What is an anesthesiologist? What training is involved?
An anesthesiologist is a doctor (MD or DO) who practices anesthesia. Anesthesiologists are physicians specializing in perioperative care, developing anesthetic plans, and the administration of anesthetics. He or she has finished college, then medical school (four years), then an internship (one year) followed by a residency in anesthesia (three years). Some anesthesiologists pursue additional years of training (a fellowship).
Who are the HSS anesthesiologists?
Our attending physicians have completed fellowship in fields such as regional anesthesia, pediatric anesthesia, critical care medicine, cardiothoracic anesthesia, chronic pain, and anesthesia research. Your anesthesiologist will be assigned the day before surgery and will be chosen based off of your patient history and individualized needs and the physician’s specializations within anesthesiology.
What do anesthesiologists do?
Anesthesiologists help ensure the safety of patients undergoing surgery. The anesthesiologist provides care for the patient to prevent the pain and distress they would otherwise experience. This may involve general anesthesia (“putting the patient to sleep”), sedation (intravenous medications to make the patient calm and/or unaware) or regional anesthesia (injections of local anesthetic near nerves to “numb up” the part of the body being operated on (i.e. nerve blocks or spinal/epidural injections)).
Many types of orthopedic operations are well suited to regional anesthesia, most often with sedation as well. Each HSS anesthesiologist specializes in regional anesthesia.
Before the procedure, your anesthesiologist will talk with you and establish an anesthetic plan in coordination with your surgeon. At this time, your anesthesiologist will also ensure you are ready for the operation. The first priority is getting the patient safely through the procedure. If the patient is sick and could be made healthier, then the operation may be postponed or cancelled (to allow “optimization” of the patient’s medical condition). This reduces the potential risk to which a patient may be exposed.
In addition to getting through the operation safely, your anesthesiologist tries to reduce post-operative pain after the operation. This may involve intravenous pain medications, but in many cases at HSS pain relief will involve placing local anesthetic near nerves.
At HSS, the Department of Anesthesiology, Critical Care & Pain Management also runs the recovery room for specialized care immediately after surgery. We also manage an Acute Pain Service to help you manage post-operative pain and oversee the Critical Care Team to provide specialized care for critically ill patients.
Some anesthesiologists at HSS practice pain management. Some HSS anesthesiologists also act as administrators for the hospital and the Department.
Why should patients care about anesthesia?
Your anesthesiologist allows you to undergo surgery safely and comfortably. Anesthesiologists use specialized techniques during surgery to accomplish this. For example, the method of controlled lowering of the blood pressure during hip surgery reduces bleeding and the need for transfusions.
Good pain management is obviously desirable from the patients’ perspective. Good pain management also helps patients perform physical therapy and leads to better surgical outcomes after many orthopedic procedures. Good pain management may reduce the rate of heart attacks and other postoperative complications.
Can’t the anesthesiologist just do the injection (or put the patient to sleep) and then leave?
No. That would be unsafe. The anesthesiologist, or someone working with him or her (a resident, a fellow, or a nurse anesthetist) must remain with the patient. This is needed so that the patient status can be monitored (heart rate, blood pressure, breathing, level of awareness during sedation), and changes made as needed (so as to prevent or manage major problems that could arise during the surgery).