Anesthesiology

<p>My experience with medicine has been limited to the simple fact that my mother has spent a lot of time in hospitals, and our low-income status means scrutiny of the bills. One of the large, seemingly disproportionate charges that comes up every time can be attributed to the anesthesiologist.</p>

<p>I've since come to find more respect for what it is an anesthesiologist does, essentialy; in a household where my mother's mood was determined by the amount of pain she was or was not in at the time, I fully understand the need for these professionals and the high price they and their materials command.</p>

<p>That aside, I've been looking into medical school for years. More recently, I've been narrowing my interests down. At the moment, I'm waffling between neurosurgery, anesthesiology and medical research. For the sake of the topic, let's focus on the second one.</p>

<p>Aside from the obvious (anesthesiologists=analgesics, anesthetics), I can't quite figure out what the heck an anesthesiologist <em>does</em>. I've tried looking it up, but all of the sites I've been to have been sorely lacking in specifics (they're geared more toward professionals who are already well aware of what makes their jobs), the university's journals collection is lacking, and I just plain haven't had a chance to swing by the hospital and do some digging.</p>

<p>So can anyone tell me what an anesthesiologist is responsible for in the hospital environment? If anyone knows what an anesthesiologist needs to be particularly proficient in (I would guess biochemistry for starters), that would be great too. Heck, any leads are good!</p>

<p>-- undecided</p>

<p>The selection of any specialty prior to the end of med school is just not realistic. Focus on getting into med school and then, with much more knowledge, you'll be exposed to each and every specialty & subspecialty.
Put another way, you must first find yourself attracted to the species before you can select the individual.</p>

<p>Okay. I had meant that as a preliminary idea of what I was interested more than a "I am going to be an anesthesiologist" thing. I am still trying to be realistic.</p>

<p>Would the question have been better phrased had I simply asked "What exactly does an anesthesiologist do?"</p>

<p>... Well, it certainly would've been a lot shorter.</p>

<p>I think you've missed my point and of course I didn't answer your question. </p>

<p>You must first be passionately interested in medicine as a whole, in the human being and in how the organism works (1st year), how it behaves when it doesn't work (2nd year), and just how to recognize the difference in person or clinically (3rd year) and finally how to fix the problems (4th year)*. </p>

<p>Now that path represents so many hours and so much exposure to so many things that I just can't fathom how jumping over it is of use or even intelligible. What an anesthesiologist does besides put people to sleep is something you'll come across during those years. Meanwhile, I'd say if you don't find the job of your family doc appealing, medicine is not right for you.</p>

<ul>
<li>The references to what happens in the first 4 years is more an illustration than a hard and fast rule.</li>
</ul>

<p>i've also been thinking about neurosurgery and anesthesiology.. and am having the same difficulty finding out exactly what an anesthesiologist does.</p>

<p>see ASA</a> - Patient Education</p>

<p>The wikipedia entry on anesthesiology is brief and not incorrect, in contrast to many wiki entries.</p>

<p>I originally posted this in the other thread started by dOllab1ll.</p>

<p>Anesthesiologist generally handle the preoperative, intraoperative, and postoperative care of the patient. The post-op is generally short term in the PACU and then is generally taken over by the surgeon in the SICU (or specialty ICU). The draw for many is that they get to be in the OR, and dont have to worry about being on the floor (like rounding and figuring out 10 reasons a patient has an infection, etc) which is handled by IMs. They are apart of the code team and will handle the airway. They are consider experts of nonsurgical airways, so if a difficult airway is expected in the ED, they might call a gas resident down. Surgical airways are generally done by ENT or gen surg. They get to do a lot of procedures such as intubations, lines, epidurals, spinals, transesophageal echocardiograms (TEEs), bronschoscopes, local/regional blocks, etc. They oversee the ICUs, except for the MICU. However, that is not universal. And obviously they monitor the patient throughout the surgery. The complex procedure include liver transplants and a coronary artery bypass graft. After residency, some decide to practice the ACT model and they will supervise two CRNAs (or AAs). They will be in the room for induction and waking up, and they will come by to make sure things are going well. CRNAs/AAs are usually limited to the simple cases like a lap chol. They also can do pain management stuff for cancer suffers, addicts, etc. Fellowships include CT, peds, trauma, pain, OB, neuro, and critical care. They can also can an operation if they feel the person is not healthy enough to survive it.</p>

