The Doctor behind the Mask
By Dr. Rajesh T. Eapen, MBBS, DA
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 25 million surgical procedures are performed each year in India alone. Clearly, the health and well being of almost everyone you know has been touched by the science of anesthesiology.
Many surgical procedures, now considered routine, are carried out in hospitals and outpatient settings by the thousands every day. You usually take them for granted, as the current safety figures are impressive. So much so, you may lose sight of how far the physicians have come in the last 100 years, and especially 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 practice one of the most complex disciplines of medical specialization. During a major operation, anesthesiologists choose from a variety of drugs to fulfill many different functions such as stopping pain, making the patient unconscious, relaxing the body's muscles and maintaining normal body functions. The anesthesiologist must skillfully orchestrate all of these drugs in accordance with the individual medical and surgical needs of each patient.
The anesthesiologist constantly monitors, evaluates and regulates our critical body processes because they can change significantly during the operation due to the stress and reflexes from surgery itself, the effects of the anesthetic medications and our medical condition. For example, in most operations specialized equipment is used to actually control the patient's every breath. This is because certain medications temporarily decrease breathing capability, which is further reduced by necessary muscle relaxants.
Only 40 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.
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! This masked medical man has many responsibilities:
- The anesthesiologist must possess a wide range of knowledge about medications, internal medicine, how the human body works, and its responses to the stress of surgery.
- 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.
- Beyond ensuring the patient's comfort during surgery, the anesthesiologist makes judgments to protect and regulate the patient's critical life functions including breathing, heart rhythm, blood pressure, and brain and kidney functions during surgery.
- Those patients who have received medical evaluations or treatment from their physicians before surgery must have the same medical care continued during surgery by their anesthesiologist.
- These medical specialists manage, and treat any medical problem that may develop during or immediately after surgery during the recovery period.
- Anesthesiologists interpret the sophisticated monitors used during surgeries in order to appropriately diagnose, regulate and treat the body's organ systems while a personalized, very delicate balance of anesthetic medication is administered.
- 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. They also take part in the treatment of pain of long standing durations.
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