Anesthesiologist's role

Definition

The anesthesiologist's role is the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during, and after surgery.

Training

Anesthesiologists are fully trained physicians. After completing a four-year college program and four years of medical school, anesthesiologists undergo four additional years of specialized residency training. Some will spend one to two more years training in such anesthesiology subspecialty areas as obstetrics, neurosurgery, cardiac surgery , pediatrics, or critically ill patients, or to learn more about the treatment of pain. Others may select to work in research laboratories, investigating, for example, how anesthetics work and how they influence disease or recovery.

In the United States, the education of anesthesiologists takes into account their ever-expanding role

in offering the best-quality health care available anywhere in the world.

Description

The medical expertise of recent generations of anesthesiologists has significantly expanded the role of the anesthesiologist. Historically, the anesthesiologist's role was limited to that of the physician who administers anesthesia to suppress pain and consciousness in a patient undergoing surgery. Now, anesthesiologists also provide medical care in settings other than the operating room. The American Society of Anesthesiologists defines the anesthesiologist as the perioperative physician—the “all-around” physician responsible for providing medical care to each patient undergoing surgery at all stages. This includes providing the medical evaluation of the patient before surgery (preoperative), holding consultations with the surgical team, providing pain control and support of life functions during surgery (intraoperative), supervising care after surgery (postoperative), and discharging the patient from the recovery unit.

Specifically, the anesthesiologist's role has moved beyond just the operating room and into other areas of care.

• Ninety percent of the approximately 40 million anesthetics used annually in the United States is administered by anesthesiologists. During a surgical procedure, the anesthesiologist continually assesses the medical status of the patient, monitoring and controlling vital life functions, as well as managing pain.
• Postoperatively the anesthesiologist determines when a patient can return home following an outpatient procedure and when a patient can be moved to another ward following a procedure that requires hospitalization.
• The anesthesiologist is also involved in postoperative pain management, prescribing the appropriate pain-relieving medication and therapies.
• The anesthesiologist prescribes individualized drug therapies to patients suffering from acute, chronic, and cancer pain.
• During childbirth, the anesthesiologist must provide pain relief with epidural or spinal blocks for the mother while managing the life functions of both the mother and the baby.
• In critical care and trauma medicine, the anesthesiologist makes immediate diagnoses while supporting respiratory and cardiovascular functions, controlling infection, providing airway management, cardiac and pulmonary resuscitation, advanced life support, and pain control.
• The anesthesiologist is also present during cardiac catheterizations, angioplasties, radiological imaging, gastrointestinal endoscopies, in vitro fertilization, electroshock therapy, and respiratory therapy.
• The anesthesiologist participates in research and clinical studies, as well as medical education programs and legislative activities.

In the past, complications caused by the use of anesthesia were a medical issue; however during the past 25 years, complications have significantly declined. Despite the growing need for anesthesia and the doubling of the total number of anesthesiologists practicing within the United States since 1970, patient outcomes have improved. During the past 10 years, the number of deaths resulting from anesthesia have dropped from an estimated one in 10,000 to one in 250,000.

KEY TERMS

Anesthetic —A drug that causes unconsciousness or a loss of general sensation.

Anesthesia —Loss of normal sensation or feeling.

Angioplasty —The surgical repair of a blood vessel.

Catheterization —Placement of a flow-directed catheter for measuring pulmonary arterial pressures.

Endoscopy —The visual inspection of any cavity of the body by means of an endoscope.

Intraoperative —During surgery.

Postoperative —After surgery.

Preoperative —Before surgery.

Resources

BOOKS

Jaffe, R. A. and S. I. Samuels, eds. Anesthesiologist's Manual of Surgical Procedures. Philadelphia: Lip pincott Williams and Wilkins Publishers, 1999.

Morgan, G. E., M. S. Mikhail, M. J. Murray, and P. C. Larson. Clinical Anesthesiology. New York: McGraw-Hill, 2001.

Stoelting, R. K. and R. D. Miller. Basics of Anesthesia. New York: Churchill Livingstone, 2000.

PERIODICALS

Guzzi, L. M. “The Anesthesiologist's Role in Nuclear, Biological and Chemical Warfare: A Response.” ASA Newsletter 66, no. 3 (March 2002).

ORGANIZATIONS

American Board of Anesthesiology. 4101 Lake Boone Trail, Suite 510, Raleigh, North Carolina 27607-7506. (919) 881–2570. http://www.abanes.org/.

American Society of Anesthesiologists. 520 N. Northwest Highway, Park Ridge, IL 60068-2573. (847) 825-5586. http://www.asahq.org/.

OTHER

“Anesthesiology.” [cited April 24, 2003]. http://jhhs.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/surgicalpro/anesthesiology.html.

Florida Society of Anesthesiologists. “The role of an anesthesiologist.” [cited April 24, 2003]. http://www.fsahq.org/role.htm.

Monique Laberge Ph.D.