Anaesthesiology & Critical Care

What is Anaesthesiology & Critical Care?

Anaesthesia forms an important tenet and an integral part of modern surgical care. From the Latin word “an-aesthesia,” or “loss of sensation,” an anaesthesiologist renders a patient unconscious so that surgery could be performed. This ensures a controlled, immobile patient for the surgeon to operate on, while also ensures the psychological well-being of patients, since they “sleep through” the entire surgical procedure. The anaesthetic is then reversed after the surgery, allowing the patient to awaken, without memory of what has transpired under anaesthesia. This type of anaesthesia is known as general anaesthesia (GA), and is the most common type of anaesthesia performed worldwide.

Besides general anaesthesia, the other types of anaesthesia commonly performed include:

• Local anaesthesia (LA)

The simplest form of anaesthesia, where anaesthetic is injected onto a small area, numbing only that area. This is the simplest form of anaesthetic and is commonly performed by the surgeon (in other words, presence or anaesthesiologist is not needed). This technique is used for minor procedures, such as breast biopsy, tooth extraction, or cataract surgery.

• Regional anaesthesia (RA)

Anaesthetic is injected close to specific nerves, thereby numbing the parts of the body supplied by the nerve. Regional anaesthesia is usually performed for surgeries on the limbs, or purely for pain-relief (e.g. orthopaedic fractures).

• Central neuro-axial block

Anaesthetic is injected into either the fluids surrounding the spinal cord (spinal anaesthesia), or outside the sac surrounding the spinal cord (epidural anaesthesia), thereby numbing the spinal cord. When both spinal and epidural anaesthesia are performed together, the technique is called combined spinal-epidural (CSE) anaesthesia. Common surgeries needing central neuro-axial block include pelvic surgery, caesarean section, gynaecological surgery, urological surgery, and lower limb surgeries. Occasionally, epidural anaesthesia is performed on parturients to ease the pain in the labour suite.

For certain procedures, such as bronchoscopy, colonoscopy, or bone marrow aspiration, a milder form of GA, monitored sedation is used. Monitored sedation makes patient sleepy enough to forget the procedures, yet, unlike GA, does not affect the breathing or blood pressure. The choice of anaesthetic depends on several factors, such as the medical fitness, types of surgery, and psychological preparedness of the patient. Ultimately, the best anaesthetic is chosen after thorough discussion among surgeon, anaesthesiologist, and the patient.

What is Critical Care?

Critical care, also known as intensive care, is a specialty that deals with patients in life-threatening conditions who need constant and complete care and monitoring. There are various situations where critical care is needed, such as severe infection, major trauma, major bleeding, heart attack, or organ failures. The intensivist - doctor specialized in intensive care, stabilizes a patient, providing support such as ventilation, inotropes, antibiotics, sedation and pain relief, and nutrition. In Beacon Hospital, “open ICU” model is practiced, where various medical experts co-manage a patient together, therefore ensuring only the best treatment and outcome for the patient.

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