Texas Society of Anesthesiologists

Know Your Anesthesiologist

As physicians providing the lifeline of modern medicine, anesthesiologists are highly-skilled medical doctors dedicated to improving patient safety and the broad practice of anesthesiology in all practice settings.

Know Your Anesthesiologist

Anesthesiology is the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery. The medical expertise of the anesthesiologist has caused a dramatic expansion of the role of this specialist in health care delivery. Although historically anesthesiologists have been known primarily as physicians who administer anesthesia to alleviate pain and suppress consciousness of the patient undergoing surgery, they also provide medical care and consultations in many other settings and situations outside of the operating room.

Before your surgery, you will meet an important physician specialist — your anesthesiologist. A vital member of the surgical team, your anesthesiologist has the critical responsibility for your welfare when you undergo anesthesia. The anesthesiologist is your advocate in the operating room.

Who Are Anesthesiologists?

Most people think of their anesthesiologist only as the "doctor behind the mask" who helps them sleep through surgery without pain and who wakes them up when surgery is over. Let's lift the doctor's mask and take a look at the responsibilities and education of the anesthesiologist.

Today’s anesthesiologists are physicians who complete a four-year college program, four years of graduate doctoral training and four more years of anesthesiology residency. They apply their knowledge of medicine to fulfill their primary role in the operating room, which is not only to ensure your comfort during surgery, but also to make informed medical judgments to protect you. These include treating and regulating changes in your critical life functions — breathing, heart rate, blood pressure — as they are affected by the surgery being performed. These medical specialists are the doctors who will immediately diagnose and treat any medical problems that might arise during your surgery or recovery period.

Medical Training

Anesthesiologists are doctors of medicine who, after graduating from college with a strong background in physics, chemistry, biology and mathematics obtain a medical doctorate degree after completing four years of medical school.

After medical school, today's anesthesiologists learn the medical specialty of anesthesiology during an additional four years of postmedical school training (one year of internship and three years in an anesthesiology residency program).

During the first year, anesthesiologists must complete training in diagnosis and treatment in other areas of medicine-such as internal medicine, neurology, obstetrics, pediatrics or surgery-or complete a rotating internship where they spend an equal amount of time training in each of the other areas of medicine. Today's anesthesiologists then spend three intensive years of training in anesthesiology learning the medical and technical aspects of the specialty. In addition, they may further specialize in a subspecialty, such as neurosurgical anesthesiology, by completing one to two more years in a subspecialty training program.

But, even when residency training is completed, anesthesiologists continue to spend a great deal of time in special courses and seminars studying new medical advances and anesthetic techniques throughout their careers. Today's anesthesiologists are educated in cardiology, critical care medicine, internal medicine, pharmacology and surgery to be able to fulfill their role in modern medicine.

Role in Modern Medicine

The role of an anesthesiologist extends beyond the operating room and recovery room. Anesthesiologists work in intensive care units to help restore critically ill patients to stable condition. In childbirth, anesthesiologists manage the care of two persons: they provide pain relief for the mother while managing the life functions of both the mother and the baby. Anesthesiologists are also involved in pain management, including diagnosis and treatment of acute and chronic problems.

Most people believe that anesthesiologists are the doctors who administer medications which keep them from feeling pain and sensations. However, few people realize that beyond ensuring the patient's comfort, today's anesthesiologists' primary role in the operating room is to make informed medical judgments to protect and regulate the patient's critical life functions that are affected by the surgery being performed. Also, these medical specialists are the doctors who will immediately diagnose and treat any medical problems that might arise during surgery or the recovery period.

Anesthesiologists need a wide range of knowledge about medications, internal medicine, how the human body works, and its responses to the stress of surgery. As physicians, anesthesiologists are responsible for administering anesthesia to relieve pain and for managing vital life functions, including breathing, heart rhythm, blood pressure, and brain and kidney functions during surgery.

As doctors, they manage, and treat any medical problems which may be present before surgery or that may develop during or immediately after surgery. Those patients who have received medical evaluations or treatment from their physicians before surgery must have that same medical care continued during surgery by their anesthesiologist.

Prior to surgery, anesthesiologists evaluate the patient's medical condition and formulate an anesthetic plan for each individual patient taking into consideration that patient's physical status. During surgery, advanced technology is used to monitor the body's functions. Anesthesiologists must interpret these sophisticated monitors in order to appropriately diagnose, regulate and treat the body's organ systems while a personalized, very delicate balance of anesthetic medications is administered. In some hospitals, nurse anesthetists may assist the anesthesiologists with the monitoring responsibilities. However, it is the anesthesiologists who are responsible for the interpretation of that monitoring and who make educated medical judgments concerning the patient's responses, and when it is and when it is not appropriate to treat the patient.

At the conclusion of surgery, anesthesiologists reverse the effects of the anesthetic medications, and return the patient to consciousness once again.

They maintain the patient in a comfortable state during recovery, and are involved in the provision of critical care medicine in the intensive care unit. Anesthesiologists also are involved in the practice of chronic pain management.

During the Surgery, What Does My Anesthesiologist Do?

Your anesthesiologist is personally responsible for your comfort and well-being before, during and after your surgical procedure. In the operating room, the anesthesiologist will direct your anesthesia and manage vital functions, including heart rate, blood pressure, heart rhythm, body temperature and breathing. The anesthesiologist also is responsible for fluid and blood replacement, when necessary. He or she will regulate the anesthesia so that you will be comfortable until your anesthetic care is completed.

