What is anesthesiology

What is anesthesiology? Anesthesiology is medical specialty. An anesthesiologist or anesthetist, as is commonly said, is a doctor that follows a specialty program in anesthesiology after six years of medical school and one year of general medical training. This specialty program takes 5 years and, at the end of the training, doctors must be approved in a national exam organized by the Portuguese Medical Board. Given that, a doctor is certified to practice anesthesiology after 12 years of medical education.

All anesthesiologists or anesthetists are doctors and anesthesiology can only be practiced by doctors. An anesthesiologist doesn’t take care of more than one patient at a time. Anesthesiologists work with specially trained nurse during most medical procedures, and this collaboration is crucial. 

The Department of Anesthesiology includes all anesthesiologists and specialty trainees and is one of the clinical departments with the highest number of doctors in the hospital. 

Anesthesiology is one of the specialties with which patients have greater contact. In turn, anesthesiology contacts everyday with most of the other specialties. Usually, patients don’t know much about anesthesiology and don´t recognize its importance, however this specialty is seen as one of the biggest medical advances in the last centuries. As a medical specialty, anesthesiology is one of the most recent. 

Medicine, as we know it today, wouldn’t be possible if anesthesiology wasn’t created. 

In Centro Hospitalar do Porto, thousands of medical procedures take place every year that wouldn’t be possible without anesthesiology. 

Most people correlate anesthesiology with the procedure of administering general anesthesia and, although recognizing its importance and risks involved, are not familiar with the role of the doctor performing the anesthesia. 

During general anesthesia, the patients’ vital functions are in the anesthesiologist’s hands, this is why anesthesiology is sometimes compared with aviation. The role of the anesthesiologist is similar to that of an aviation pilot as he assumes the responsibility of taking his passenger on a journey, which includes a smooth take off (falling asleep), quiet trip (unconsciousness during the procedure) and a safe landing (waking up). The difference is that the anesthesiologist drives one patient at a time; the resemblance is that the goal is to allow the passenger a safe return home. 

Even though anesthesiology is associated with big responsibility, and the control of vital functions is very sophisticated, it is the medical specialty with the highest level of safety. This is the reason why nowadays the risk related with an anesthetic procedure is lower than the risk of flying on a commercial flight. 

Anesthesiology is the specialty in which the doctor interferes the most with the main functions: breathing, heart activity, circulation and brain functions. This allows the anesthesiology have a vital role and high competence in emergency medicine and intensive care medicine, treating critical care patients. Anesthesiologists are part of critical care teams in intensive care units, here patients with life-threating conditions are treated, using artificial life support. These patients are usually said to be “connected to machines and tubes”, this machines are the same as the anesthesiologists use in the operating room, which makes this doctors suitable to use them in the intensive care unit. 

In the emergency department there is also a room specially equipped for severe emergent situations, here the anesthesiologist has also an important role, as he is expert in this situations. 

The pre-hospital emergency and the transport of critical patients are also areas in which the involvement of an anesthesiologist is crucial. 

These emergent interventions require the ability to deal with trauma and cardiac arrest situations, and are known as “resuscitation”. The technics used in “resuscitation” were invented by an american anesthesiologist in 1960, and today most anesthesiologists can still perform it with expertise. 

Anesthetists are man and women of action, specially trained to deal with emergent and severe situations. They are prepared to be team leaders in these situations. 

This is why they are also present when a medical exam involves a special risk and there is a chance the patient will need resuscitation, such as during cardiac catheterization. There are other exams in which the anesthesiologist´s role is to guarantee the patients’ comfort and safety. As is the case of endoscopies, painful procedures and radiology exams, for children or people unable to cooperate. 

It is important to emphasize that anesthesiology is not limited to the act of anesthesia/sedation itself or the monitoring of vital functions and level of anesthesia. The anesthesiologist’s involvement starts before the surgery and finishes long after. Usually when a patient is scheduled for a surgery or painful procedure, an anesthesiology evaluation is programed. The anesthesiologist visits the patient the day before surgery to introduce himself and explain the procedure to the patient. There are several different anesthetic technics, drugs, monitoring devices and exams that can be used according to the surgery, the patient and his health issues. The anesthesiologist deals with a wide range of patients, from newborns to the very elderly with multiple diseases. The surgeon in mainly concerned with the problem that triggered the surgery; the anesthesiologist must evaluate the patient has a whole. The choice of anesthetic technic for each patient is an important chore of the anesthesiologist. After the surgery the patient stays in the recovery room for at least an hour, where an anesthesiologist takes care of him. The main concern of the anesthesiologist during this period is to avoid pain. Most of the times the anesthesiologist will visit the patient the day after surgery to access him, so that he can continue to improve the provided care. This is called “perioperative medicine”. The anesthesiologist is not only an anesthetist, but a perioperative doctor, that follows the patient through the whole process associated with the surgery, designing a plan that involves other doctors and health care professionals. 

One of the core interventions of anesthesiology is the pain control. During surgery it is mandatory to prevent pain and the deleterious effects of the surgical stimulation. After surgery is essential to avoid pain as well. Anesthesiologists are experienced professionals in the treatment of pain, and have expertise using strong analgesic drugs. Nowadays, anesthesiologists are involved in the treatment of pain outside the theaters and recovery rooms, specifically in chronic and acute pain. Some anesthesiologist specialize in the treatment of chronic pain conditions, they do so in the chronic pain clinic. The acute pain unit, accesses and treats the post-surgical pain in the first days after surgery, this is also a field in which anesthesiologists are proficient. 

Pain control and anesthesia can also be achieved by using local anesthetics. These drugs are used to abolish sensibility in a body part, like an arm or leg. This will allow the patient to be awake without feeling the body part where the surgery is being performed. This kind of anesthesia uses needles to deliver the anesthetic to the nerves or spinal roots. These technics include epidural anesthesia/analgesia, spinal anesthesia and nerve blocks. Anesthesiologists are experts in this so-called regional anesthesia, which sometimes is more desirable than general anesthesia. Given this expertise, anesthesiologists are also skilled to perform epidural analgesia during labor. This is an important area for anesthesiologists, all patients in labor are monitored/followed by these doctors. 

Thus, the expertise of anesthesia is important in multiple fields of medical practice. Anesthesiology has a technical side that is very important and the knowledge in anatomy, physiology and pharmacology is core to the specialty. There is an increasing interest in the field of investigation, which is important to establish the scientific grounds of anesthesia. This medical specialty uses modern technologies and sophisticated equipment. The workplace of the anesthesiologist is always equipped with monitors and machines to control the patient´s vital functions. For each procedure, checklist for patient and material are used and thorough records are kept. 

Anesthesiology involves not only scientific grounds and high technology, but also an important human dimension. Even thought the contact between doctor and patient is limited in time, it is very valuable. The patient understands that his life is in the anesthesiologist´s hands and the doctor recognizes that he is responsible for the patient’s wellbeing and safety. The human dimension involved in this relationship is powerful and built on trust and safety. 

Because someone has to look after the patient in his sleep or sickness, anesthesiology and anesthesiologists are there to guarantee comfort, relief and safety.