Part I: Physicians approach the anesthesiologist you don’t know
Increasingly Advanced Medical Technology
Modern people seem to be much less tolerant of pain than before
Painless childbirth, painless abortion, painless gastroscopy ……
Treatments and even surgeries are labeled as painless
Anesthesiologists have quietly come into the public eye –
Half of the credit for a good surgery should go to anesthesiologists
”Such an evaluation comes from the mouth of Professor Shi, the vice president of the hospital affiliated with xx Medical College, who is also an expert returned from studying abroad, and the tone is sure and irrefutable.
For such an evaluation, ordinary people seem to be difficult to understand. The majority of patients and their families only know that they should have a good relationship with the surgeon in charge before the surgery, and if necessary, they should also ask for a relationship gift for peace of mind, and those “little” anesthesiologists who stay on the sidelines during the surgery should really be ignored.
In fact, anesthesiology is the same level of clinical discipline as surgery and internal medicine within the hospital, anesthesiologists are also clinicians, the same into the layers of the doctor’s title assessment system, and they must have both a doctor’s qualification and anesthesiologist induction certificate, not the usual understanding of the “skilled workers”.
The anesthesia profession has a tendency to return
The first is faster than the general physician.
At present, the country has a number of medical institutions of higher learning have opened anaesthesia, like our region’s Ningxia Medical College and China Medical University, Tongji Medical University, Xuzhou Medical College …… but more clinical anaesthesia doctors or from the general clinical medicine graduates. According to the relevant professionals, with the lengthening of medical undergraduate years, the anesthesia profession is likely to return to the scope of the large clinical.
And specifically to the training of hospital anesthesiologists, currently I go to anesthesia students graduated from the training of an average of three years to complete the general surgical anesthesia operation and management of anesthesiologists, this rate of success is coming faster than the general doctors.
International trend
Anesthesiologists have veto power over surgery
This has been a real misconception for many years, and even today, many people within the hospital do not see the value of anesthesiologists.
Of course, this is not unrelated to the historical development of anesthesiology. In most Chinese hospitals, anesthesiology has been separated from major surgery to become an independent department for only about 20 years, and it was first treated as an auxiliary department, and many of those who were engaged in specific anesthesia work at that time were nurses, whose lack of education and professional skills directly affected their status in the hospital.
However, with the substantial improvement of surgical techniques and equipment power in recent years, all kinds of complex surgeries have been launched, and at this time, as the only independent clinical department in the hospital that has a direct relationship with all the operating departments, the position of the Department of Anesthesiology has suddenly become important, and the use of equipment and drugs can be brought into line with international standards.
However, in terms of recognition, compared with the extraordinary status of anesthesiologists in the international arena, there is a big gap between the recognition and income treatment of anesthesiologists in China. Internationally, the anesthesiologist even has veto power over the surgery, and he is the leading surgeon.
Pre-operative and post-operative professional visits
Patients actually do not understand
Professor Jue Wu, the patriarch of the domestic anesthesia industry and one of the founders of Chinese anesthesia, has been working in anesthesia for nearly 50 years. He summarized his responsibilities in one sentence — in surgery, the surgeon who operates is the one who cures the disease, and the anesthesiologist is the one who preserves life. He also mentioned many times: during any surgery, the anesthesiologist is the direct object of giving life support to the patient, and he has to supervise a series of vital indications such as the patient’s heartbeat, blood pressure, respiration, body temperature and the balance of the internal environment.
For surgical subjects of different ages, 30, 50, 80 years old, there is no significant difference when the surgeon is operating on the same disease; however, there is a world of difference when the anesthesiologist is considering the anesthesia plan. There is an 80-year-old woman with esophageal cancer who has coronary heart disease and poor heart function. For similar complex cases, the anesthesiologist has to take more risks and responsibilities during the whole operation.
At the same time, for surgical patients, anesthesiologists are not just present during the operation, they also have to make very detailed inquiries and visits before and after the operation. However, a survey in Guangdong once showed that about 99% of the patients to be operated on did not understand the preoperative visits of anesthesiologists.
