Anesthesiology has come a long way from the days when a person took a swig of whiskey prior to a procedure to help dull the pain. Today’s anesthesiologist has an array of tools and medications to make the process easier for both patient and doctor. There is a much better understanding of the anatomy and physiology of the human body today, and how it interacts with various medications and procedures.
“We have a huge role in taking care of patients in the pre-operative, intra-operative and post-operative stages,” says Dr. Matthew Grady, one of Cedar Valley Medical Specialists (CVMS)’ eight anesthesiologists. “We help patients get ready for surgery, we make sure they are adequately managed prior to surgery and that they can be put under anesthesia safely. We treat pain, we keep patients asleep and we keep them alive.”
Although you are asleep during a surgery, you still are able to feel pain. It is the anesthesiologist’s job to make the procedure tolerable to the body. They have control of your entire body. They can raise or lower your blood pressure as needed and adjust your oxygenation levels — actually breathe for you.
“We have very good equipment, very good drugs and very good monitoring techniques,” Dr. Grady says. “Anesthesia is very safe today. The American Society of Anesthesiologists (ASA) has put together very good practice standards and guidelines.”
A typical procedure uses the ASA’s monitors for checking the heart rate, the blood pressure, the pulse, the breathing, the temperature, and for making certain the carbon dioxide levels are adequate. Additional monitoring can be done, depending upon the need, to see how deeply you are anesthetized or to check the filling pressures in your heart.
There are different types of pain management. Epidurals used for labor and delivery pain also can be used for post-surgical discomfort, for example, or nerve blocks in the neck can numb the arm.
An anesthesiologist continues to monitor the patient until he or she is moved from the recovery unit or until the epidural has been removed.
Dr. Grady says one advance in anesthesiology has been the introduction of direct video laryngoscopes. These provide a consistently clear, real-time view of the airway and tube placement, enabling quick intubation in patients who might otherwise have been difficult to intubate.
“When we put people under anesthesia and we give you muscle relaxation, essentially you can’t breathe on your own,” Dr. Grady explains. “We have to get a breathing tube or some kind of device into you through your vocal chords in order to breath for you. With some patients, that’s very difficult to do.
“We used to use a long fiberoptic scope, put it in the back of your throat, look at your vocal chords, put in a breathing tube, and then put you under anesthesia. It’s not pleasant having a breathing tube put in while you are awake. It’s labor-intensive and takes time.
“About 10 years ago it became standard to have a video laryngoscope where we can look at your vocal chords after you are asleep. I think it’s made anesthesia safer,” he says.
Medications also have improved over the past 20 years. Halothane used to make people sick, but there are better-inhaled anesthetics now.
Another recent advancement is the management of temperature. People who go into cardiac arrest have a higher risk of death and brain damage. “ ‘Code Chill,’ also known as hypothermia protocol post-cardiac resuscitation, is a treatment for patients who meet a certain criteria after they have been resuscitated,” says Dr. Karl Terwilliger, CVMS’ expert in the practice. “In order to preserve neurological function in patients whose brains have not received oxygen due to their hearts stopping, we cool down their bodies to 33 degrees Celsius for 24 hours. Then we re-warm the patients over 17 hours.
“There is good data showing improved outcomes in these patients. Larger hospitals usually have this available. Allen Hospital has been doing it since 2013, with promising success,” Dr. Terwilliger says.
CVMS has eight physicians and seven CRNAs in the Anesthesiology Department. The physicians take all of the first calls, including the overnight calls. The CRNAs work independently in the OR and are a big help in providing care for the patients. However, a physician is always in the hospital when anesthesia is being delivered.
Dr. Grady says he chose anesthesiology because he enjoys performing procedures, the operating room environment and the physiology of the specialty.
“One of the things I enjoy about this job is that every patient is different,” says Dr. Grady.
“There are no hard and fast rules. What works for one person may not work for the next. We have to be prepared for that.”