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<center>**Now, let's talk about one of the most underappreciated people in the medical field; the anesthesiologist.**</center>
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Hi guys,
It's been a few days since my last article and it has been a very busy week for me. I have to run here and there, working while organising an event for my hospital and now, I have 2-days break which is kinda awesome (because my weekly holiday was usually once per week and now it's two). Yeay for me! Today we're going to talk about one of the most underappreciated jobs in the medical field which is the anesthesiologist. I mean people usually remember the name of the people who cut them (surgeons), but never the people who take care of their vital signs, put them into a deep sleep coupled with a few other drugs which would allow you to be at ease and make it possible for surgeons to operate without much hassle. Anesthesiologists are pretty much the unsung heroes of the medical field.
<center><a href="https://en.wikipedia.org/wiki/Cardiothoracic_anesthesiology#/media/File:Cvt_anesthesologist.jpg">Sciarra - Wikipedia (CC0)</a></center>
When I asked my laymen friends some questions about anesthesiologists to test their knowledge in general, only a few of them knew that they were the one who will be staying with you from the moment you enter the operating room, looking at the monitor, guarding anxiously while you were being operated, take a good care of you while you were in the post-operative recovery cubicle and send you off to the ward when finally your vital signs have been stabilised. They were the host of the operating rooms and they pretty much knew anything and everything regarding it, brought you while you were anxious, accessing your general health condition and finally, giving their consents to the surgeon to start the procedure.
> *The secret life of an anaesthetist: if surgeons are the blood, we are the brains*
Anyone of you (who have been operated before) have ever say your gratitude to your anesthesiologist? Most of you don't, right? People were grateful to the surgeon when certain surgeries succeed but they don't know (or just being ignorant) to the fact that they were others who contributed just as much to the success of that particular surgery. An anesthesiologist is a vital role in the operating room. A good anesthesiologist would be able to allow surgeons to focus wholeheartedly on the operation they were assigned to without being concerned with the other factors that might have just arisen from the surgery itself. Every single necessary thing was prepared beforehand by an anesthesiologist to provide surgeons with a better access to the surgical field while maintaining an almost ideal condition for the surgery to be carried out.
<center><a href="https://www.flickr.com/photos/dfataustralianaid/10666543983">Department of Foreign Affairs and Trade - Flickr (CC BY 2.0)</a></center>
Studying to become an anesthesiologist can be quite frightening due to the fact that they were dealing with all kind of drugs necessary to keep the patient in the best condition as they could be. An undercalculated dosage of anaesthetic drug can interfere with the surgical process (I mean it would be harder for the surgeon to operate if the patient is moving due to miscalculation of muscle relaxant) and an overdose can lead to fatal complications which can include brain death. If for the sake of argument, an emergency situation arises, all of the operating room staffs would turn their head towards the anesthesiologist for some action plans while letting the main surgeon focus on fixing whatever visible problems that could be fixed; it's like the operating room was governed by two leaders.
In 2013, a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3919360/">study</a> was carried out by B.R. Uma and Anitha S. Hanji to measure the awareness and knowledge level among the population in Davangere regarding anesthesiologists. Questionnaires were distributed among 200 patients from various educational backgrounds who underwent various procedures between January to May 2013. About 54% of patients didn't know that anesthesiologists would stay inside of the operating room, monitoring patients while allowing the surgeon to operate under a favourable condition. Between 69 to 82% of patients felt like anaesthesiologists will not influence the outcome of the surgery and about 79.5% of patients don't really aware that anesthesiology is a part of specialised medical fields.
## Simplified Overview Of Anaesthesia
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<div class="pull-left"><center>https://cdn.steemitimages.com/DQmNMgnPHgLhKC4JFKLnsC36QxDcBTycw8xY8Prb75FbHqW/image.png<a href="https://pixabay.com/en/nurse-syringe-doctor-medical-527621/">Pixabay</a></center></div>
To make it simple for laymen, there are two kinds of anaesthesia which are called the general and regional anaesthesia. General anaesthesia is when an anaesthetic would give a patient a few drugs to put you into a deep sleep while blunting their pain sensation to prevent complications such as hypertension, tachycardia and generally, imposing a stressful condition to the patient. Even though people always associate anaesthesiologists with drugs and all, their roles were beyond that. In the most hospital, anesthesiologists were the head of the intensive care unit (ICU) which houses most of the critically-ill patients requiring strict monitoring and intensive care. Of course, their main concern and interest after you have been operated on were the severity of pain but sometimes, they were the one who is required to take the administrative role in combining a few teams together for patients' benefits.