Because in their view, anesthesiologists are just “anesthesia” anesthesiologists, so when anesthesiologists in the preoperative visit to ask medical history, some patients do not actively cooperate, some patients even private mutter: “anesthesiologists ask so much why, is not an anesthetic? “
Your life is actually in the hands of the anesthesiologist
However, this misconception will affect the patient’s own surgical treatment. Director Wei said that with the development of medicine, anesthesiologists are no longer anesthesiologists in the traditional sense, has been tasked with intraoperative monitoring and treatment, 24 hours or more after surgery to continue to treat patients. Surgeons have no time to take care of intraoperative changes in the patient’s condition because they need to concentrate on surgical operations such as resection, repair or hemostasis, etc. The pathophysiological changes in the patient at this stage need to be corrected by anesthesiologists. This is the work of anesthesiologists and an important part of surgical treatment.
As we all know, surgery is a traumatic treatment, surgical trauma can make the patient’s physiological function has been in a high stress state, although anesthesia can reduce the stress of surgery, but can destroy the stability of the patient’s physiological state; In addition, if the surgical patient has other diseases, such as hypertension, coronary heart disease, may be aggravated under surgery and anesthesia, the anesthesiologist only in the preoperative patient’s whole body Only when the anesthesiologist has a full understanding of the patient’s whole body and the physiological function of important organs before surgery can he or she choose the anesthesia method according to the condition and be aware of the possible complications during surgery to ensure the safety of surgery.
In addition, surgical patients inevitably have various ideological concerns, such as fear, nervousness and anxiety, through preoperative visits and patient communication, so that patients feel friendly, thereby reducing the mental burden, which is conducive to the success of surgical anesthesia.
This kind of work intensity simply means that compared to surgeons, anesthesiologists have to come earlier, leave later, and run around more diligently to patients.
The function of anesthesia is expanding
My friend Xiao Li, who just became a mother last week, is a strong advocate of pain-free delivery. She said the whole birth process was smooth and easy, not as painful as people imagine a normal birth to be. In this regard, Xiao Li guessed that it was probably because the anesthesiologist was very skilled, as the director of the hospital’s anesthesia department did it himself.
At present, in addition to our well-known surgical anesthesia, anesthesiologists are actually more involved in the rescue of critically ill patients and the work of pain management, their role is becoming increasingly diverse. Out of the operating room and into the limelight.
What are the risks of anesthesia?
All surgery and anesthesia carry some risk, determined by a variety of factors such as how the procedure is performed and the physical condition of the patient.
Fortunately, there are fewer real negative effects. Your doctor will take steps to prevent and avoid the risks. You can ask your anesthesiologist about the dangers associated with anesthesia.
To ensure that the anesthesiologist provides safe and effective treatment to the patient, there should be some necessary tests and preparations before anesthesia, basic anesthesia monitoring during surgery, and some monitoring treatment during recovery from anesthesia.
Some people do not understand anesthesia and think that anesthesia has effects on the body and is bad for the human body, and some people are afraid of anesthesia. Their understanding of anesthesia is very one-sided. Anesthesiologists are specially trained in the treatment of pain and dominate the treatment of many types of acute and chronic pain, including intraoperative, postoperative, childbirth, and advanced cancer.
Some patients may have serious life-threatening illnesses prior to surgery, some surgical operations are inherently life-threatening, and some anesthesia, such as complex general anesthesia, has a large impact. These patients are overwhelmingly dependent on the work of anesthesiologists to get through the surgical and anesthetic periods safely.
There is a saying in the industry that surgeons treat disease and anesthesiologists preserve life. They use advanced instruments to monitor the patient’s vital functions at any time, and if they find that a patient’s life is threatened by surgery, anesthesia, or the patient’s pre-existing disease, they will take various treatment measures to maintain the stability of the patient’s vital functions and ensure the patient’s safety.
Without anesthesia, tens of millions of patients worldwide would not be relieved of their pain each year, and many of them would die as a result.
Without anesthesia, an ordinary gastrectomy would not only be a painful thing for the patient, but the patient might have died on the operating table long before the operation is over. It is because the anesthesiologist monitors the patient’s vital signs and maintains the stability of vital functions at any time after relieving the patient’s pain that the patient recovers safely and comfortably, which of course must have the cooperation of all departments.
