Dr Yatin Mehta, Chairman, Institute of Critical Care and Anesthesiology, Medanta-The Medicity
There are several checkboxes a patient needs to tick off when he is preparing for a major surgery. Some of the big concerns include researching on the surgical background of the doctor, his previous patient reviews and the technology being administered for the planned treatment. You have asked who is your surgeon but have you ever asked whose my anesthesiologist? Why not? Due to lack of knowledge about the significance of an anesthesiologist during surgery, he misses out on a thorough checking of doctors credentials - who is responsible to administer drugs that put him in deep sleep during the surgery. The anesthesiologist /anesthetist provides comprehensive medical care between a patient sleeping for surgery and waking up afterwards. He is not the doctor who only puts you to sleep – he is the one who ensures that you remain in deep sleep, without any pain during your operation, you don’t wake up midway and that you fully wake up, land safe and sound in the postoperative ward!
While most people assume that the role of anesthesiologist is limited to knocking people off during surgery, what they do not know is that while the surgeon is involved in cutting and repairing parts of their body, it is the anesthesiologist who protects and regulates critical life functions throughout the duration of the surgery. With their understanding of how human body responds to the stress of surgery, they mostly are the first to diagnose and treat complications that arise before, during and after the surgery. Anesthesiologists, thus can be understood as ‘life guards’ who rescue patients to safe waters if there’s an emergency mid-surgery. However, recent statistics released by the World Federation of Societies of Anesthesiologists (WFSA) indicate that in India there are only 1.26 such life guards per 100,000 people. This puts our country in a position that is only slightly better that Gambia, Somalia, and the Central African Republic!
While top hospitals in India have full-time anesthesiologists, some of whom are qualified super-specialists for neuro, cardiac, critical care and other high-end procedures, it is the small hospitals and nursing homes who manage with freelance practitioners, available on-call. This is quite a challenge in a scenario where a patient must undergo an emergency surgery at such a hospital, and, for some reason, their freelance anesthesiologist is unavailable. This puts the patient in a very vulnerable spot. Patients who need to get surgeries have the right to ask for the availability and credentials of the anesthesiologist who is assigned to them because they are limited in number and most small hospitals don’t have them available full-time. The patient and their caregivers should not ignore this important aspect of their treatment.
The mix of drugs in anesthesia includes the triad of an analgesic to relieve pain, an anesthetic to put the patient to prolonged deep sleep, and a paralytic drug that paralyzes the body so that it remains still during the surgery. This is because if a patient wakes up mid-surgery because of a wrong drug dosage by the anesthesiologist, there is no way they can signal the surgeon that they are feeling pain – which is due to the paralytic effect of the powerful muscle relaxants. Oxygen tubes are placed running down the patient’s throat, & their eyelids are taped to prevent the cornea from drying. While this does not happen every day, such nightmarish incidents are not rare either, leaving helpless patients to deal with the excruciating pain of the procedure and long-term psychological problems, such as depression, bad dreams and anxiety. For every successful surgery, there is an anesthesiologist who actively monitors and controls the patient’s vital life functions, including heart rate, breathing, blood pressure, body temperature and body fluid balance. He is the doctor behind the scene who makes your surgery painless and possible!