient remains awake or may be given sedatives if needed. Usally the drugs used for local and regional anaesthesia are safe but can react adversally some times and serious complications can occur but if diagnosed in time, they can be prevented and controlled.
In this technique the patient remains unconscious by anaesthetic drugs and has no awareness or any sensation. Many drugs are used including anaesthetic gases and vapours.
For minor and short duration surgery, the patient is put to sleep by giving injection into vein in the arm or by allowing patient to breath anaesthetic gases and vapours through a face mask. For major and long duration surgery, the anaesthetic gases and vapours are administered into the lungs by a face mask or a rubber/plastic tube introduced into the wind pipe. Sometimes drugs which stop breathing by relaxing muscles are injected, then the anaesthesiologist breathes for patient artificially by pumping oxygen into the lungs manually or by machine.
The duration and level of anaesthesia is controlled carefully. After the surgery, the general anaesthesia is terminated by withdrawing anaesthetic agents and administering suitable antidotes. This allows the patient to wake up from anaesthetic state.
For genral anaesthesia, special instruments i.e. anaesthesia machine, monitors etc. are used.
To- day anaesthesia is much more safe because of new drugs, agents, special equipments and vigilant anaesthesiologist but anaesthetic mishaps can occur. The chances of anaesthetic complications depend upon patient’s health prior to operation and complicated surgery.
To help anaesthesiologists to provide the best and safest patient care possible, international and national standards/guidelines have been developed to enhance the safety and quality of anaesthesia. These standards/guidelines along with sophisticated monitoring and anaesthetic equipments as well as improved medications, techniques and vigilant anaesthesiologist, have contributed enormously toward making anaesthesia safer than ever before.
Anaesthesiologist’s work place is not only limited to operation theatre but plays a great role in different capacity at different places.
He looks after patients before, during and in immediate post operative period. He also takes consent for anaesthesia from patients and relatives. Anaesthesiologist can not refuse for anaesthesia but gives anaesthetic risks and inform patient, relatives and surgeon accordingly. Anaesthesiologists are involved in the care of patients in ICU particularly those who need mechanical ventilation. He also provides training to all category of people in cardio pulmonary brain resuscitation. He manages pain clinic, relieves pain casued by advanced cancer and other non surgical cases. He plays a great role in relieving pain of normal child birth. Anaesthesiologist provides a helping hand in trauma, rescue and disaster management. Anaesthesiolgist also provides his services during ECT, MRI, and CT Scan.
Patients select their surgeon for surgery, I hope in coming years, the patients will also choose their anaesthesiologist for anaesthesia.
This text is a small effort for public awareness to know about anaesthesiology and anaesthesiologists.