Monthly Archives: June 2013

Facts about Anesthesiology and Anesthesiologists

 

Anesthesiology is the practice of medicine dedicated to the relief of pain and the total care of the surgical patient before, during, and after surgery. Without anesthesia, many of modern medicine’s greatest benefits would not exist. More than 25 million surgical procedures are performed each year in the United States. All of those patients were touched by the science of anesthesiology and the skill and dedication of their anesthesiologist.

The anesthesiologist is the perioperative physician (peri meaning “all-around”) who provides medical care to patients throughout their surgical experience. This includes evaluating the patient before surgery (preoperative), consulting with the surgeon, providing pain control and monitoring life functions during surgery (intraoperative), supervising care after surgery (postoperative), and medically discharging the patient from the recovery unit.

The education of today’s anesthesiologists has kept pace with their expanding role in health care. After completing a four-year college program and four years of medical school, they enter a four-year anesthesiology residency-training program. Fellowships in an anesthesia subspecialty involve an additional year of study.

As a result, complications from anesthesia have declined dramatically over the last 30 years. The youngest of premature infants in neonatal units survive intricate, lifesaving procedures while at the same time, 100-year-old patients successfully undergo major surgeries once thought impossible.

Today’s new safe, short-acting anesthetic medications and sophisticated monitoring devices enable anesthesiologists to provide patients with the best medical care possible.

http://medicine.yale.edu/anesthesiology/care/facts.aspx

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Anesthesia Fact Sheet

In the Past

 

  • Prior to the 1840s, doctors and dentists did not routinely use anesthesia when operating on patients. Most doctors attempted surgery only when it was absolutely necessary to save a person’s life, and operations were largely limited to amputations and removal of external growths. Although alcohol, opium or other botanicals sometimes helped alleviate the agony, most surgical patients remained conscious and endured excruciating pain.
  • Replica of the inhaler used by William T. G. Morton in 1846 in the first public demonstration of surgery using ether. Credit: Wood Library/Museum, Park Ridge, IL.Replica of the inhaler used by William T. G. Morton in 1846 in the first public demonstration of surgery using ether.

    Wood Library/Museum, Park Ridge, IL.

    In 1846, a dentist publicly demonstrated that ether would put patients to sleep during surgery, and the practice began to spread. Doctors soaked a sponge or a cloth with ether and had patients breathe in the fumes through an inhaler. The fumes knocked the person out, but there was no way to control the amount inhaled. If patients inhaled too little, they could wake up and flail about in pain; if they inhaled too much, they might never wake. To make matters worse, ether is highly flammable, and a spark in the operating room could cause a dangerous explosion. Despite the problems with ether, its use enabled surgeons to perform internal procedures that would have been too painful or complicated to conduct on conscious patients.

  • The introduction of less flammable anesthetic gases made operating rooms safer, and the discovery of intravenous anesthetic agents such as sodium thiopental made it possible for surgeons to control the dose. But well into the 1950s, doctors still usually sedated their patients using some type of anesthetic gas and monitored them with nothing more sophisticated than a stethoscope. Dangerous side effects were common and included heart rhythm and breathing problems, lowered blood pressure and nausea and vomiting.
  • For many decades after anesthetics became a routine part of surgery, practically nothing was known about how they work. Virtually all scientists believed that anesthetics blocked nerve cell signaling by disrupting fatty molecules in the membranes that envelop cells. This theory, first put forward in the early 1900s, dominated research on anesthetics for much of the 20th century. Anesthetics are difficult to work with in the laboratory, and the lack of tools to study them at the molecular level contributed to this period of slow scientific progress.

 

Today

 

  • Every year, millions of Americans undergo surgery safely with general anesthesia, although some risks remain. Many of these procedures, which have improved the health, longevity and quality of life of the U.S. population, would not have been possible without modern anesthetic techniques.
  • Scientists have learned that general anesthesia consists of several components, including sedation, unconsciousness, immobility, analgesia (lack of pain) and amnesia (lack of memory). They have developed agents that can provide each of these elements separately, which enables anesthesiologists to tailor the regimen to each procedure and patient.
  • Advances in cell biology, genetics and molecular biology have transformed anesthesiology into an active area of research. Scientists have largely abandoned the idea that anesthetics work by acting on fatty molecules in cell membranes. The bulk of the evidence now supports the idea that the drugs target specific protein molecules embedded in nerve cell membranes and interfere with neurotransmission. Researchers now believe that each anesthetic acts on a different set of molecules to bring about its characteristic effects.
  • New general anesthetics, both inhaled and intravenous, act quickly and disappear rapidly from the bloodstream, so patients can go home sooner after surgery.  Side effects are less common and usually not as serious as they once were. Despite these improvements, general anesthetics are still among the most dangerous drugs used by doctors, particularly for elderly patients and those with certain chronic, systemic diseases, such as diabetes.
  • The discovery that local and regional anesthetics can be used to block specific nerves has provided doctors with an alternative to general anesthesia for many procedures, especially minor ones.  With local and regional anesthetics, patients can remain conscious and comfortable during surgery. But these anesthetics can have side effects, and delivering them to the right spot is sometimes difficult.
  • Anesthesiologists have become leaders in the area of patient safety. Their training includes practice responding to emergency situations using computer-controlled mannequins called patient simulators.

