Care 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.
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.
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.
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.
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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.
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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.
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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.