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Although the use of anesthesia has been described as early as the 13th century, anesthesiology as a profession only began to develop in the early 20th century with the formation of anesthesiology departments, training programs, and the American Board of Anesthesiology (1). Most commonly, anesthesiologists are thought of in relation to surgery; however, anesthesiologists are integral in critical care medicine, obstetric analgesia, and pain management. Several studies across the globe have shown that there is low awareness of the anesthesiologist’s role, even within the healthcare system (2-4). A 2013 study from Mayo Clinic found that only approximately 20% of patients knew that anesthesiologists are involved in care in the ICU or pain management clinics (5). I will explore the role of an anesthesiologist inside and outside of the OR, illuminating the key functions they have in keeping patients safe throughout surgery and beyond.
Anesthesiologists are responsible for preparing and caring for patients before, throughout, and after their surgeries. Anesthesiologists perform a preoperative evaluation to characterize individualized patient risk factors that could lead to adverse impacts in the perioperative period. During surgeries, anesthesiologists - in conjunction with CRNAs - monitor vital signs, sedation, and airway management. After surgery, anesthesiologists continue to monitor patients, optimize pain control, and manage side effects as patients remain under residual effects of the anesthetic agents used during surgery. Anesthesiologists also staff procedures that occur outside of the OR that are integral to patient care across specialties. Examples include gastrointestinal endoscopy, cardiac catheterization units, electroconvulsive therapy, and imaging studies (especially for children) (6).
Outside the OR, anesthesiologists have diverse roles in patient care throughout the healthcare system. Anesthesiologists are rigorously trained in resuscitation and emergent management of patients, making them uniquely positioned to contribute to intensive critical care. Beyond intubation, ventilation management, and resuscitative efforts, anesthesiologists can pursue advanced training to serve as intensivists on critical care units. Additionally, pain management is an emerging field in which anesthesiologists provide multimodal forms of analgesia, including oral medications and regional blocks. Pain clinics serve patients suffering from cancer, burns, neuropathy, and chronic pain. In obstetric care, anesthesiologists perform analgesia during both vaginal deliveries and cesarean sections. There are vast options in pain management options including but not limited to – epidural catheters, spinal blocks, and patient-controlled analgesia (6).
Ranging from providing sedation in surgery to treating chronic pain to managing critically ill patients, anesthesiologists treat a wide spectrum of people and must easily adapt to varying roles on the medical team. The prevalence of pre-operative anxiety ranges up to 80%, and a 2022 study out of India found that pre-operative counseling on anesthesia reduced anxiety significantly (7). It is important for patients and the medical team to understand the many roles that anesthesiologists can fill, both inside and outside the OR, to improve patient outcomes and facilitate teamwork.
References:
1. AMA J Ethics. 2015;17(3):258-264. doi: 10.1001/journalofethics.2015.17.3.mhst1-1503.
2. Nicolescu T, Doerfel J, Khan Q. Patient perceptions of the care received from their anesthesiologist: a survey study. J Okla State Med Assoc. 2016;109(10):481-483.
3. Swinhoe, C.F. and Groves, E.R. (1994), Patients’ knowledge of anaesthetic practice and the role of anaesthetists. Anaesthesia, 49: 165-166. https://doi.org/10.1111/j.1365-2044.1994.tb03380.x
4. Roublah EA, Alqurashi RN, Kandil MA, et al. Patients' concerns and perceptions of anesthesia-associated risks at University Hospital: A cross-sectional study. Saudi J Anaesth. 2020;14(2):157-163. doi:10.4103/sja.SJA_560_19
5. Garcia-Marcinkiewicz AG, Long TR, Danielson DR, Rose SH. Health literacy and anesthesia: patients’ knowledge of anesthesiologist roles and information desired in the preoperative visit. J Clin Anesth. 2014;26(5):375–382.
6. Verma R, Mohan B, Attri JP, Chatrath V, Bala A, Singh M. Anesthesiologist: The silent force behind the scene. Anesth Essays Res. 2015;9(3):293-297. doi:10.4103/0259-1162.159775
7. Kharod U, Panchal NN, Varma J, Sutaria K. Effect of pre-operative communication using anaesthesia information sheet on pre-operative anxiety of patients undergoing elective surgery- A randomised controlled study. Indian J Anaesth. 2022;66(8):559-572. doi:10.4103/ija.ija_32_22
posted June 15, 2024
Date of last update: June 14, 2024
