Anesthesiology Basics
What is 'anesthesiology'?
Anaesthesiology is a branch of medicine that deals with anesthesia and anaesthetics. It is both an art and a science. The science involves the physiology of the human being, it involves the anatomy of the human being, and it involves the farmical kinetics and the farmical dynamics of the anesthetic agents that are used. The art involves developing an intense short lived relationship with the patient in that you have to calm them when you meet them in the pre-operative area. You have to bring them to surgery and be vigilant all during the surgical procedure and then you have to safely bring them into the recovery room awake, responsive and stable.
What is 'anesthesia'?
Anesthesia as a noun would be defined as the lack of, or insensitivity to, pain. That insensitivity to pain can be created in many different ways. It can be created with local anaesthetics, it can be created with regional anesthetic, it can be created with inhalational anesthetics, as well as with a potpourri of other medications. It can also be created with acupuncture or hypnosis, or even cold therapy.
What is 'analgesia'?
Analgesia simply means insensitivity to pain, or lack of pain.
What is an 'anesthetic'?
An anesthetic agent can be a local anesthetic, an inhalational anesthetic, a potent gas, or an intravenous anesthetic, that substance which creates analgesia, or lack of pain.
What is an 'anesthesiologist'?
An anaesthesiologist is a physician who has finished medical school and gone on to specialize in anesthesia. An anaesthesiologist, after finishing four years of medical school, can do an internship in any speciality and then does a residency in anesthesia specifically which lasts two to three years. After that, there is additional post-graduate training if an anaesthesiologist wants to sub-specialize in one of the many separate sub-specialities in anesthesia. For example, some anaesthesiologists practice only obstetrical anesthesia or paediatric anesthesia or neural anesthesia. Others do addiction medicine. Others do neural anesthesia.
What is a 'board certified anesthesiologist'?
A board certified anesthesiologist is an anesthesiologist that has finished his training and taken a written exam first, and then followed that with an oral exam which is two days long, and he obtains boards in his specialty. That can be in anesthesiology itself, or you can obtain specialty boards in pain management and/or addiction medicine as well.
What is 'regional anesthesia'?
Regional anesthesia is when you make a region of the body numb, as opposed to general anesthesia, which anesthetizes the entire body. Regional anesthesia techniques includes final or epidural anesthesia. They will make the region of the body numb from approximately the umbilicus or belly button down. You can therefore operate on the groin area, or the perineum with the lower extremities. Caudal anesthesia is also a regional aesthetic, which is used to anesthetize an area which would basically be whatever touches a saddle. For instance, if you are riding a horse or a donkey. And that's used for perinea surgery as well. These are regional anesthesia techniques that make a certain area of a body numb and or give a motor block. Motor block means the area will not move when the surgeon is operating upon it.
What is 'local anesthesia'?
Local anesthesia is when the surgeon himself takes a local anaesthetic. it is an agent that will impede the pain impulses from travelling from the nerves on the skin or subcutaneous tissue to the spinal cord and the brain. In other words it will make you insensitive to pain. He will inject a local area on your body. This technique is good for dermatologic procedures, and the removal of cysts. It can be used for small hand procedures and other minor surgeries. When a procedure is scheduled under local anesthesia, it usually means an anaesthesiologist will not be present. You will still be monitored by a nurse in the operating room, who will monitor your blood pressure, EKG, and the oxygen level in your bloodstream.
What is 'spinal anesthesia'?
Spinal anesthesia is an example of a regional anesthesia technique. A spinal needle is placed in the lumbar spine after the back has been prepped and draped to prevent infection. The spinal needle enters the sub-arachnid space where the cerebral spinal fluid is. The way you identify proper location of the needle is by the return of that spinal fluid through the needle. A small amount of local anaesthetic is then placed in the spinal canal. It anesthetizes the spinal cord and the painful impulses that would have normally travelled through the spinal cord to the brain where it is perceived, are therefore blocked. Spinal anesthesia is a very effective anaesthetic for any operation below the umbilicus.
What is 'general anesthesia'?
General anesthesia implies loss of consciousness and analgesia. The patient is completely asleep. It entails the use of many different medications; some to keep the patient asleep, some to provide muscle relaxation for that patient, and some to provide analgesia.
What is 'conscious sedation'?
Conscious sedation is a sedation technique whereby the patient is responsive to the commands of either the surgeon or the anaesthesiologist. This type of sedation was used for endoscopic procedures in the past, such as colonoscopy. It is presently used for disco grams, which is a diagnostic test whereby a orthopaedist or pain management specialist determines which disc is creating the pain in a patient. They pressurize the disc and the patient is sedated, yet responsive and can tell the surgeon or procedurist which disc is giving or reproducing the pain that he has.
What is 'intravenous sedation'?
Intravenous sedation is now referred to as TIVA or Total Intravenous Anesthesia. This is a deeper IV sedation. The patients are breathing spontaneously but they are in essence completely asleep. They will not respond to commands. Their airway is patent because they are breathing on their own and it does not have to be secured by the anesthegioligist through incubation or mass airways or any of the other devices we sometimes use.
During surgery, how does the anesthesiologist monitor the patient?
During surgery, how does the anaesthesiologist monitor the patient? The most important quality in an anaesthesiologist is vigilance, and vigilance is accomplished by monitoring the patient with a multitude of devices. The patient is monitored with a blood pressure cuff, an EKG machine, which shows both the EKG patterns and the pulse. Each patient is monitored with a pulse oximeter, which tells us the oxygen concentration in the bloodstream, and each patient is monitored with a capnograph, which shows the patient is ventilating either artificially with our mechanical ventilator or spontaneously breathing.
What happens immediately after surgery?
Immediately after any surgery, the patient is brought to the recovery room. The patient is then hooked up to very similar monitors that were used in the operating room. In the recovery room, the blood pressure, the EKG and the pulse oximeter are re-applied and the nurse in the recovery room will monitor the patient in that manner. When we bring the patient to the recovery room we present to that patient, and we explain what surgery was performed, how that patient did, and if any untoward reactions occurred we would tell the nurse at that time. The patient presentation would be very thorough and would include any pertinent data that the recovery nurse might need to know.
What are 'barbiturates'?
The barbiturates are classified as sedative-hypnotic drugs, and in the past were used for induction of anaesthesia. The barbiturates of the past were great for inducing anaesthesia, but they did not have analgesic, or pain-protective properties. The old barbiturates of Secobarbitol, Pentothal, Gravital, have been supplanted by a new medication called Propofol which has the same properties as barbiturates, but does also have analgesic properties. That is now the major medication that is used to induce anaesthesia.
