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 here.

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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 proper rest.

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 medicine:

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 if necessary.

For diagnostic procedures and nonsurgical treatments:
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 and safety.

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.

Patient Safety

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.