Anesthesia is indispensable in relieving patients’ pain, especially in surgical patients, and in ensuring the safety of patients’ lives during surgery. For patients who are healthy but whose main problem is pain, it is also very important to relieve their pain, as exemplified by analgesia in childbirth.
Part 2: Patients know some common problems with anesthesia and can choose their anesthesiologist
Commonly used anesthesia methods
How to choose an anesthesia method
The risks of anesthesia
Preparing the patient for anesthesia
Do I have a choice of anesthesiologists?
This question is often asked by patients who want to be treated by a medical specialist.
Many people are referred by others or other doctors, but of course you can choose your own anesthesiologist.
Of course you must contact your anesthesiologist in advance so that he or she can make arrangements.
If the patient does not contact the doctor in advance, the chief of anesthesiology will arrange for a particular doctor to give you anesthesia.
What types of anesthesia are available?
There are three main types of anesthesia.
General anesthesia
Regional block anesthesia
Local anesthesia
Each of these has many forms and uses.
Can a patient request which type of anesthesia to use?
Yes, some surgeries can be performed with multiple anesthesia methods, and the anesthesiologist, once informed, will advise which anesthesia to use, how it will be administered, and how it will affect you. If you have your own opinion about a particular anesthesia, you can discuss it with your doctor, and although the doctor’s opinion is professional, he will consider the patient’s opinion in order to make an effective plan.
General anesthesia – what’s really going on?
General anesthesia consists of three processes, divided into induction, maintenance, and recovery phases. The anesthesia is preceded by the establishment of intravenous access and the connection of the appropriate monitors. Evaluation of vital signs before anesthesia is made.
Induction phase
The purpose of induction of anesthesia is the process of changing the patient from the awake state to the anesthetized state.
Usually intravenous general anesthetics, analgesics, inotropes, etc. are used, and the patient undergoes the following changes within a few minutes: from a conscious state to loss of consciousness; respiration 16-20 times/min to respiratory arrest, a process that requires tracheal intubation (using an endotracheal tube inserted into the lungs, replacing the patient’s breathing with a ventilator); the presence of pain to its disappearance, etc.
During this period, the patient’s vital functions change considerably, requiring close monitoring and readiness to deal with what happens.
Maintenance period
After the induction period, the surgeon prepares for surgery. Anesthetics during the induction period can only be maintained for a short period of time, and anesthetic drugs are continuously applied during surgery to maintain a certain depth of anesthesia.
Usually there are intravenous general anesthetics, inhalation general anesthetics, etc., and the medication is adjusted according to the depth of anesthesia and the effect of the drug on the patient.
Monitoring is performed during the maintenance period, and the effect of surgical operation on the patient’s life is always observed and treated when necessary to ensure the patient’s life safety.
Recovery period
When the surgery is over, the patient enters the recovery period. The anesthetic drugs will be discontinued and some drugs will be used to reverse the effects of the anesthetic drugs.
In the anesthesia recovery room your consciousness will gradually return, the patient’s vital symptoms are still continuously monitored, some medications are used to reduce your discomfort, and the tracheal tube is removed when the patient’s respiratory function returns better. When the patient feels pain, postoperative pain management is performed.
The whole process is managed by anesthesiologists and nurses, and the patient is unaware of the procedure when he or she regains consciousness. Why anesthesiologists ask many questions
Because surgery and anesthesia will largely affect the human body, the anesthesiologist wants to know as much as possible about his patient.
In addition to relieving you of pain and comfort during surgery, the anesthesiologist is overwhelmingly responsible for the maintenance of vital life functions, so it is very important to know the patient’s medical status, which includes history of previous illnesses, recent medications, allergy history, previous anesthesia history, etc.
The anesthesiologist must be very familiar with your health condition in order to provide the best anesthesia treatment during the procedure.
A thorough knowledge of the case scenario will help the surgeon to make quick and accurate judgments and treatment of what is happening.
There are patients who undergo surgery with other medical conditions such as diabetes, asthma, bronchitis, heart disease other medical conditions.
During the anesthesiologist’s preoperative visit to the patient, you should inform the doctor of your past medical history so that the anesthesiologist is prepared to treat some diseases during the anesthesia so that they do not affect life safety.
