Anaesthetists form the single largest hospital medical specialty and their skills are used in all aspects of patient care.
BY: Dr MEDHA HUILGOL
Whilst the perioperative anaesthesia care of the surgical patient is the core of this specialty (and this includes all types of surgery to the most complex in patients of all ages, including the premature newborn), many anaesthetists have a much wider scope of practice, which may include:
- The perioperative preparation of the patient;
- The resuscitation and stabilization of the patients in the emergency department;
- Pain relief in labor for obstetric patients;
- Transport of acutely ill and injured patients;
- Pre-operative hospital emergency care;
- Pain medicine, including:
- Relief of post-operative pain;
- Acute pain medicine and its management;
- Chronic and cancer pain management;
- The provision of sedation and anaesthesia for patients undergoing various procedures outside the O.R. E.g., endoscopic procedures, interventional radiology, dental surgery.
Anaesthesia enables the painless performance of surgical and medical procedures that would otherwise cause severe or intolerable pain to an unanaesthetized patient.Anaesthesia may be categorized as:
- General Anaesthesia -Temporarily suppresses the brain and central nervous system activity and results in unconsciousness and total lack of sensation;
- Sedation– Suppresses the central nervous system to a lesser degree resulting in anxiolytics without resulting in unconsciousness;
- Regional Anaesthesia – Local anaesthesia blocks transmission of nerve impulses between a targeted part of the body and the central nervous system, causing loss of sensation of the targeted body part. The patient remains conscious.
The likelihood of a complication occurring is proportional to the relative risk of a variety of factors, including:
- Co-morbids related to the patient’s health;
- Complexity of the surgery being performed;
- The type of anaesthesia.
Of the three factors mentioned above, the person’s health prior to surgery has the greatest bearing on the probability of a complication occurring.
Minor risks of anaesthesia include:
- Sore throat
- Nausea and vomiting
- Blurred vision and headache
- Breathing difficulties
- Allergic reactions
Major risks of anaesthesia include:
- Heart attacks, arrhythmia
- Pulmonary embolism
- Cognitive dysfunction, i.e., long term memory loss, especially in elderly / aged patients
It is to be noted that smoking and alcohol intake can further elevate an individual’s risk of negative outcomes.
Prior to surgery, the patient is thoroughly evaluated by the anaesthetist. The patient is examined with regard to his/her previous medical history. Some of the general factors that are explored by the doctor prior to surgery are:
- Current medications
- Mouth and dental airway inspection
- A clinical examination of the heart and lungs.
Patients are instructed to remain fasting for a minimum of six hours prior to surgery.
The following are some of the steps that one is required to follow to minimize the side effects of anaesthesia:
- Avoid getting out of bed quickly
- Begin the intake of food and fluid as early as possible or as instructed by the doctor;
- Eat light meals;
- Correctly take prescribed medications.
About the writer: Dr. Medha Huilgol is a veteran Anesthesiology specialist at Columbia Asia Hospital, Yeshwanthpur. She has various publications on general anesthesia and on ultrasound guided procedures in regional anesthesia in national journals. She has been responsible for organizing and coordinating annual conference for Columbia Asia – CAUSE on the use of Ultrasound Guided Procedures in Anesthesia, since 2009.