    Anesthesiology students training with a patient simulator. Credit: Jeffrey Taekman.Anesthesiology students training with a patient simulator.

    Jeffrey Taekman.

    Patient simulators have lifelike features such as a pulse, blood pressure and heart and breath sounds, and they are programmed to respond to drugs and other medical interventions much like a real patient would.

  • Anesthesiologists carefully monitor patients throughout surgery using electronic devices that continually display vital signs. Major advances in monitoring include the continuous measurement of blood pressure, blood oxygen levels, heart function and respiratory patterns. These advances have dramatically improved the safety of general anesthesia and make it possible to operate on many patients who were previously considered too sick to undergo surgery.
  • The role of the anesthesiologist has expanded beyond the operating room to include caring for patients during postoperative recovery. Anesthesiologists also provide anesthesia for nonsurgical procedures such as endoscopy and various cardiac interventions, as well as during labor and delivery. In addition, anesthesiologists are often called upon by other specialists for advice on how to manage pain.

 

Tomorrow

 

  • As scientists learn more about the molecular mechanisms by which anesthetics cause their various effects, they will be able to design agents that are more targeted, more effective and safer, with fewer side effects.
  • Observations of the short- and long-term effects of anesthetics on subsets of the population, such as the elderly or cancer survivors, will reveal whether certain anesthetics are better than others for members of those groups. Research on how a person’s genetic makeup influences the way he or she responds to anesthetics will enable doctors to further tailor anesthesia to individual patients.
  • Research will yield a better understanding of why surgery sometimes triggers life-threatening postoperative events such as heart attack, kidney failure and respiratory distress. This may allow anesthesiologists to preempt and better respond to these dangerous conditions.
  • Scientists will gain a better understanding of the mechanisms that underlie pain and consciousness from knowledge of how anesthetics affect these physiological states. This could lead to new ways to alleviate pain and to new treatments for conditions associated with a decrease or loss of consciousness, such as epilepsy and coma.  Studies of the mechanisms of anesthesia may also provide insights into the nature of consciousness itself.

 

http://www.nigms.nih.gov/Education/factsheet_Anesthesia.htm

 

The Role of the Anesthesiologist – from Surgical Anesthesia to Critical Care Medicine and Pain Medicine

Anesthesiology3Care of the Surgical Patient

The anesthesiologist is the perioperative physician (“peri-” meaning “all-around”) who provides medical care to each patient throughout his or her surgical experience. This includes medically evaluating the patient before surgery (preoperative), consulting with the surgical team, providing pain control and supporting life functions during surgery (intraoperative), supervising care after surgery (postoperative) and discharging the patient from the recovery unit.

Preoperative Evaluation

Anesthesiologists play a vital role in assessing a patient’s medical readiness for surgery. They are unique in their advanced knowledge of both the medical illnesses a patient undergoing surgery may suffer, as well as the effects on the body of the specific operation to be performed. The anesthesiologist’s preoperative evaluation may be very brief (such as in the case of a surgical emergency) or very prolonged (as in the case of a patient with multiple chronic medical problems who is to undergo an extensive operation). In all cases, however, the anesthesiologist performs a focused history and physical examination, reviews available laboratory and special test results, and assesses the need for additional testing prior to proceeding with surgery.

Intraoperative Care

It is estimated that nearly 40 million anesthetics are administered each year in the United States. Anesthesiologists provide or participate in more than 90 percent of these anesthetics. In the operating room, they are responsible for the medical management and anesthetic care of the patient throughout the duration of the surgery. The anesthesiologist must carefully match the anesthetic needs of each patient to that patient’s medical condition, responses to anesthesia and the requirements of the surgery.

In many surgical settings, anesthesiologists work in the anesthesia care team mode, medically supervising the work of nonphysician anesthetists such as nurse anesthetists and anesthesiologist assistants, who, though not physicians, have been trained in the technical administration of anesthetics.

Anesthesiologists have important functions outside of the operating room, but the majority of their vital work takes place in the surgical suite. Their main roles during surgery are:

  • Provide continual medical assessment of the patient
  • Monitor and control the patient’s vital life functions, including heart rate and rhythm, breathing, blood pressure, body temperature and body fluid balance
  • Control the patient’s pain and level of consciousness to make conditions ideal for a safe and successful surgery

Most of the time, the patient won’t even realize the anesthesiologist is providing these critical functions during surgery, but rest assured you have a physician by your side making sure your health and safety is protected at all times.

The Postanesthesia Care Unit (PACU) or “Recovery Room”

After surgery, patients are transferred to the Postanesthesia Care Unit, where they continue to emerge from the effects of anesthesia under the watchful eyes of the peri-anesthesia nurse with anesthesiologist consultation immediately available. Evidence of recovery – including activity level, adequacy of breathing, circulation, level of consciousness and oxygen saturation – is continuously monitored. Pain control is optimized. In most cases, the anesthesiologist decides when the patient has recovered enough to be sent home following outpatient surgery or has been stabilized sufficiently to be moved to a regular room in the medical facility or transferred to an intensive care unit.