**General anaesthesia (GA)** is the main and probably the most favourable route that a patient prefers to take especially if they were having their first surgery. In some procedure, people can opt to choose GA as their preferred way of going through a surgery but sometimes they were suggested for another kind of anaesthetic technique called the regional anaesthesia (spinal, epidural, combined spinal-epidural, peripheral block). They were kinda more specific in terms of location where the numbing action would be applied to; for example, in a wound debridement surgery (a surgical procedure whereby a surgeon would remove infected and necrotic tissues to preserve the integrity of a healthy one) which involves the lower limb, a spinal anesthesia is usually suggested. They have a shorter duration of numbing action, few complications but scary as hell as they would not put you into a deep sleep.
<center><a href="https://pixabay.com/en/doctor-dentist-dental-clinic-1149149/">Pixabay</a></center>
GA might sound simple, "put the patient into a deep sleep and then you were done", but the preparation and the procedure itself is quite complicated. There were so many drugs to choose from and the type of drugs being used by an anesthesiologist must factor every single medical condition that the patient was having to predict potential complications so that either a new anesthesiological plan can be made or a few drugs which can control foreseeable complications can be prepared beforehand. In essence, there were three kinds of drugs which make up the general anaesthesia:
- Opioids
- Hypnotics
- Muscle relaxants
The drugs will usually be delivered in that specific orders to facilitate the process while maintaining the best condition for the patient throughout surgery. An opioid is given to lessen the pain of the surgery and the reason why they were given first among the three is to ease up pain which might be posed by the hypnotic such as propofol which can produce a painful sensation when they are being delivered. There were a few kinds of opioids which are used and the most common one being used in a surgical setting in my hospital is a drug called the *Fentanyl*; It has a fast onset of action and poses a few complications.
<div class="pull-right"><center>https://cdn.steemitimages.com/DQmb6HZaCP2x7tE9Z5Lutk14VbzGnFVY9n4AmJeK5WJ5BEk/image.png<a href="https://commons.wikimedia.org/wiki/File:Propofol.jpg">Erich Gasboy - Wikimedia (CC0)</a></center></div>
I think *Propofol* is one of the most well-known hypnotics even among laymen; after all, it is the drug related to Michael Jackson's death. There were a few others (inhalational and intravenous alike) which might have been used in a different clinical setting (for example, Ketamine is used commonly when operating on a battlefield) or targeted population (inhalational gases were usually used on paediatric population) but propofol has a quick onset of action, making it one of the favourite hypnotics to be used in a major surgery (unless if you have some kind of allergy to soybean of course. Propofol has some soybean in it). Among the three, muscle relaxants are usually important for both anaesthetist and surgeon so that they can facilitate or carry out a procedure with ease. A muscle relaxant is used to facilitate intubation and to provide suppress movement so that the surgeon can carry out their cutting work efficiently. I'll explain regarding general anaesthesia in a great detail sometimes in the future.
For regional anaesthesia, there are two which were considered as the commonest method employed by anesthesiologists and one of them is usually used post-operatively for pain management; spinal and epidural anaesthesia. Other than being delivered in a different potential space at the back and different duration of action, both spinal and epidural anaesthesia were quite similar; they even have the same noted complication if they were carried out wrong. Between the two epidural is a much difficult procedure to be carried out as the method used was quite relative; it will depend on how good the anesthesiologist is. They have to find an exact potential space which doesn't have any resistance to it, before deploying a catheter into it. I've seen a few epidural and rarely people found the space in a single try; usually it will take a few tries and if it keeps on failing, they might want to change their anaesthetic plan possibly converting it to spinal or general anaesthesia (unlike epidural, spinal pose a short duration of anaesthetical benefits and it can't be prolonged due to the absence of catheter).
