Wake Up Call: Anesthesia Services
An Eye-Opening Q&A with AAMC’s Chief of Anesthesia Services
Advances in the skills of surgeons and the surgical techniques they perfect appear across the healthcare landscape in a steady procession. Procedures that only a short period ago required a long incision and an extended hospital stay are performed today with smaller incisions and precision instruments.
Often lost amid all the ongoing improvements and advances, however, is this simple proposition: Few if any of these surgical procedures would be possible at all were it not for the skills and training of the anesthesiologist.
From the moments when the first noticeable drowsiness sets in to the recovery room when consciousness slowly returns, the anesthesiologist plays a central role in a patient’s well-being before, during and after surgery. Yet, this role is often unclear or misunderstood by patients.
In the interview that follows, David Corddry, M.D., Chief of Anesthesia Services at AAMC, answers questions that shed more light on the role and importance of anesthesiologists and the practice of anesthesiology.
Dr Corddry, how do you see what you do for patients?
In essence, what we do is “hijack” a patient’s nervous system, so that he or she does not respond to surgery. However, in doing so, we impair or eliminate many reflex and automatic body functions that keep a person safe. Our major task is to take over for those reflex and automatic body functions and assure that the patient is kept stable and is protected. The big issues for people under general anesthesia are: maintaining an airway, keeping them breathing, and maintaining circulation. But there is a long list of other issues, such as protecting vulnerable eyes and nerves, and maintaining normal temperature.
Is the science of anesthesia changing?
We have made steady improvement in anesthetic medication, monitoring technology, and equipment. This has helped us meet the challenges posed by evolving surgical techniques, especially the welcome trend to minimally invasive procedures. A benefit of less invasive surgery is a faster recovery period, which lessens the chance for complications. Newer anesthetics help a patient to be up quickly—around, alert, and comfortable. The use of local anesthesia or blocks after surgery is a big part of this. We place emphasis on integrating post-operative pain management into the anesthesia care.
Is it a problem that patients don’t meet the doctor who will anesthetize them until shortly before their surgery?
It sometimes leads to a perception that we are technicians. But, like emergency room or critical care physicians, we are staffing a hospital-based service that is very fluid and requires around-the-clock coverage. Our group provides anesthesia care at 21 sites around the hospital. The ever-shifting nature of the surgical schedule would be thrown into gridlock if we tried to couple ourselves tightly to specific patients.
Can a patient request a specific anesthesiologist?
Either the patient or the surgeon can, and they often do. Those requests are honored when they are within the constraints of our schedules.
What do you discuss with patients when you meet them?
First I review and refine the medical history I have learned from their record. I explain anesthetic options, and review the benefits and risks associated. I try to ensure that they understand our anesthetic plan, and I answer any questions they have. Throughout the conversation I strive to put them at ease, partly by giving them knowledge about what to expect.
Is an anesthesiologist’s training similar to that of other physicians?
Yes. Following medical school, we serve a one-year internship followed by a three-year residency in anesthesiology. Many of us also have fellowship training. Our group here at AAMC is all physicians. Many groups use nurse anesthetists as part of an anesthesia care team.
Where can one get more information?
Our group is developing an online resource which should be available soon. In the meantime an excellent resource is the American Society of Anesthesiologists Patient Education site.