What is Anesthesiology?
Anesthesiology is the practice of medicine dedicated to the care of the surgical patient before, during and after surgery.
Who are Anesthesiologists?
Anesthesiologists are medical doctors who have completed a four-year college degree, four years of medical school and four years of an anesthesiology residency. They are specialists trained in all aspects of perioperative care. This includes evaluating patients prior to surgery, monitoring vital signs and controlling pain during the surgical procedure, as well as supervising the postoperative care. Anesthesiologists are trained to assess each patient’s medical conditions and carefully design an anesthetic plan that is safe and effective.
Anesthesiologists not only immediately diagnose and treat medical problems that arise during surgery; they also provide medical care and pain relief in the recovery room. Many anesthesiologists chose to complete fellowships (specialty training) in areas such as critical medicine, obstetric, pediatric, cardiac, neuro anesthesia, or pain medicine. They provide more than 90% of the estimated 40 million anesthetics performed in the United States each year.
What is the Anesthesia Care Team?
Anesthesiologists frequently work with certified registered nurse anesthetists (CRNA’s) as an anesthesia care team during surgery. CRNAs are advanced practice nurses who have completed specialized training in the field of anesthesia and assist the anesthesiologist in carrying out the plan that was established during the preoperative interview.
What is the Preoperative Interview?
Since your anesthesiologist is responsible for your safety and comfort during surgery it is important that they conduct a preoperative interview prior to entering the operating room. During the preoperative visit, an anesthesiologist will ask several questions to help evaluate your medical conditions, medications and anesthetic history. After evaluating your medical history the anesthesiologist will discuss the anesthetic options, as well as the risks and benefits of the anesthetic choices.
What are the Types of Anesthesia?
Levels of anesthesia (least to most) include: local, conscious sedation, regional and general anesthesia. The choice of anesthesia depends on the nature and duration of the procedure, as well as your health. These options will be discussed during your preoperative anesthetic interview.
This type of anesthesia is used to block pain to a specific area of your body, and allows you to remain fully alert. This type of anesthesia is usually used for very small, superficial procedures.
This type of anesthesia is used to help you relax and make you feel sleepy. It typically includes administration of medications through an intravenous line to help minimize discomfort. You are not completely asleep, even though you may not remember much of the procedure. Conscious sedation is frequently combined with regional or local anesthesia.
This type of anesthesia is used to block sensation to a specific region of your body, such as an arm, leg or the entire lower half of your body. Local anesthetic medication is injected near a single nerve or group of nerves that supply the area involved in the surgical procedure. A spinal, epidural or caudal may be administered to eliminate pain in the lower half of your body for procedures on a leg, pelvis or for childbirth. An axillary, interscalene or bier block may be administered to eliminate pain for procedures on an arm, hand or shoulder.
The benefit of regional anesthesia is that it will provide dense anesthesia to a limited area, while having no or little effect on other areas, such as your heart, lungs and brain. It also helps control postoperative pain because the area remains numb for a period of time after the surgery.
This type of anesthesia is used for larger procedures or procedures that are not amenable to regional anesthesia. Medications are given either through and intravenous line or are inhaled through a mask which will make you go to sleep. These medications affect all areas of your body, including heart, lungs and brain. Because you are completely asleep, a general anesthetic requires the use of a mask or breathing tube.
Is Anesthesia Safe?
Anesthetics and anesthesia techniques are inherently dangerous because they have the potential to cause death or serious permanent injury. Nevertheless, in the last decade, deaths due to anesthesia have decreased 25-fold, from 1 in 10,000 to 1 in 250,000. In just over 40 years anesthesiologists have developed drugs, procedures and sophisticated monitors to improve the safety of the surgical patient. Anesthesia deaths have decreased to the point that 1:250,000 perioperative deaths are attributed to anesthesia. They use very sophisticated monitors to ensure your safety.
What is Awareness?
It is very rare to have awareness during a general anesthetic. It is important to remember that only a general anesthetic is intended to eliminate awareness and relief of pain. It is also common to remember the period of time when you are going to sleep and waking up from a general anesthetic. Memories during conscious sedation, local or regional anesthesia are not unusual and shouldn’t be cause for concern. If you do experience awareness during general anesthesia, be sure to discuss it with your anesthesia provider or surgeon.
If you have more questions, we recommend that you visit the American Society of Anesthesiologists – Patient Education Website. At the ASA website, you can find important and useful information to help you become a more informed patient about the medical care you receive before, during and following surgical and diagnostic procedures.