<p>
[quote]
Anesthesiologists work in a variety of practice settings. Operating room anesthesia is provided in tertiary-care academic medical centers, community hospitals, "surgi-centers", and military hospitals. This encompasses anesthesia for general, cardiac, neuro, ENT, orthopedic, ophthalmologic, pediatric, and transplant surgeries. In the obstetric suite anesthesiologists provide epidural, spinal, and general anesthesia for vaginal and cesarian deliveries. Anesthesiologists my provide, or assist CRNAs in providing sedation and airway control for psychiatric patients undergoing ECT, as well as patients in the cardiac catheterization lab, and endoscopy suites. Anesthesiologists work in pain clinics, performing pain management techniques in an office, or OR setting using fluoroscopy for needle guidance. Anesthesiologists work as critical care doctors in the MICU/SICU. So-called "office-based anesthesia" is a growing field in which anesthesiologists assist in office-based surgery by providing anesthetic care that approaches or equals the standards expected in a hospital.

[/quote]
</p>

<p>Some gas procedures:
1. New</a> York School Of Regional Anesthesia - Techniques
2. EMRAPTV</a> Episode 31: Glidescope demo
3. RASCI</a> - Movies and Description of Blocks
4. Anesthesia</a> Machine Simulation - Virtual Anesthesia Machine - VAM
5. Anesthesiology</a> Elective
6. Neuraxiom</a> Ultrasound Guided Nerve Blocks
7. EMRAPTV</a> Episode 8: New sedative cocktail Ket-o-phol</p>

<p>
[quote]
So can anyone tell me what an anesthesiologist is responsible for in the hospital environment? If anyone knows what an anesthesiologist needs to be particularly proficient in (I would guess biochemistry for starters), that would be great too. Heck, any leads are good!

[/quote]
</p>

<p>Key subjects include physiology (heart, lung, etc), pharmacology (propofol, roc, ketamine, etc) and anatomy (brachial plexus, naso/oropharynx, etc). But they still need to know other subjects.</p>

<p>Just a clarification, when I said " the surgeons in the SICU (or specialty ICU)." I did not mean SICU = specialty ICU. It means surgical ICU. There are also specialty ICUs at some hospitals for neuro, cardio, peds, etc.</p>

<p>Also, ' They can also cancel an operation if they feel the person is not healthy enough to survive it."</p>

<p>I would also like to add this blog entry by Dr. Au from the</a> underwear drawer . This was her last day of residency in anesthesia.</p>

<p>
[quote]
My last day of residency was Sunday, June 29th [2008], taking home call for cardiothoracic anesthesia, and I have to admit, I was hoping for a softball. I figured I would get called in for something at the very least, but maybe something small, like a washout or a chest closure. The moving van was coming the next morning, and so I needed to request to be on call on Sunday so that I could have the next day off to, you know, be around as burly men carted off all my material possessions on dollies. I was hoping, perhaps naively, that I might actually get a chance to finish some packing. I would have been perfectly happy with an anticlimactic end to my residency. The universe apparently had other plans.</p>

<p>I already knew the night before that they had scheduled a BiVAD for the following morning to start at 8:00am--essentially, the placement of a mechanical ventricular assist device, often used in failing hearts as a bridge to transplant. So I knew already that I would be going in for that case, which would take a good couple of hours, at least until the afternoon, but I hoped...I mean, there was always the possibility...that the service would be quiet after that. There was nothing else looking ominous up in the CTICU. The OR desk had a blank slate otherwise, as far as they were concerned.</p>

<p>The BiVAD was going smoothly, patient doing well, when we got word that the thoracic team had just booked a lung transplant. Then, moments later, further word, that cardiac had booked a heart transplant. Same donor, two different patients. And that, as they say, was the ballgame.</p>

<p>Once my attending and I realized that the whole day was basically written off, I actually started to enjoy myself. "Going out with a bang!" I kept saying for the rest of the day. My attending was not quite so happy at how the cards had fallen (he's one of those brilliant sarcastic-types) but I think was pleased enough that it was my last day. "Why?" I joked, "Because I'm leaving, and you'll never have to put up with me again?" </p>

<p>"No," he answered, "because you're almost an attending, and I can basically leave you alone and let you manage things." He turned to the surgeons, the perfusionists, anyone that would listen. "Hey, in about eight hours, she's going to be an attending!" Everyone cheered, congratulations were lofted about. I thanked them, and nervously hoped that I was actually ready for all this.</p>

