| Patient Awareness
- What Is It?
Although awareness during anesthesia
is extremely rare, a brochure was created by ASA due
to controversy surrounding a few isolated incidences
of awareness and recent media attention given to brain-wave
monitoring technology. It addresses questions patients
can ask their physicians about awareness, the important
role anesthesiologists play during surgical procedures
and the latest science behind brain-wave monitoring.
To access the brochure, click
What is Anesthesiology?
Anesthesiology is the practice of medicine
dedicated to the relief of pain and total care of the
surgical patient before, during and after surgery.
The education of today's anesthesiologists
has kept pace with their expanding role in offering
the highest quality health care available anywhere in
the world. After completing a four-year college program
and four years of medical school, they enter a four-year
anesthesiology residency training program. Fellowships
in an anesthesia subspecialty and in education or research
may also be taken for an additional year.
More than 90 percent of the active membership of the
American Society of Anesthesiologists have been certified
as diplomates of the American Board of Anesthesiology.
Scope of Practice
The medical expertise of this specialist
has caused a dramatic expansion of the role of the anesthesiologist.
Although historically, anesthesiologists have been known
primarily as physicians who administer anesthesia to
alleviate pain and suppress consciousness of the patient
undergoing surgery, they also provide medical care and
consultations in many other settings and situations
in addition to the operating room.
The anesthesiologist is the perioperative
physician ("peri-" meaning "all-around")
who provides medical care to each patient throughout
his or her surgical experience. This includes medically
evaluating the patient before surgery (preoperative),
consulting with the surgical team, providing pain control
and support of life functions during surgery (intraoperative),
supervising care after surgery (postoperative) and medically
discharging the patient from the recovery unit.
In the operating room:
An estimated 40 million anesthetics are administered
each year in this country. Anesthesiologists provide
or participate in more than 90 percent of these anesthetics.
In the operating room, they are responsible for the
medical management and anesthetic care of the patient
throughout the duration of the surgery. The anesthesiologist
must carefully match the anesthetic needs of each patient
to that patient's medical condition, responses to anesthesia
and the requirements of the surgery.
Within the confines of the operating
room suite, which is often comprised of several separate
operating rooms, the activities of the anesthesiologist
are seen by few people outside of the surgical and nursing
team. Even the patients themselves are unable to recall
much of their involvement with this vital specialist
because most of the anesthesiologist's critical work
is done while the patient is anesthetized! The role
of the anesthesiologist in the operating room is to:
1) provide continual medical assessment of the patient;
2) monitor and control the patient's vital life functions
-- heart rate and rhythm, breathing, blood pressure,
body temperature and body fluid balance; and 3) control
the patient's pain and level of unconsciousness to make
conditions ideal for a safe and successful surgery.
In the postanesthesia care
unit (recovery room)
This is where patients are transferred after surgery,
allowing them to emerge fully from the effects of the
anesthesia under the watchful eyes of skilled nursing
personnel with anesthesiologist consultation immediately
available. While safety is of course the foremost priority
during surgery, it is also of utmost concern that the
patient be monitored and continually assessed while
fully regaining consciousness. In most cases, the anesthesiologist
decides when the patient has recovered enough to be
sent home following outpatient surgery or has been stabilized
sufficiently to be moved to a regular room or ward in
the medical facility.
For pain management:
In addition to the patient's pain being relieved or
blocked entirely during a surgical procedure, it is
equally important to provide adequate pain relief postoperatively
for the patient's comfort and well-being. After surgery,
the anesthesiologist is involved in prescribing pain-relieving
medication and techniques that are best for each individual
patient to maintain a level of comfort and to follow
Because of their specialty training,
anesthesiologists are uniquely qualified to prescribe
and administer drug therapies for acute, chronic, cancer
and childbirth pain. In childbirth, the anesthesiologist
manages the care of two people, providing pain relief
with epidural or spinal blocks for the mother while
managing the life functions of both the mother and the
baby. Read "The Management of Pain" brochure.
In critical care and trauma
As an outgrowth of the postanesthesia
care unit, critical care units are now found in all
major medical facilities throughout the country. The
role of the anesthesiologist in this setting is to provide
medical assessment and diagnosis, respiratory and cardiovascular
support, and infection control.
Anesthesiologists also have the medical
background to deal with many emergency situations. They
provide airway management, cardiac and pulmonary resuscitation,
advanced life support and pain control. As consultants,
they play an active role in stabilizing and preparing
the patient for emergency surgery.
During cardiac laboratory procedures:
In most institutions, anesthesiologists
are available during cardiac catheterizations and angioplasty
procedures for emergency airway management or resuscitation
For diagnostic procedures and nonsurgical
As medical technologies have advanced, so has the need
for anesthesiologists to become involved in caring for
patients during radiological imaging or scanning procedures,
gastrointestinal endoscopies, in vitro fertilization,
lithotripsy procedures, electroshock treatment, nutritional
support and respiratory therapy.
Research and Clinical Studies
Some of the most significant strides
in medicine and surgery have been directly attributed
to anesthesiology's advances in patient monitoring,
improved anesthetic agents and new drug therapy. Research
at the clinical and basic science levels has been done
almost exclusively by anesthesiologists or Ph.D. scientists
with the goal of continually improving patient care
Research is conducted in each of the
subspecialties of pediatric, geriatric, obstetric, critical
care, cardiovascular, neurosurgical and ambulatory anesthesia.
Other areas of study include: blood transfusions and
fluid therapy, infection control, difficult airway management,
cardiopulmonary resuscitation, complications, new devices
and methods of monitoring, pharmacology, pain therapy
and organ transplant.
Complications from anesthesia have
declined dramatically over the last 25 years. Since
1970, the number of anesthesiologists has more than
doubled and, at the same time and at virtually the same
rate, patient outcomes have improved. In just the last
decade, estimates for the number of deaths attributed
to anesthesia have dropped 25-fold from 1 in 10,000
anesthetics to 1 in 250,000 today.
All this has occurred during a time
when the youngest of premature infants in neonatal units
survives intricate, lifesaving procedures and 100-year-old
patients undergo and recover from major surgeries that
were once thought to be impossible.