Anaesthesiologists are highly trained medical specialists who specialize in the perioperative care of patients. They play a crucial role in ensuring patients’ comfort and safety throughout their perioperative period.
“Anaesthesia” means “without sensation”; from the Greek roots “an-” (meaning without) and “-aisthēsis” (meaning sensation). Anaesthesiologists administer anaesthetics before surgery to render the memory coding part of the brain inactive, thereby making the patient unaware of the procedure.
There are a few types of anaesthesia, in short:
- General Anaesthesia renders a patient fully unconscious during surgery
- Monitored Anaesthesia Care (or monitored sedation) keeps a patient sedated but responsive during a minimally invasive procedure
- Regional Anaesthesia numbs a specific region of the body, includes techniques such as spinal anaesthesia, epidural analgesia, and nerve blocks
- Local Anaesthesia numbs a small area for a minor procedure
Before surgery, anaesthesiologists conduct a thorough clinical assessment to ascertain the fitness of patient to tolerate the surgery. If needed, the patient’s condition is optimized beforehand, often via a multidisciplinary approach with other specialties (e.g. cardiologist, internal medicine). The options for anaesthetics are then discussed jointly with the patient and the surgeon, to make sure that patient is fully aware of the journey he/she will embark on in the operating theatre.
During surgery, anaesthesiologist’s responsibility is multifold. Other than performing the anaesthetics and controlling the patient’s pain, anaesthesiologist is constantly monitoring the patient’s vital signs (blood pressure, heart rate, blood oxygen level, and temperature), and will intervene if necessary. In the event of an emergency, for example, massive bleeding, anaesthesiologist focuses on stabilising the patient’s condition, to avert any untowards complications.
After surgery, anaesthesiologists collaborate closely with surgeons to facilitate a smooth and optimal recovery process. They play a vital role in post-surgical care, which encompasses intensive care unit (ICU) management, pain relief, and rehabilitation. In the ICU, anaesthesiologists also work collaboratively with a multidisciplinary team of healthcare professionals to provide comprehensive care for critically ill patients.
Neuroanaesthesiologist as a subspecialty
Medicine, like other fields, has evolved from having generalist care to subspecialist care. With the recent growth in neuroscience, the role of neuro-anaesthesia in neurosurgery patients has become increasingly prominent. Neuro-anaesthesiologists are anaesthesiologists who specialize in anaesthesia for neurosurgeries, which involves surgical procedures involving the brain, spinal cord, and/or nervous system.
Let’s shine the limelight on them.
While general anaesthesiologists may provide care during brain and spine surgeries, the specialized role of a neuro-anaesthesiologist is indispensable in optimizing surgical condition. They possess extensive knowledge of the unique considerations and challenges involved in neurosurgery, such as maintaining precise control of blood flow in the brain (cerebral blood flow) and intracranial pressure.
For example, in cases of brain tumors located in different regions, there can be varying complications. When dealing with tumors at the back of the brain, which govern our conscious level, extra caution is required in controlling blood pressure, adjusting the anaesthesia dosage, and determining the appropriate ventilation strategy for the patient using a ventilator.
Furthermore, neuro-anaesthesiologists have unique skills specific to their field. They are capable of providing care for awake craniotomy, a procedure where brain surgery is conducted while the patient is awake. In this specialized role, a neuro-anaesthesiologist adeptly manages the delicate balance of ensuring the patient remains relaxed and calm while also maintaining their cooperation during the surgical procedure.
In high-risk neuro-vascular surgeries, they may even temporarily halt the patient’s heart, if necessary, using medication. This demonstrates the exceptional importance of the specialized field of anaesthesiology in ensuring optimal conditions and patient safety during intricate neurosurgeries.
In summary, neuro-anaesthesiologists and other anaesthesiologists alike possess indispensable expertise and contribute significantly to the success of surgeries. Operating behind the scenes, their meticulous attention to detail, broad knowledge of anaesthesia techniques, constant monitoring, and unwavering dedication to patient safety truly make them specialists in the background.
Dr Leong Kok Weng serves as a Consultant Anaesthesiologist at Beacon Hospital, Malaysia, and has completed a Fellowship in Neuro-anaesthesia & Trauma. He has developed a special interest in anaesthesia for critically ill and elderly patients, and for neuro-interventional procedures involving the brain and spine.
