Historically, the role of the anesthesiologist was limited to the physician who administers anesthesia to suppress pain and consciousness in a patient undergoing surgery. Today, The American Society of Anesthesiologists defines an anesthesiologist as a perioperative physician, the “all-around” physician responsible for providing medical care through all junctures of a patient’s surgical course. In the current health care system, in addition to providing pain control and life support functions during and after surgery, anesthesiologists play important roles in preoperative surgical planning and preparation as well as many other aspects of patient care.
At many teaching institutions around the country you may encounter anesthesia residents in training. Anesthesiology residency is a four-year program after medical school requiring one year of internship and three years of anesthesia-specific training. Quick tip for medical students: if you do not enjoy physiology and pharmacology, anesthesiology may not be the right specialty for you. A resident performs the roles and responsibilities of an anesthesiologist under supervision of a staff (fully trained) anesthesiologist. During the operation many of the OR staff may come and go but an anesthesiologist will be present during induction, emergence, and all critical portions of the operation. Anesthesia residents often spend rotations in specialized areas of anesthesia as part of their training including cardiac, transplant, pediatric, regional, ambulatory, and neuroanesthesia, as well as critical care, acute pain, and chronic pain. Following residency, some anesthesiologists will pursue fellowship training in these specialties.
THE ANESTHESIOLOGIST’S JOB
The anesthesiologist’s job starts prior to surgery with assessment of the patient’s medical and surgical history. This may start weeks before a planned operation to allow time for appropriate testing and medical treatment if a patient has complex medical problems. The aim of this preoperative evaluation is to discover risk factors that must be assessed and managed, including acute and chronic diseases of the heart, lungs, kidneys, and liver, allergies, medications, and difficult access to the circulation or airway. Failure to carefully evaluate and manage the patient preoperatively may result in delay of the operation or increased complications during or after the surgery. The preoperative evaluation and plan may be performed by another anesthesia provider weeks before but will be reviewed by the anesthesiologist on the day of the operation. Intraoperatively the objectives of the anesthesiologist for the patient include loss of awareness, pain control, vital sign monitoring and intervention, airway management and breathing, and appropriate hydration with intravascular fluid administration. The anesthesiologist assumes control of the patient’s general physiology throughout their operative case.
If a general anesthesia is planned, on arrival into the operating room the patient will first be placed on appropriate monitors for the procedure. For every anesthetic, the patient’s oxygenation, breathing, and circulation are continually monitored as well as temperature if changes are anticipated, intended, ...