By Susan J. White
NorthShore University HealthSystem
As advances in technology and knowledge have made modern anesthesia exceptionally safe, there may be greater risk of mortality in driving to the hospital for surgery than in undergoing anesthesia.
Twenty five years ago the risk of a critical complication from anesthesia was about one in 5,000, but thanks to safety advances that risk is just one in 200,000 or 300,000 today, according to NorthShore University HealthSystem (NorthShore) anesthesiologist Glenn Murphy, MD.
“Anesthesia is remarkably safe,” says Dr. Murphy. “We have seen dramatic improvements in anesthetic medications, technology and training.”
Most people probably do not have a true understanding of an anesthesiologist’s role, adds Dr. Murphy. “We are perioperative physicians responsible for patients’ medical care throughout the hospitalization period,” he explains.
An anesthesiologist’s care begins with a thorough pre-operative evaluation to ensure that an individual’s medical conditions and history are known and appropriate for scheduled surgery. Even in trauma or emergency situations, anesthesiologists will gather as much information as they can to make sure the surgical experience is as safe as possible, says Dr. Murphy.
During an operation anesthesiologists use several different drugs, and each anesthetic is individualized to the patient using a variety of factors including weight, age, and medical conditions to determine the right drug and dose.
Sophisticated monitoring systems looking at everything from heart rate and rhythm to brain function allow anesthesiologists to carefully tailor the amount of anesthesia needed during a surgical procedure, as each patient reacts differently. “We are constantly adjusting the amount and the type of drugs we are giving a patient on a minute to minute basis,” explains Dr. Murphy.
Anesthesiologists continue to monitor patients after surgery to ensure a smooth recovery, and they are increasingly involved in helping with pain management after surgical procedures and in caring for cancer patients and others with chronic pain issues.
“We are specially trained to help people with acute and chronic pain; we are not just in the operating room putting people to sleep,” says Dr. Murphy.
There are three different types of anesthesia, and patients often ask what kind they should have. Sedation with local anesthesia is generally given so patients remain sleepy and comfortable, but generally have no recollection of the surgery.
Regional anesthesia—in the form of spinal, epidural, or peripheral nerve blocks—blocks nerves in a particular area of the body and can be given in combination with sedation drugs. General anesthesia renders patients unconscious and pain-free and often requires a tracheal tube or mask to keep patients breathing during the procedure. General anesthesia is often required for more complex procedures like neurosurgery or heart surgery.
Patients should discuss the types of anesthesia with their surgeon and anesthesiologist, explains Dr. Murphy.
Some patients may experience post-operative nausea and vomiting related to anesthesia and other factors, but anesthesiologists now use a number of strategies to prevent and treat these conditions.
Improvements in the field of anesthesia continue with research aimed at methods to improve patient safety as well as techniques to improve the quality of recovery.
“In particular we at NorthShore are trying to improve the quality of recovery after surgery. There are things we can do as anesthesiologists in the operating room to help patients feel better and make a quicker return to their normal quality of life,” Dr. Murphy says.
As an example, NorthShore anesthesiologists have conducted several studies using a small dose of steroids administered in the operation room, which has been shown to significantly improve patients’ recovery in terms of a quicker return of appetite, less nausea, less fatigue and less pain.
NorthShore anesthesiologists are also looking at the effects of narcotics used during surgery on postoperative recovery and at new monitoring technology.
“We already do a great job in terms of patient care, but we are constantly utilizing the latest technology to continue to reduce the risk of any adverse affects after surgery,” says Dr. Murphy.
