Anesthesiologists are doctors. They are doctors who make medical assessments and diagnoses, practice critical care medicine, provide anesthetics, care for both healthy and critically ill patients of all ages, apply life-saving techniques to keep people breathing, and manage pain. Like other physicians, Anesthesiologists attend medical school and complete residency programs for 8-10 years after college.
It is important to remember that medical and surgical procedures can range from small, elective procedures done in offices, to large scale, life-saving or emergent operations in the setting of serious illness. These major events often require specialized equipment, hospital facilities and teams of physicians and health care professionals. Anesthesiologists are integrally involved in all these types of procedural care. Additionally, patients at times need immediate life-saving measures for which seconds to minutes matter for patient outcome. For patients who are unable to breathe, whose hearts have stopped and who need emergency intubation, Anesthesiologists are the most experienced and able members of the hospital team to deliver this care. Other specialized locations where Anesthesiologists deliver care include Labor and Delivery, MRI, Interventional Cardiology, Radiology and Endoscopy suites, free standing ambulatory surgery centers, and Intensive Care Units.
When you are having a procedure requiring anesthesia, an Anesthesiologist will be a member of the team of physicians guiding and administering your care before, during and after the procedure. An anesthesiologist makes an initial medical assessment of a patient and determines the patients level of risk, readiness for surgery and the need for any pre-procedure medical treatment or testing. Based on the patient’s history and condition, and the type of procedure, the Anesthesiologist will decide on the appropriate anesthetic and monitoring for a patient. This means that, in conversation with the patient and other physicians involved, they will decide on the best way to keep the patient safe and comfortable during the procedure and into the awake recovery period. A determination and plan will usually be made at that time how best to manage and minimize pain post-operatively.
In the procedure room, the Anesthesiologist applies techniques to keep the patient safe and comfortable throughout the case. They will establish intravenous access and patient positioning, apply non-invasive or invasive monitoring, administer medications and do procedures to maintain comfort or induce sleep. They may use a variety of airway devices and machines to maintain breathing. Generally, anesthetics must be delivered and adjusted throughout a procedure and other medications given to maintain physiologic stability under the stress of surgery and anesthesia. These treatments generally involve adjustments to blood pressure, heart rate, tissue oxygenation, respiratory performance, blood sugar and intravascular volume, and may include responses to arrhythmias, elevated intracranial pressure, massive bleeding, blood clots, heart failure, electrolyte derangements, embolic events, allergies, anaphylaxis and more. An Anesthesiologist will diagnose and respond to developing or ongoing medical issues as the procedure progresses.
As a procedure concludes, the Anesthesiologist readies the patient for emergence and for the post-operative period. These adjustments involve tapering off the anesthetic while initiating the methods for postoperative comfort and stability. Depending on the procedure and the patients medical conditions, additional treatments may be necessary to safely reestablish adequate spontaneous respirations for the patient and to maintain the patients vital signs in a safe range as their bodies awaken and respond to their surgery. At times, patients cannot safely be awakened after surgery. The Anesthesiologist at that time determines and applies the most appropriate method for transfer of the patient to the Post Anesthesia Care Unit (PACU) or the Intensive Care Unit (ICU).
In the Recovery Room, an intensive care area, the Anesthesiologist will continue care of the patient to address pain and medical issues that may be either ongoing or acutely develop. Anesthesiologists determine their patients’ readiness to return home after minor procedures and recommend safe monitoring and pain management for patients staying in the hospital. As the recovery period ends, patients are transitioned into the care of other physicians, though Anesthesiologists often remain involved with them through the Acute Pain Service.