Preoperative Evaluation
Anesthesiologists play a vital role in assessing a patient’s medical readiness for surgery. They are unique in their advanced knowledge of both the medical illnesses that a patient undergoing surgery may suffer, as well as the effects on the body of the specific operation to be performed. The anesthesiologist’s preoperative evaluation may be very brief (such as in the case of a surgical emergency) or very prolonged (such as in the case of a patient with multiple chronic medical problems who is to undergo an extensive operation). In all cases, however, the anesthesiologist performs a focused history and physical examination, reviews available laboratory and special test results, and assesses the need for additional testing prior to proceeding with surgery.
Intraoperative Care
It is estimated that nearly 40 million anesthetics are administered each year in this country. Anesthesiologists provide or participate in more than 90 percent of these anesthetics. In the operating room, they are responsible for the medical management and anesthetic care of the patient throughout the duration of the surgery. The anesthesiologist must carefully match the anesthetic needs of each patient to that patient’s medical condition, responses to anesthesia, and the requirements of the surgery.
Anesthesiologists also have important functions outside of operating room suites, such as evaluating patients prior to surgery or conducting postoperative visits. However, the majority of their activities, which are performed inside the operating room, are seen by few people outside of the surgical and nursing team. Even patients themselves are often unable to remember much of their involvement with their anesthesiologist because much of the critical work is done while the patient is anesthetized! The role of the anesthesiologist in the operating room is to: 1) provide continual medical assessment of the patient; 2) monitor and control the patient’s vital life functions, including heart rate and rhythm, breathing, blood pressure, body temperature and body fluid balance; and 3) control the patient’s pain and level of consciousness to make conditions ideal for a safe and successful surgery.
The Posstanesthesia Care Unit (PACU)
or "Recovery Room"
After surgery, patients are transferred to the Postanesthesia Care Unit, where they continue to emerge from the effects of anesthesia under the watchful eyes of the peri-anesthesia nurse with anesthesiologist consultation immediately available. Evidence of recovery – including activity level, adequacy of breathing, circulation, level of consciousness and oxygen saturation – is continuously monitored. Pain control is optimized. In most cases, the anesthesiologist decides when the patient has recovered enough to be sent home.
Acute Pain Management
In addition to relief of patients’ pain during a surgical procedure, it is equally important for the patient’s comfort and well-being to receive adequate pain relief postoperatively. Anesthesiologists are responsible for ensuring that a patient’s pain is under control before they are discharged from the PACU. An anesthesiologist may prescribe specific pain medications or perform specialized procedures to maximize patient comfort, which helps to minimize stress on the patient’s heart and blood pressure. The techniques that are best suited for each individual patient are chosen to allow for proper rest and healing.