<p>There was a point, I believe, where we were running four cardiac surgery rooms at once. (There was one more case that got rushed in while I was still in with the BiVAD--a post-op bleeder.) It was insane. Thankfully, the general surgery add-on schedule was virtually empty, another unusual circumstance, but this at least allowed the general anesthesia call team to pitch in, the second year residents teeing up rooms to start and occasionally actually starting the cases. We even enlisted the help of two of our first year residents (first years for the next two days, anyway) to help finish a case as the surgeons were closing, transfusing blood products and running blood gases as I ran next door to start one of the transplants. Neither of them had done their cardiac rotations yet, and as I signed out to them and explained the monitoring and told them what to watch out for before sprinting to the OR next door, I saw their hubcap-sized eyes floating over their masks and gave them this empty comfort: "Don't worry, you guys are going to be fine." I remember how many times I've been told that during my training, when I've been put in situations that I felt were completely beyond me, and how meaningless that seemed--"What do you mean I'm going to be fine? How about the fact that I don't know what I'm doing? What's going to happen to the patient?"--and yet, it was. Fine, that is. The attending popped in and out, the second year residents helped out, and the patient made it up to the ICU a few hours later, humming VADs in tow.</p>

<p>How fitting, really, to do a heart transplant as one’s last case of residency. Much like the process of medical training, an organ transplant takes the ordinary and transposes it into extraordinary circumstances—in this case, taking the heart of a freshly deceased patient and having it work in the body of a patient who still might be saved. The recipient that day was a 57 year-old man with dilated cardiomyopathy—with a sick and dying heart that did not beat so much as feebly tremble, barely moving enough blood through his body to keep his organs alive. The sight was quite impressive really, once the patient was anesthetized and the sternum was sawed open to reveal the chest cavity underneath. The patient's old heart was huge, congested, an angry and mottled looking purplish mass looking more like a dead thing in a butcher’s window than anything else. We worked together to get the patient onto cardiopulmonary bypass, the surgeons snipped the old heart out, and suddenly the chest cavity was huge, empty, a yawning expanse waiting to be filled.</p>

<p>For surgery scheduling, there is usually what we call a "send time" and a "cut time," the send time being the time that the patient should be physically wheeled into the OR, and the cut time being after induction of anesthesia and placement of all the necessary monitoring and lines, that the surgeons will be making initial incision. In organ transplants, this is all rigorously timed to coincide with the trajectory of the harvested organ--when the clamp the old heart from the donor, how long it will take them to drive (or in this case, fly) back from the harvest site, when they think the organ will be physically arriving into the hospital. All this is designed to minimize the ischemic time of the new organ, the amount of time that the organ needs to be on ice; basically, the shorter the ischemic time, the better the organ will perform.</p>

<p>However, as with anything in the hospital, the timing was not as precise as planned, and so after we went on bypass, after the old heart was out, there was some stalling. During the wait, which seemed interminable after all the rush, we exchanged stories of transplants past, one in particular where one member of the harvest team grabbed the Playmate cooler with the organ, jumped out of the ambulance, and simply ran across the George Washington Bridge as fast as he could to the hospital, rather than wait for the upper deck to clear. We laugh at this image for a little while, all the while noting how ****ing cool it would be to be able to tell the family offhand afterwards that yes, that was me, I didn't want to keep you all waiting, so I ran your heart across the bridge. </p>

<p>Finally, with some fanfare, the new heart for our patient arrived, about 25 minutes later than predicted. The harvest team, we gathered, had been stuck in some traffic. The heart was double-bagged and floating in a slurry of ice, looking small and cold and waxy. The surgeons peered at it intently, turning it over in their hands, occasionally trimming small pieces away in preparation for the anastamosis.</p>

<p>As new connections were made, the patient, who had been cooled down for his run on bypass, was gradually allowed to warm up, and with him warmed his new heart. It twitched irregularly at first, then started to beat. Its waxy, clay-like appearance melted away as the heart filled with the patients blood, and it flushed pink, then bright red. It needed to be shocked once, twice, with internal defibrillation paddles, and the anastamoses were tested, checking for leaks, but by the time the surgeons started to close the sternum, the heart was beating vigorously, snappily, fairly jumping out of the chest like healthy hearts do. The heart looked like it knew what it was doing. As though it had known what it was supposed to do all along.

[/quote]
</p>