Why should a patient not eat or drink before surgery?
Fasting is very important in most anesthesia patients to make the chances of vomiting and accidental aspiration much less.
This is because some anesthetic drugs diminish the body’s normal protective reflexes.
For example, the lungs have protective reflexes against foreign objects, such as food in the stomach, to prevent them from entering the lungs. However, after anesthesia, these reflexes disappear. And stomach acid is so irritating to the lungs that it often causes aspiration pneumonia, which can lead to respiratory failure and affect life.
Therefore, for your safety, you should follow your doctor’s orders and fast before surgery.
How does the anesthesiologist ensure patient safety?
Sphygmomanometers, oximeters, respiratory monitors, blood gas monitors, mean arterial pressure, central venous pressure, inotropic monitors, temperature, ECG, SWANGANZ catheters and other instruments are often used for monitoring in anesthesia, providing information on changes in the patient minute by minute, the doctor can evaluate the patient’s condition more effectively and carry out treatment, monitors – -a beneficial weapon for anesthesiologists.
What do I need to pay attention to before surgery?
Before the surgery the patient should first of all be relieved of ideological concerns , you can consult with your doctor about the purpose of the surgery, the type of anesthesia, the surgical position, various risks and possible discomfort during the operation.
You should try to cooperate with the medical staff to make good preparations before surgery, quit smoking and drinking, brush your teeth in the morning and evening, get early treatment if you have oral diseases, and carry out various training required after surgery.
If you are taking medication for other diseases before surgery, you must explain to the doctor to clarify whether you need to stop the medication.
Before entering the operating room, patients should abstain from drinking and eating for 10 hours (4-8 hours for children), and patients without a urinary catheter should empty the urine.
In addition, since the anesthesiologist needs to make preoperative visits, it is best for the patient to stay in the ward the day before surgery and not to go out. Those who have difficulty communicating must be accompanied by a family member who is familiar with their condition.
Why is it necessary to sign the anesthesia consent form?
Due to individual differences and co-morbidities, everyone tolerates and reacts differently to anesthesia, and accidents and complications may occur during anesthesia.
Any anesthesia comes with certain risks, and as a patient and family member, it is necessary and right to fully understand the risks of anesthesia, which is why surgical patients are required to have a pre-anesthesia conversation and sign.
Why do I still feel anesthesia?
After anesthesia, many patients ask the anesthesiologist this question.
In fact, except for general anesthesia, most anesthesia methods do not affect consciousness, the patient remains awake, and not all sensation is lost in the nerve block area (the area that has been anesthetized).
Since most patients are nervous to varying degrees after entering the operating room, the anesthesiologist will usually give appropriate medication to sedate the patient to sleep, so there is no need to worry at all.
Why should I go into the anesthesia recovery room after surgery?
Both surgery and anesthesia can disrupt the normal physiology of the body to some extent, especially for patients who are in poor general condition before surgery, have undergone general anesthesia or major surgery.
Patients who require continuous monitoring after surgery, such as those who have not awakened from anesthesia or whose respiratory and circulatory functions are unstable, will be admitted to the anesthesia recovery room.
The anesthesia recovery room is equipped with full-time medical staff and complete equipment to perform timely and effective monitoring and resuscitation, so that patients can successfully pass the unstable period after surgery and anesthesia and further ensure patient safety.
Will postoperative analgesia affect wound healing?
After surgery, anesthesiologists will use different analgesic methods depending on the patient’s condition, and these analgesic methods will not increase the rate of wound infection or affect the growth of incision margins.
Effective analgesia also improves sleep, enhances postoperative immune function, facilitates patients’ coughing and sputum removal and early bed movement, thus speeding up postoperative recovery and effectively reducing postoperative complications such as lung infection and lower limb vein embolism.
Why would postoperative chills occur?
Postoperative chills refer to involuntary muscle contraction and twitching after surgery, the exact cause of which is unknown. Local anesthetics, inhaled anesthetic gas, prolonged surgery, large intraoperative blood and fluid transfusion and exposure of the operative field can increase the incidence of chills.