Anesthesiologists’ responsibilities to patients include:

A. Preanesthetic evaluation and treatment;

B. Medical management of patients and their anesthetic procedures;

C. Postanesthetic evaluation and treatment;

D. On-site medical direction of any nonphysician who assists in the technical aspects of anesthesia care to the patient.

Frequently, people requiring surgery may have other medical conditions, such as diabetes, asthma, high blood pressure, arthritis or heart problems. Because of your preoperative evaluation, your anesthesiologist will be alert to these conditions and well-prepared to treat them during your surgery and immediately afterward. Your continued medical management during surgery is necessary to help you have a speedy recovery. As doctors, anesthesiologists are uniquely qualified to treat not only sudden medical problems related to surgery itself, but also your chronic conditions that may need special attention during your procedure. This is because their medical training provides a strong background in the principles of internal medicine and critical care.

Many people are apprehensive about surgery or anesthesia. If you are well-informed and know what to expect, you will be better prepared and more relaxed. Talk with your anesthesiologist. Ask questions. Discuss any concerns you might have about your planned anesthetic care. Your anesthesiologist is not only your advocate, but also the physician uniquely qualified and experienced to make your surgery and recovery as safe and comfortable as possible.

The Nervous System - Your Body's Communication System

Your body has an amazing communication system composed of a network of billions of nerve cells which interconnect with your brain and spinal cord. This network is called the nervous system and spreads messages throughout your body including your internal organs and skin's surface. Through this network, constantly changing electrochemical signals transmit information from the outside world to your brain, including messages of injury that translate to your brain as pain sensations. These signals travel incredibly fast from the tip of your nerve endings to your spinal cord, and on to various areas in your brain where they're processed into emotions, sensations, thoughts and actions.

The three different types of anesthesia-local, regional and general-interrupt these pain signals at specific points. Think of your nervous system as a telephone system in an office; your brain is the switchboard your nerves are the telephone cables and the parts of your body that are experiencing pain are the telephones.

For example, your foot may need minor surgery and your doctor has decided that local anesthesia will be sufficient. Local anesthesia only will numb a small area, such as part of your foot. The numbed nerves do not allow the 'pain signal' from your foot to be sent through the nervous system. It is as if the phone is 'off the hook' and the phone message cannot be sent.

Perhaps you need surgery to repair a hernia and regional anesthesia is chosen. Regional anesthesia is used to eliminate pain in a larger part of the body by temporarily blocking large groups of nerves or the spinal cord so that the pain signal cannot reach the brain. If a telephone cable broke, all the phones in one area of the office would temporarily stop operating and no messages from that entire area could be sent to the switchboard.

Finally, you may need a major operation, such as heart surgery, and your anesthesiologist decides that general anesthesia is best. General anesthesia temporarily makes you unconscious so that your brain does not perceive any pain signals from the nervous system. During that time, no messages are processed, and you cannot experience pain or other conscious sensations. It is as if the switchboard operator is on a coffee break and is not there to connect the phone calls.

The Conquest of Pain

Try to imagine today's health care without surgery. It's almost impossible. Now try to imagine surgery without anesthesia. Equally impossible. Without anesthesia, many of modern medicine's greatest benefits simply would not exist.

More than 48 million surgical procedures are performed each year in the United States alone. Clearly, the health and well being of almost everyone you know has been touched by the science of anesthesiology.

These and many other surgical procedures now considered routine are carried out in hospitals and outpatient settings by the thousands every day. You usually take them for granted-and you should; current safety figures are impressive. So much so, you may lose sight of how long a way physicians have come in only the last 100 years, and even in the last five years when more lengthy and complex operations than ever before have been made possible by recent advances in anesthesiology.

Today's anesthesiologists now practice one of the most complex disciplines of medical specialization. These doctors command a vast amount of medical knowledge about the human body, about drugs and how they act upon the body, and about the sophisticated technology used to track every major organ system during surgery and to administer drugs in a variety of ways.

During a major operation, anesthesiologists choose from a variety of drugs to fulfill many different functions such as stopping pain, making the patient unconscious, and relaxing the body's muscles. To do this, they may administer inhalational anesthetic agents, sedatives, muscle relaxants and many other drugs that act to help maintain normal body functions. The anesthesiologist must skillfully orchestrate all of these drugs in accordance with the individual medical and surgical needs of each patient.

At the same time, anesthesiologists have improved techniques for turning off a patient's response to pain in specific regions of the body; this means that patients may remain conscious and recover more quickly after certain surgical procedures.

Only 50 years ago, administering ether through a mask and monitoring the patient with a simple stethoscope was considered to be the state of the art. Today, ether is not used for anesthesia and very sophisticated monitors are standard procedure. Currently, drugs designed molecule by molecule on computer screens for more effective applications within the human brain are in use in today's operating rooms. Dramatic advances in technology continue to create monitoring devices with even more subtle and accurate measuring capabilities. National and international anesthesiology conferences are regularly convened to transmit the explosion of research, new information and new applications for patient care. The future of medicine-surgery in particular-will continue to benefit from new advances in anesthesiology. All of this progress will allow anesthesiologists to better perform their most crucial and basic task: safely caring for the health, comfort and quality of life of all their patients.

Copyright © 2014 American Society of Anesthesiologists.
All rights reserved. Reprinted with permission