What is an anesthesiologist? What do anesthesiologists do?

Date: Jan-20-2015Anyone undergoing surgery that involves being put into a drug-induced sleep comes into contact with an anesthesiologist - but these specialist physicians are also involved in numerous other medical scenarios. Use this page to find out about their role, and how they will have qualified to get into it.

Contents of this article:

What is anesthesiology?
Anesthesiologists' qualifications
The surgical role of anesthesiologists
The medical role of anesthesiologists

What is anesthesiology?

Anesthesiology is a specialist field of medicine practiced by specially trained doctors. It is defined by the American Society of Anesthesiologists simply as follows:1

"The practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery."

Anesthesiologists exercise this responsibility in an estimated nine out of every ten of the more than 100 million surgical procedures that are carried out in the US every year.1

In 2013, there were over 30,000 anesthesiologists employed in the US and many more working self-employed.2

Anesthesiologists' qualifications

Anesthesiologists do four years of medical school - as for all medical doctors in the US - before going into their specialty of anesthesiology, for which they must complete a further four years in an anesthesiology residency program, starting with a one-year internship.3

After becoming fully qualified anesthesiologists after 8 years of general and specialist medical study and training, most go on to sit a further examination for certification from the American Board of Anesthesiology.3

Anesthesiologists are responsible for the anesthesia and overall medical management during surgery.

The training and level of specialization often does not stop there, with many also going into more specific areas of anesthesiology after a fellowship program of one year or more. For this they may have special training in:3

Pain management

Cardiac anesthesia

Pediatric anesthesia

Neuroanesthesia

Obstetric anesthesia

Critical care medicine

Hospice and palliative medicine.

The surgical role of anesthesiologists

The anesthesiologist's responsibilities for a patient undergoing surgery start at the point of making a pre-anesthetic evaluation and creating an anesthesia plan for the operation, and they keep responsibility for the medical management of the patient throughout the procedure, with the surgeon taking responsibility for the surgical work.4

The patient is under continual assessment by the anesthesiologist during surgery, monitoring their vital life functions:4

Heart rate and rhythm

Breathing

Blood pressure

Body temperature

Fluid balance.

The anesthesiologist controls these vital measures and the patient's level of pain and unconsciousness throughout the operation.

After the procedure, they remain responsible for the overall medical care and carry out post-anesthetic evaluation and treatment, directing non-anesthesiology staff as appropriate to maintain a comfortable state for the patient in recovery.4

If necessary following the operation, critical care medicine is carried out in the intensive care unit, and this is also the responsibility of specialist anesthesiologists known as intensivists.

Some areas of surgical care involve other specialist anesthesiologists: cardiac anesthesia (for heart surgery), pediatric anesthesia (pain management and anesthetics in children) and neuroanesthesia (related to surgery for the nervous system, brain and spinal cord).3

The medical role of anesthesiologists

The main responsibility of physician anesthesiologists is for the safety and wellbeing of a patient before, during and after surgery - perioperative care to administer drugs that keep the patient in a controlled state of unconsciousness.4

Every anesthesiologist has been trained for this responsibility, but many go on to specialize in non-surgical areas of medical care, particularly in pain medicine (pain specialists) and critical care (intensivists).

Some are involved in the care of women giving birth - for the relief of labor pain, but also for anesthetic responsibilities around obstetric surgery during any complications. Such doctors are known as obstetric anesthesiologists.

Other areas of medical care include pediatric anesthesia (pain management and anesthetics in children) and care of the dying in hospice and palliative care.3

Anesthesiologists specializing in pain medicine

The diagnosis and management of pain is a major area of specialty for anesthesiologists, who will work in this area with physicians from other fields, including internal medicine, neurology, neurosurgery, orthopedic surgery, psychiatry and rehabilitation (physiatry).5

As well as being found in operating theatres, some anesthesiologists specialize in treating pain.

Of course, anesthesiologists are concerned with any pain resulting from surgery - postoperative pain - but there is a long list of other scenarios in which anesthesiologists specializing in pain medicine could become involved - from headaches, through chest, abdominal and pelvic pain, to burns, diabetes and herpes pain to name but a small number of conditions.6

The American Board of Pain Medicine, which is responsible for the certification of anesthesiologists working in the specialty, lists a number of roles:6

Treating the patient directly

Prescribing medication

Prescribing rehabilitative services

Performing pain-relieving procedures

Counseling patients and families

Directing a multidisciplinary team, or coordinating other health care professionals

Acting as consultants to public and private agencies for the best delivery of care to patients in pain.