<center><a href="https://pixabay.com/en/laryngoscope-medical-1099950/">Pixabay</a></center>
I won't explain much about both of the anaesthetic technique, as they will be covered in my future articles, but I can say that, despite our judgement, carrying out the procedure is much more difficult than it seems and mind you, anesthesiologists need to master their own drugs while retaining a high level of proficiency in using instruments to aid physiological processes like breathing. In a war, an anesthesiologist can be thought of as the weapon master and sometimes a sniper, monitoring the condition from afar, preparing to assist anytime when they are required to.
## Overview Of Misconceptions Related To Anaesthesiology
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https://youtu.be/3DcBpcV1z10
<center><a href="https://www.youtube.com/watch?v=3DcBpcV1z10">Marian Regional Medical Center - Youtube</a></center>
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Surgery can be a scary ordeal for laymen especially if it is poorly understood. There were a lot of speculations which have been circulating among the public regarding anaesthesia, which is one of the most important components that could determine the outcome of a surgery. Gossips, fake news and other types of ambiguous information have been a crucial component of a society making it difficult and worse for people. The truth is, giving patients anaesthesia is safe as long as it is managed by a well-trained and well-informed professional that is well-equipped to handle all sort of risks and complications that might arise from the usage of anaesthesia. Afterall, becoming an anesthesiologist is not that easy, you have to be committed to a long-life education and research.
According to a research in 2010 which has been published in the Journal of Advanced Nursing, 85% of patients who were having surgery in May 2010 have been reported of feeling anxious prior to being anaesthetised and among them, 1 out of 5 patients was worried they will suddenly wake up in the middle of the surgery.
> Key concerns included dying while asleep, not waking up after surgery, waking up during surgery and anxiety while waiting to go into surgery or arriving at the theatre door.
<center><a href="https://www.news-medical.net/news/20100521/Common-misconceptions-about-general-anesthesia.aspx">Source</a></center>
It's actually a valid concern. A few minutes into the surgery, the effect of hypnotics would wear off causing the patient to gain consciousness but eventually, the deep sleep state would be maintained by inhalation agents such as *Sevoflurane* or a total intravenous infusion, by giving *Propofol* continuously. This would maintain unconsciousness and the patient's vital signs would be monitored throughout the surgery.
<center><a href="https://pixabay.com/en/surgery-hospital-doctor-care-1822458/">Pixabay</a></center>
It is important to give patients an ample amount of time with adequate information in order to make an informed decision but in some situation whereby patients were unconscious (in an accident for example), the decision regarding choices of anaesthesia would be made by the attending medical officer based on clinical judgement with consent from the patient's next of kin. It will be difficult to comprehend the information that will be provided by the medical officer possibly because they will be distracted by the patient's condition. However, it is vital for them to make an informed decision in a limited amount of time especially when the surgery that is about to be performed is a major one. In this situation, myths regarding anaesthesia can really affect the decision that would be made by anyone involved in a negative way.
Every myths and concern which have been the source of fear for people have its own reasons and explanation. In my future article, I would list a few myths along with some explanation with it which will include some sort of solution to the anaesthetic shortcoming. Til next time then.
## Sources
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- <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3919360/">“Anaesthesia and Anaesthesiologists: How Famous are We among the General Population?”- A Survey</a>
- <a href="https://www.theguardian.com/commentisfree/2016/sep/12/secret-life-anaesthetist-surgery-doctor">The secret life of an anaesthetist: if surgeons are the blood, we are the brains</a>
- <a href="https://www.news-medical.net/news/20100521/Common-misconceptions-about-general-anesthesia.aspx">Common misconceptions about general anesthesia</a>
- <a href="http://time.com/3006511/under-appreciated-professions-invisibles-zweig/">10 of the Most Under-Appreciated Professions</a>
- <a href="https://www.quora.com/Are-anesthesiologists-underappreciated-in-the-O-R">Are anesthesiologists underappreciated in the O.R.?</a>
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