Anesthesiologist : the unsung hero of the surgical team.
In the recent developments at Bangalore where in two people
lost their life during and postoperatively brings the Anesthesiologist to the
lime light for the other reason, the Surgeon, hospital management, relatives,
and finally media, have judged the anesthetist as a criminal who has killed the
patients by overdose of drugs ! The mentioned team except the surgeon, do not
know the ABCD of anaesthesia,its methods, drug effects ,complications etc .without going in to the fact, what went
wrong during the conduct of anesthesia
at the Operation theatre, they came to the conclusion that it was
anesthesia problem. It's really
ridiculous that the poor anesthetist is targeted for no fault of his. This
practice of blaming anesthetist for the operation room mishap has been running
since ages... The Surgeon grabs the credit of the successful operation
and for the catastrophes he holds the anesthesia and the anesthetist
responsible. Pity the hapless Anesthesiologist who is at his mercy.
Anesthesiologist for the most of the time remains behind the
scene of surgery. He is not exposed to the patients most of the time. He is
called to give anesthesia, where in the patients is already on the operation table.
Rarely will he be asked to see the
patients pre operatively although it should be insisted in every case in the
interest of the of the patient's safety and
successful outcome of surgery.
Anesthesiologist is the one, who prepares the patients for
the proposed surgery, no doubt the Physicians and Cardiologist would have done
their job of clearing the patient fit
for the surgery by routine ECG and
Echocardiograms and other investigations, but the final say is from the anesthesiologist
as he is the one who faces the music in the Operating Room when patients end up
with problems during anesthesia, No
Physician and Cardiologist who had vouched fit, will come to the rescue of the anesthesiologist
and the ailing patient.
Normally the Anesthesiologist will examine the patient along
with all his investigations to find out whether this patient will tolerate
the proposed surgery and anesthesia. He
clinically examines the patient's respiratory, cardiac, GI, metabolic systems, enquires
about the diseases the patient suffering, the drugs he is on for the ailments, finally
orders and reviews some of the investigations before declaring him fit for
surgery.
After this pre
anesthetic checkup the anesthesiologist
will plan the procedure of anesthesia
and he will explain the details to the patient.
He will decide about the procedures such as GA, regional, epidural, spinal etc
.Normally a six hours of fasting is ordered to keep the stomach empty to
prevent aspiration of stomach juice in to the lungs causing the pneumonia,
infection and sometimes even the death.
Once the patient is wheeled in the OT the Anesthesiologist
takes charge of the patient in Toto. He starts and IV line ,connects the
patient to the multimonitors such as, ECG,SPO2.ETCO2,HR,BP .These
gadgets will always
reflect the physiology of the patient undergoing the surgery, where in the
surgeon is busy correcting the anatomical abnormality of the patient who has
come for corrective surgery.
Anesthesiologist puts the patients to sleep, takes control
of the airway ,sees that the patient does not move a bit during the operation
by using relaxant drugs, he sees that the patient does not feel any pain of the
surgery and blunts the recall of events
during the surgery, he infuses required IV fluids and blood that patients needs
during the surgery and lastly has a look at the kidney function by looking at
the urine output of the patient.
At the end of the surgery ascertaining everything is fine,
he will reverse the patient back to life from anesthesia induced sleep. He then orders shifting of the patient to the ICU
or the recovery room for the further monitoring and provides sufficient pain
relief medicines to keep the patient comfortable in the post operative period.
Patients preexisting disease condition may worsen during
surgery, patient may respond in a different ways than expected, surgical bleeding may be too
much to cope up with, irregular rhythm of the heart causing the cardiac arrest
and so on so forth, these will land the patient to the complications during the
procedure.
The eternal vigilant
anesthesiologist identifies the problems and takes corrective steps to bring the patient to the normal
physiology. Most of the time he is successful in doing so, which will be never
noticed and appreciated. But at times when he fails to revive the patient, the
entire world looks him down, and begin
all sort of mudslinging ,treats him as a criminal who took away the life of the
patient. People often forget that he is the only person in the operation room
who goes all out to save the patient, tries all his methods, in saving the life
of the patient. But how many people come to know about his efforts ?
Normally the lay public are not aware of the job
anesthetist does in the operation room it
is presumed that the anesthesia doctor
will either give one injection to the back or through the IV line and put a
mask over the face of the patient and that's all !!! no matter how complicated
and long the surgical procedure be.
Anesthesiologist is the real friend and not a foe of the
patient, who sees that the patient is through his surgery without any complications
.Every patient who undergoes surgery should be indebted to the anesthesiologist
for the safe journey through the painful surgery otherwise.
Lastly the Anesthesiologist is stepping out of the operating room to aid pain relief in chronic and cancer patients provide the painless labor child birth and helps to man the
critically ill patients in the Intensive Care Unit and Cardiac care unit.