Critical care - anesthesiologists in intensive care units

Today, a wide variety of clinical services are provided by the anesthesiologist working in 'critical care' - usually in intensive care units.7

The involvement of these 'intensivist' anesthesiologists has its roots in looking after those who have had surgery, but now they also have a role in the care of many types of critically ill patients, young and old.7

The expertise of anesthesiologist-intensivists helps with diagnosing and managing disorders of various body systems:7

Anesthesiologists provide critical care and have overall responsibility in intensive care units.

Respiratory (breathing)

Cardiovascular (heart and circulation)

Neurological (brain, spinal cord and nerves)

Gastrointestinal (including metabolic and nutritional support)

Renal (kidneys; including providing fluids and electrolytes and managing acid-base
disorders).

Anesthesiologists working in critical care are also called on for their expertise in managing the unconscious patient - so whatever the cause of the unconsciousness, they may be involved in the care of:7

Multiple organ injury

Disease that leads to multiple organ dysfunction syndromes

Patients needing life support.

The physician anesthesiologists in these situations have the role of coordinating the overall medical management.7

Anesthesiologists in the intensive care unit (ICU) have overall responsibility for the patients - but work with a wide variety of people, including those in the patient's support network.

Dr. Mark Nunnally, an anesthesiologist-intensivist at the University of Chicago Medical Center, sums up the role:8

"Anesthesiologist-intensivists are the managers of the ICU. We bring all the people together.

There are surgeons, ancillary service providers, nurses, physical and occupational therapists, social workers, nutritionists, pastoral services, and on and on.

Each person has a specific role and function, but the anesthesiologist-intensivist is in charge of seeing the patient as a whole. We look out for conflicts and reconcile them across services."

Obstetric anesthesiologists

Obstetricians are not the only doctors involved in the care of women giving birth - anesthesiologists also work in the maternity unit to administer the anesthesia to mothers choosing a pain-free delivery and to work with obstetric surgeons if there are complications.9,10

Dr. Craig M. Palmer, professor of anesthesiology at the University of Arizona, Tucson, has described a life-saving role for obstetric anesthesiologists, in addition to helping expectant mothers with normal deliveries. Writing in a column at KevinMD.com on behalf of the American Society of Anesthesiologists (he is chair of its committee on obstetrical anesthesia),11 he says that his role "often extends beyond merely being a 'pain reliever:'"

"While most labors and deliveries go very smoothly, on occasion things can go wrong suddenly - the baby might get 'stuck,' the placenta may fail to deliver properly, or one of a dozen other complications may arise which can put the mother's and the baby's safety, and even life, at risk.

In these situations, the years of training anesthesiologists undertake can make a profound difference in the outcome of a delivery."

The following anesthetic procedures are the responsibility of anesthesiologists working in obstetrics departments:9

Regional anesthesia

Epidural - An epidural is a thin plastic tube that is placed in the lower back through which anesthetic medicines are given to lower the amount of pain felt from contractions. The same administration point can be used for stronger anesthetics that work well enough to numb the lower body completely during a surgery such as Caesarean section

Spinal - the same effect as an epidural but given in a single injection of anesthetic medicines through a needle in the lower back, which is removed after administration. It works for the defined duration needed for a Caesarean section

General anesthesia

If there is an emergency because of complications, or if a woman cannot receive an epidural or spinal regional anesthetic for a Caesarean section.

In the US, the most commonly used method of labor pain management is an epidural.12 Alternatively, standard painkilling drugs are administered by the obstetricians and midwives, and the following are often used during childbirth: fentanyl (Sublimaze), remifentanil (Ultiva), butorphanol (Stadol) and nalbuphine (Nubain).9

Women giving birth may choose other options for pain relief, including to attempt no pain relief at all. But women often try breathing techniques, massage, heat packs, and water baths, for example.10

If the painkillers given by the obstetric staff are insufficient, anesthesiologists can administer medicines intravenously (IV) - such as morphine, fentanyl and others. Here, the control of the pain is handed to the woman under the anesthesiologist's supervision through the use of an infusion pump, which has a button for the woman to press whenever the pain relief is needed.9

Inhaling laughing gas - nitrous oxide - is also an option for pain relief during childbirth, although this is a much more common practice in the UK, for example, than in the US - where only a handful of centers offer it.12

A leading anesthesiology and perioperative pain medicine specialist from the Brigham and Women's Hospital at Harvard Medical School in Boston, MA, has produced a website detailing more options for women's pain control during childbirth.9

See Dr. Bhavani Shankar Kodali's educational website at painfreebirthing.com, which has been recommended by the Society for Obstetric Anesthesia and Perinatology.10

Written by Markus MacGill

Not to be reproduced without permission.

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Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.