Critical Care and Trauma Medicine

As an outgrowth of the PACU, critical care units are now found in all major medical facilities throughout the United States. Anesthesiologists are uniquely qualified to coordinate the care of patients in the intensive care unit because of their extensive training in clinical physiology/pharmacology and resuscitation. Some anesthesiologists pursue advanced fellowship training to subspecialize in critical care medicine in both adult and pediatric hospitals. In the intensive care unit, they direct the complete medical care for the sickest patients. The role of the anesthesiologist in this setting includes the provision of medical assessment and diagnosis, respiratory and cardiovascular support, and infection control.

Anesthesiologists also possess the medical knowledge and technical expertise to deal with many emergency and trauma situations. They provide airway management, cardiac and pulmonary resuscitation, advanced life support and pain control. As consultants, they play an active role in stabilizing and preparing the patient for emergency surgery.

Anesthesia Outside the Operating Room

As medical technology has advanced, so has the need for anesthesiologists to become involved in caring for patients during uncomfortable or prolonged procedures in locations outside the traditional operating suite. These procedures include radiological imaging, gastrointestinal endoscopy, placement and testing of cardiac pacemakers and defibrillators, lithotripsy and electroconvulsive therapy. In most institutions, anesthesiologists are available during cardiac catheterizations and angioplasty procedures should emergency airway management or resuscitation become necessary. It would be impossible to perform many of these tests on infants and young children without the use of anesthesia or various sedation techniques provided by an anesthesiologist.

Pain Medicine

Because of their specialty training and vast experience in controlling pain during surgery, anesthesiologists are uniquely qualified to prescribe and administer drug therapies or perform special techniques for acute, chronic and cancer pain. Here are two of the most common areas in which anesthesiologists treat pain:

  • Acute Pain Management
    In addition to relief of a patient’s pain during a surgical procedure, it is equally important for the patient’s comfort and well-being to receive adequate pain relief postoperatively. Anesthesiologists are responsible for ensuring that a patient’s pain is under control before they are discharged from the PACU. An anesthesiologist may prescribe specific pain medications or perform specialized procedures to maximize patient comfort, which helps to minimize stress on the patient’s heart and blood pressure. The techniques that are best suited for each individual patient are chosen to allow for proper rest and healing.
  • Chronic and Cancer Pain Management
    Anesthesiologists are the vanguard of those who are developing new therapies for chronic pain syndromes and cancer-related pain. Anesthesiologists who specialize in the treatment of chronic pain often dedicate their practices exclusively to a multidisciplinary approach to pain medicine, working collaboratively with other medical specialists in a pain clinic.

Obstetric Anesthesia

It is very common for anesthesiologists to provide expectant mothers with pain relief during labor and delivery. While many mothers choose to use natural childbirth techniques, the demand for epidural anesthesia for labor and delivery has increased dramatically over the last several years due to the proven safety and benefits of this resource. During childbirth, the anesthesiologist manages the care of two patients, providing effective pain relief for the mother while maintaining a high degree of safety for her unborn infant. In most cases, this involves administration of local anesthetics and/or narcotics via spinal or epidural routes. In the event of an emergency cesarean section, the anesthesiologist provides surgical anesthesia while managing the life functions of both the mother and the baby.

Ambulatory and Office-Based Anesthesia

The number of operations performed in ambulatory surgical centers and doctors’ offices continues to rise. Many of the patients being treated in these facilities are from an increasingly elderly population with more complex medical problems. Patients deserve the same high standard of care in these facilities that they receive in the hospital setting. Anesthesiologists are working with federal and state legislators and agencies and collaborating with other physicians and accrediting bodies to establish safety standards for such facilities.

Operating Room Management

In addition to providing patient care, the anesthesiologist often is responsible for managing the resources of the operating suite, including the efficient use of operating rooms, supplies, equipment and personnel. Unlike most surgeons, who spend much of their time seeing patients in private offices, anesthesiologists work in the operating suite every day. Their continuous presence, along with their wide-based appreciation for the needs of surgeons and other physicians who perform procedures requiring anesthesia, uniquely qualifies anesthesiologists for leadership positions in operating room administration and management.

Basic Science and Clinical Research

Some of the most significant strides in medicine and surgery are directly attributable to anesthesiology’s advances in patient monitoring, improved anesthetic agents and new drug therapy. Anesthesia research at the clinical and basic science levels has been completed almost exclusively by anesthesiologists or Ph.D. scientists with the goal of continually improving patient care and safety. Research is conducted in each of the subspecialties of pediatric, geriatric, obstetric, critical care, cardiovascular, neurosurgical and ambulatory anesthesia. Other areas of active study include blood transfusions and fluid therapy, infection control, difficult airway management, cardiopulmonary resuscitation, complications, new devices and methods of monitoring, pharmacology, patient safety, pain therapy and organ transplantation.

http://www.lifelinetomodernmedicine.com/Who-Is-An-Anesthesiologist/The-Role-of-the-Anesthesiologist.aspx