I am an anesthesiologist and have been in practice for fourteen years. Anesthesiologists in the United States are required to go through four years of college, four years of medical school (M.D. degree), a year of internship and then three years of residency. Some seek subspecialty training after that. I work in a hospital setting and do all kinds of cases: inpatient, outpatient, orthopedics, podiatry, general surgery, etc.
My typical day begins at 6:45 AM when I prepare patients for the first cases of the day. I work with CRNA's (Certified Registered Nurse Anesthetists) and occasionally, anesthesia residents. In addition to taking care of patients immediately before and during surgery, I also watch over people in the recovery room. I really do enjoy my job. I derive a lot of satisfaction from helping patients (many of whom are frightened or anxious) through their OR experience. I also like the hands-on technical aspects (for example, doing spinals and epidurals), and the definitive "beginning-middle-end" nature of operating room work.
Depending on the surgical procedure, there are various types of anesthesia that we can give. These include:
A. Local with iv sedation, also known as "MAC" (monitored anesthesia care). We give sedatives intravenously to put the patient in a "twilight" sleep, and the surgeon then administers local anesthesia (similar to Novacaine at the dentist) to the site being operated on. The sedatives include drugs to decrease anxiety, reduce pain, and cause a state of lowered consciousness. Sometimes patients are afraid that since it is not general anesthesia, they will be "awake," but most people simply snooze through the procedure and have little or no recall. Examples: Breast biopsy, colonoscopy, some hernia repairs.
B. Regional anesthesia. Here we give injections to numb a specific region of the body. For example, spinal or epidural to numb the body from the waist down for knee surgery. There are also specific nerve blocks that can numb the shoulder area or the forearm. In addition to the anesthetic we also administer intravenous sedatives so that the patient is in a twilight sleep.
Some people are afraid of spinal anesthesia because they fear becoming paralyzed or having terrible headaches. However, the risk of paralysis is extremely low. Also, the chance of having a post-spinal headache is much smaller when thinner needles are used. Such headaches occur infrequently with the needles in use today.
C. General anesthesia. Here we give drugs intravenously to induce a total loss of consciousness. After the patient is asleep we place a breathing tube in either the back of the mouth or the windpipe, through which we subsequently deliver oxygen, nitrous oxide, and other anesthesia gases. It is rare for patients to recall the tube being there. However, it does sometimes result in a sore throat afterwards.
Some patients are understandably anxious about general anesthesia, because they are afraid they "won't wake up." However, there have been many advances in our specialty over the past thirty years, including the use of certain safety devices and monitors which have decreased the rate of death or serious complications (stroke, heart attack) to less than 1 in 500,000.
Sometimes patients wonder about the "nothing-by-mouth" rule before surgery. We are not trying to be mean, there is a very good reason for this rule! If you have something--anything--in your stomach, and you undergo anesthesia, there is the risk that the stomach contents will come up to the back of your throat. Since your gag reflex is lessened or blocked totally under anesthesia, you could then inhale some of these contents into your lungs, which could lead to a very bad pneumonia from which you could die. The technical term for this is "aspiration." You do NOT want aspiration pneumonia. At our hospital we also tell patients no candy, mints or gum, in addition to no food or drink past midnight. Even if you chew gum and don't swallow it, that still stimulates the stomach to secrete digestive juices (since the stomach thinks that something is coming down the pipe), and these juices can theoretically cause a problem if aspirated. The exception to the nothing-by-mouth rule concerns certain medications, e.g. for high blood pressure, epilepsy or heart conditions. Please confirm with your doctor which pills you should take and which you should withhold prior to surgery.
Here is a modern anesthesia machine. It includes a ventilator, gas delivery system, and various monitors. These machines have approximately as many dials and controls as are found in the cockpit of a small airplane.
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