Warmth and oxygen can relieve chills, and the doctor will give certain medication if necessary.
What about postoperative agitation?
Due to the residual effect of drugs, patients may experience emotional fluctuations and agitation after general anesthesia, so family members should cooperate with the medical staff to fix the patient to prevent falling or bruising, and try to calm the patient, observe the abnormal situation, and accompany the patient until he/she is fully awake.
Does general anesthesia affect intelligence?
The general anesthetics used in modern anesthesia are drugs that have minimal effects on the human body and are reversible, and can be completely excreted by human metabolism after surgery.
Does alcohol affect anesthesia?
This is a question that anesthesiologists often hear from friends of the cup when doing pre-anesthesia visits.
What exactly is the effect between alcohol and anesthesia? As the general public may think, chronic alcoholics do require a higher dose than the general population during anesthesia, but this is not exactly a constant rule.
Is anesthesia more risky in elderly patients?
Yes! Unlike younger patients, older patients often have systemic diseases such as diabetes, hypertension, cardiovascular disease, and cerebrovascular disease.
These high risk factors increase the difficulty of surgery and anesthesia, and sometimes the surgery is successful but the patient eventually dies due to other factors.
Therefore, the assessment before anesthesia should be prudent, and life safety should be the first priority, unless emergency surgery is required to save the life of the patient, otherwise the surgery should be suspended.
Because of the poor physiological and physical condition, it is more important to choose the appropriate anesthesia, monitor the cardiovascular, pulmonary and respiratory, and renal functions during the operation, provide postoperative care and pain relief, and maintain the body temperature.
Postoperative complications such as respiratory failure, myocardial hypoxia, angina pectoris, myocardial infarction, stroke, etc. occur. They are even higher than preoperative and intraoperative ones.
The metabolism of anesthetic drugs is also slowed down by the aging of tissues and organs in elderly patients. Therefore, attention should be paid to the reduction of the dose and the delayed effect of the drug.
Why should I fast before anesthesia?
Patients may ask, “Do I need to fast even for upper body anesthesia? Yes, you need to fast whether you are under general or hemispheric anesthesia.
Why do I need to fast? Because loss of consciousness or unconsciousness during anesthesia can cause aspiration pneumonia due to vomiting and aspiration of vomit into the patient’s lungs. Aspiration pneumonia is a potentially life-threatening anesthetic complication. To reduce this comorbidity, fasting before anesthesia is necessary.
Isn’t the patient under semi-anesthesia conscious? In principle, yes, but during surgery, general anesthesia may be administered because of the need for surgery or because the degree of pain relief or the level of anesthesia in semi-anesthesia is insufficient. In order to avoid the additional risk of switching to general anesthesia in the aforementioned cases, fasting is also required even for patients undergoing semi-body anesthesia.
How long should I fast for?
The traditional approach is to stop eating all solid or fluid foods from midnight on the day of surgery. However, this does not take into account the difference in the rate of emptying of solid foods and clear liquids in the stomach. Also, if the patient is delayed until the afternoon, he or she is likely to be anxious due to hunger and dry mouth, and some children or young women may experience hypoglycemia. Therefore, it has been changed to a more humane and safe method. As a general rule, adults and children should stop eating solid foods, including milk or fruit juices, 6-8 hours before anesthesia. Two hours before anesthesia, you can drink clear liquids such as plain water or fruit juices without grains or pomace, which can not only reduce the patient’s discomfort, but also because drinks like plain water stay in the stomach for a very short time and do not increase the risk of aspiration pneumonia due to vomiting. Infants who are fed only cow’s milk or breast milk should be fasted for 4-6 hours, but again some boiled water or sugar water can be given two hours before, which will reduce the crying of the infant.
Do I need to stop taking my usual medications?
Generally speaking, except for cardiovascular drugs such as anti-hypertensives, stop taking them during the fast. Of course, you can take them with plain water. In addition, diabetic patients should be especially careful not to take hypoglycemic drugs or administer insulin during the fast to avoid hypoglycemia during the fast or during anesthesia.
By telling your anesthesiologist your medical history and medication history honestly and clearly, and by observing the fasting rule before the anesthesia, you will be able to go through the surgery happily and safely and regain your health.