Anaesthesiology-An overview

Necessity is the mother of all inventions. Prior to the discovery of anaesthesia in the 19th century surgery was looked upon as a last and desperate resort. Conscious and without pain relief, it was beset with unimaginable terror, unspeakable agony and unmitigated risk. The experience and emotions of a patient undergoing surgery before the discovery of anaesthesia was perhaps best captured by the vivid description of Fanny Burley an English novelist who underwent surgery in the early 18th century.

“When the dreadful steel plunged into my chest, I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittently during the whole time of the incision, so excruciating was the agony, I then felt knife scraping the bone”.

It was not just the patients but also the surgeons too who suffered considerable anxiety and distress. John Abernethy a surgeon in London in the early 19th century described walking to an operating room, was like going to a hanging and often shed tears and threw up after a particularly gruesome surgery.

It was against this background that anaesthesia was discovered.

On 16th October (celebrated as world anaesthesia day)1946, William Morton, a young dentist from the United states, anaesthetised a young patient undergoing a tumour removal from the jaw in a public demonstration at the Massachusetts general hospital using Ether gas as the anaesthetising agent. Much to the surprise of the watching public and the surgeon the procedure occurred without the patient moving or complaining.

The speciality of anaesthesiology born on 16th October 174 years ago, has undergone several evolutions and refinements. From Ether to Chloroform to modern gases such as Sevoflurane and Isoflurane anaesthesia has come a long way indeed. Yet little is known about the branch and those who specialize in it. There are several misconceptions about anaesthesia and anaesthesiologist, questions like “what exactly do you do?” and “there are special doctors that give anaesthesia?” are common.

Anaesthesiologists can be looked upon as sentinels of the operating room. We are always on guard listening to the rhythm and rate of each heartbeat, monitoring the changing blood pressure and ensuring adequate oxygen reaches the lungs. Within the operation room the role of an anaesthesiologist can be summarised by 4As.

1) Analgesia-To ensure a painless surgery.

2) Akinesia-Make sure the patient is immobile

3) Amnesia-To ensure no recall of the surgery

4) Autonomic, cardiovascular and respiratory stability-To maintain the functioning of all systems of the body.

Outside the Operating room anaesthesiologist don the role of Intensivist physicians, we are trained in the resuscitation of patients in shock or who have suffered trauma and are called in whenever there is a “code blue”.

In December 2019 the first case of the corona virus was detected in Wuhan, China. Within months several countries were impacted. For perhaps the first-time anaesthesiologists, who often work in the background, were thrust into the spotlight. Along with other healthcare workers anaesthesiologists have been working on the frontlines battling this malady. Chief among their tasks is the intubation of a patient who needs to go on a ventilator and operating the ventilator-one of the top weapons in the fight against the virus. Despite the long hours and the fear of bringing home the sickness to their families, anaesthesiologists and healthcare workers all over have answered the call in the fight against COVID-19. Recognising this effort, Time magazine featured an Italian anaesthesiologist in a special report on Heroes on the frontline.

While I hope you aren’t in need of an anaesthesiologist anytime soon. I hope you will now better understand the role of an anaesthesiologist. Your life is our life’s work.

Dr Leon Da Silva.