An anesthesiologist is a doctor who gives a patient medication so they do not feel pain when they are undergoing surgery.
However, these specialist physicians play a much wider role than just putting people to sleep for surgery.
They are also involved in a range of other medical procedures, including carrying out assessments in critical care units, dealing with emergency situations, and giving advice about pain management.
Anesthesiology is defined by the American Society of Anesthesiologists as: "The practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery."
Anesthesiologists are involved in around 90 percent of the more than 40 million surgical procedures that are carried out under anesthetic each year in the United States.
This involvement may include direct care of the patient or supervision of Certified Registered Nurse Anesthetists (CRNAs) or Anesthesia Assistants, who also play a key role in the field.
In 2016, there were over 30,000 anesthesiologists employed in the US and many more who were self-employed.
The anesthesiologist provides pain relief before, during and after surgery, but they also fulfill a number of other important roles.
Pain relief in surgery
Before an operation, a patient will meet with the anesthesiologist for an evaluation. The anesthesiologist will make a plan for the operation that takes into account the individual needs of the patient.
On the day of the operation, the anesthesiologist supervises the administration of medication so that the patient will not experience pain.
However, the anesthesiologist does not physically provide most anesthetics. They supervise either a CRNA or Anesthesia Assistant while they provide the anesthetic. CRNAs often work independently without supervision as well.
The type of pain relief offered during surgery may be:
General anesthesia: The patient "goes to sleep" while the operation lasts.
Sedation: Intravenous drugs calm the patient or make them unaware of the procedure.
Regional anesthesia: Local anesthetic is injected near the nerves to numb the area that will be operated. These may be nerve blocks or spinal or epidural injections.
During the procedure, the surgeon carries out the surgical work, but the anesthesiologist will continue to be responsible for the medical management of the patient.
They monitor the patient's bodily functions, assess the best way to treat the vital organs, and provide a balance of medications suited to the individual's needs.
The functions they need to monitor include:
- heart rate and rhythm
- blood pressure
- body temperature
- fluid balance
The anesthesiologist controls these vital measures and the patient's level of pain and unconsciousness throughout the operation.
After the procedure, the anesthesiologist continues to be responsible for the patient's overall care. They will reverse the effects of the anesthesia and continue to evaluate the patient and keep them comfortable as they recover.
During this process, the anesthesiologist will direct other health workers, including specialist nurses.
Critical and emergency care and other roles
The anesthesiologist also plays a key role in critical care and treatment and trauma. They assess patients, make diagnoses, provide support for breathing and circulation, and help to ensure that infection is prevented.
Anesthesiologists are also qualified to contribute to emergency medicine, providing airway and cardiac resuscitation and support and advanced life support, as well as pain control. They help stabilize patients and prepare them for surgery.
Some anesthesiologists will seek additional training and qualifications to specialize in pain medicine and critical care.
Every anesthesiologist is trained to support surgical intervention, but many also specialize in particular areas.
- cardiac anesthesia, for heart surgery
- pediatric anesthesia, for pain management and anesthetics in children
- neuroanesthesia, related to surgery for the nervous system, brain, and spinal cord
- obstetrics, offering pain relief during labor and delivery
Other areas of medical care include pediatric anesthesia (pain management and anesthetics in children), care of the dying in hospice, and palliative care.
Pain control and advice
An anesthesiologist who specializes in pain medicine may assist patients who have pain due to a range of causes, including headaches, burns, diabetes and herpes, or where they are experiencing chest pain, abdominal, pain pelvic pain, and so on.
Their role in this field includes:
- treating the patient
- prescribing medication and rehabilitative services
- performing pain-relieving procedures
- counseling patients and families
They may also direct a multidisciplinary team, coordinate other health care professionals, and act as a consultant about the best way to deliver care to patients who have pain.
Anesthesiologists who work in critical care are sometimes known as intensivists.
The anesthesiologist-intensivist helps with diagnosing and managing disorders that affect all body systems, whether to do with circulation, digestion, the kidneys, the nervous system, or any other system.
Anesthesiologists working in critical care are also qualified to help when a patient is unconscious, whatever the reason.
This involves coordinating the overall medical management of a patient and coordinating with a range of medical professionals and possibly also the patient's family and friends.
Anesthesiologists are involved in maternity units, where they administer pain relief and assist if complications arise.
A midwife can give some kinds of pain relief medication, but if this is insufficient, the anesthesiologists can administer stronger medicines intravenously (IV).
An epidural supplies anesthetic medicines to the lower back to reduce the pain felt from contractions.
If a cesarean section is needed, stronger anesthetics can be given in the same location, to numb the lower body completely for surgery.
If severe complications arise, the anesthesiologist may need to provide a general anesthesia.
The anesthesiologist can provide or supervise the administration of medications such as morphine, fentanyl, and others.
The patient may be given control of their pain management, under the anesthesiologist's supervision. They may be given an infusion pump that delivers additional analgesic medication whenever the patient presses the button.
Anesthesiologists are doctors. Like other doctors, they start by taking a 4-year undergraduate degree, followed by 4 years of medical school.
After this, they must complete a further 4 years in an anesthesiology residency program.
Finally, they can go on to sit a further examination for certification from the American Board of Anesthesiology (ABA).
If they wish to specialize further, they will enter a fellowship program of one year or more, to train in:
- pain management
- cardiac anesthesia
- pediatric anesthesia
- obstetric anesthesia
- critical care medicine
- hospice and palliative medicine
Before a procedure, the ABA suggests that patients ask questions such as the following, to find out more about their anesthesiologist, and what to expect:
- Are you qualified by the ABA?
- What type of anesthesiology do you recommend for my case?
- What are the risks and benefits of this option, and what other options are there?
- Will I need a breathing tube, and will it be there when I wake up?
- What options will there be for managing my pain after the procedure?
To check whether an anesthesiologist is fully qualified and board certified, contact the ABA website.