I've been thinking about this post since I started the anesthesia portion of my residency last July. In part, I've been wondering myself what my career will look like; what will I do everyday? Who will I care for? But also because most people don't even know how to spell anesthesiologist let alone know what they do at work (It's okay, I still have trouble with ophthalmologist.)
It is obvious to most people that surgery is not a benign process. It is painful for one and can be very risky depending on the situation. Yet, surgery is often necessary and can in fact, make people feel better. What is not so clear to most patients and lay-people is that anesthesia is no less risky than surgery. For some, the anesthetic is actually more dangerous than the procedure.
That's where I come in.
I could tell you that anesthesiologists are "peri-operative physicians" or that we are experts in physiology and resuscitation. Yes, we put people to sleep, but more so, we keep them alive. "Vigilance" is the motto of our professional association.
Admittedly, it is sometimes easy. A young, healthy guy having an appendectomy is a walk in the park. The chances of having an adverse reaction are quite low, almost negligible, but bad things can and do happen.
Perhaps a better way to explain is with an example:
I was recently caring for a middle-aged, basically healthy male who was having a simple spine surgery (a 2 level "foramenotomy"). I noticed right away that he had a healthy low resting heart rate in the 50s before anesthesia started. After inducing anesthesia and placing a breathing tube, his heart rate sank and rested in the mid 40s. I gave a little medicine to try to pick it up some. It didn't really change. I gave a little more. His blood pressure was still stable and his oxygen levels were fine, so I wasn't too concerned, but I was aware of the pattern emerging.
The next step was for the surgeons to place a fixation device on his head to keep his spine aligned for surgery. This is a "stimulating" process (read: painful), so I gave the patient a little fast acting pain medicine as the surgeon did his work. My eyes were fixated on the EKG because I was expecting his heart rate to increase if he felt any pain.
Instead, the numbers started to go down... 40...38...35
I said to the nurse, "Call my attending back in the room!"
35...32...28
"Get him here immediately!"
25...10...0
What? 0?
I felt on his neck for a carotid pulse. Nothing. I turn to the surgical resident, "Do you feel a pulse?" He puts his hand on the neck and says nothing."
"Call a code! He's got no pulse. I'm starting chest compressions!"
I immediately go into CPR mode and try to instruct others to do the same, but it's like the other 4 people in the room are stuck in mud. No one moves.
Two other anestheiologists fly in the room. "What's going on Sara?"
"He brad-ied down and went asystolic just as they were pinning him. He lost his pulse and I started CPR. He needs epi."
My attending says, "Wait, wait I think he's got complexes, hold your compressions."
I stop and sure enough, the patient's heart rate is back. We place an arterial line, draw labs and all looks to be normal. Our diagnosis: profound bradycardia (slow heart rate) and hypotension due to anesthesia and pain medicine in a patient with an slow heart rate at baseline.
There was no adverse outcome in this particular case, which is what makes it a good example. I spoke with the patient's wife after the successful surgery and recommended that he have a cardiac evaluation for his slow heart rate.
The thing that impressed me the most was my reaction time. I'd been watching his heart rate, his physiology all along. I know what the side effects of anesthesia drugs are and how they can effect even healthy patients. I was additionally impressed when the surgical resident said to me,
"You know, I saw his heart rate dropping, but I just kept assuming that the equipment was malfunctioning. I had no idea it was real until you were doing chest compressions."
And that's what an anesthesiologist does.
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