Anyone undergoing surgery that involves being put into a drug-induced sleep comes into contact with an anesthesiologist.
These specialist physicians are also involved in numerous other medical procedures. Use this page to find out about what an anesthesiologist does, and the qualification process to become an anesthesiologist.
What is anesthesiology?
Anesthesiology is a specialist field of medicine practiced by specially trained doctors. It is defined by the American Society of Anesthesiologists as:1
"The practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery."
Anesthesiologists exercise this responsibility in an estimated 90% of the more than 100 million surgical procedures carried out each year in the US.1
In 2013, there were over 30,000 anesthesiologists employed in the US and many more who were self-employed.2
As with any medical doctor, anesthesiologists are required to complete four years of medical school before choosing their speciality. Anesthesiologists must complete a further four years in an anesthesiology residency program, starting with a one-year internship.3
A fully qualified anesthesiologist who has undergone 8 years of general and specialist medical study and training can then go on to sit a further examination for certification from the American Board of Anesthesiology.3
Anesthesiologists are responsible for the anesthesia and overall medical management during surgery.
Many board-certified anesthesiologists continue their training to specialise even further. This involves entering a fellowship program of one year or more, during which time they may choose to undergo training in an area such as:3
- Pain management
- Cardiac anesthesia
- Pediatric anesthesia
- Obstetric anesthesia
- Critical care medicine
- Hospice and palliative medicine.
The surgical role of anesthesiologists
he anesthesiologist's responsibilities for a patient undergoing surgery start at the point of making a pre-anesthetic evaluation and creating an anesthesia plan for the operation. The anesthesiologist continues to be responsible for the medical management of the patient throughout the procedure, while the surgeon takes responsibility for the surgical work.4
The patient is under continual assessment during surgery, with the anesthesiologist monitoring vital life functions including:4
- 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 maintains responsibility for the patient's overall care and is required to carry out post-anesthetic evaluation and treatment, directing non-anesthesiology staff as appropriate to maintain a comfortable state for the patient in recovery.4
Following the operation, critical care medicine is carried out in the intensive care unit, where necessary; this is the responsibility of specialist anesthesiologists known as intensivists.
Some areas of surgical care involve other specialist anesthesiologists: cardiac anesthesia (for heart surgery), pediatric anesthesia (pain management and anesthetics in children) and neuroanesthesia (related to surgery for the nervous system, brain and spinal cord).3
The medical role of anesthesiologists
The main responsibility of an anesthesiologist is for the safety and wellbeing of a patient before, during and after surgery; this is known as perioperative care and in the case of an anesthesiologist involves the administration of drugs that keep the patient in a controlled state of unconsciousness.4
Every anesthesiologist has been trained for this responsibility, but many go on to specialize in non-surgical areas of medical care, particularly in pain medicine (pain specialists) and critical care (intensivists).
Some are involved in the care of people giving birth - for the relief of labor pain, and for anesthetic responsibilities around obstetric surgery during any complications. Such doctors are known as obstetric anesthesiologists.
Other areas of medical care include pediatric anesthesia (pain management and anesthetics in children) and care of the dying in hospice and palliative care.3
Anesthesiologists specializing in pain medicine
The diagnosis and management of pain is a major area of specialization for anesthesiologists, who will work in this area with physicians from other fields, including internal medicine, neurology, neurosurgery, orthopedic surgery, psychiatry and rehabilitation (physiatry).5
As well as being found in operating theaters, some anesthesiologists specialize in treating pain.
Anesthesiologists are particularly concerned with any pain resulting from surgery - known as postoperative pain. However, there is a long list of other scenarios in which anesthesiologists specializing in pain medicine may become involved, such as when a patient is experiencing pain from headaches, burns, diabetes and herpes, or where they are experiencing chest, abdominal and/or pelvic pain.6
The American Board of Pain Medicine, which is responsible for the certification of anesthesiologists working in the specialty, lists a number of roles of pain management specialists, including:6
- Treating the patient directly
- Prescribing medication
- Prescribing rehabilitative services
- Performing pain-relieving procedures
- Counseling patients and families
- Directing a multidisciplinary team, or coordinating other health care professionals
- Acting as consultants to public and private agencies for the best delivery of care to patients in pain.
Critical care - anesthesiologists in intensive care units
Today, a wide variety of clinical services are provided by the anesthesiologist working in 'critical care' - usually in intensive care units.7
The involvement of these 'intensivist' anesthesiologists has its roots in looking after those who have had surgery, but now they also have a role in the care of many types of critically ill patients, young and old.7
The expertise of anesthesiologist-intensivists helps with diagnosing and managing disorders of various body systems, including:7
Anesthesiologists provide critical care and have overall responsibility in intensive care units.
- Respiratory (breathing)
- Cardiovascular (heart and circulation)
- Neurological (brain, spinal cord and nerves)
- Gastrointestinal (including metabolic and nutritional support)
- Renal (kidneys; including providing fluids and electrolytes and managing acid-base disorders).
Anesthesiologists working in critical care are also called on for their expertise in managing the unconscious patient, whatever the cause of the unconsciousness. These specialists may be consulted in cases involving:7
- Multiple organ injury
- Disease that leads to multiple organ dysfunction syndromes
- Patients needing life support.
The physician anesthesiologists in these situations have the role of coordinating the overall medical management of a patient.7
Anesthesiologists in the intensive care unit (ICU) have overall responsibility for the patients, but work with a wide variety of people, including those in the patients' support networks.
Dr. Mark Nunnally, an anesthesiologist-intensivist at the University of Chicago Medical Center, sums up the role:8
"Anesthesiologist-intensivists are the managers of the ICU. We bring all the people together.
There are surgeons, ancillary service providers, nurses, physical and occupational therapists, social workers, nutritionists, pastoral services, and on and on.
Each person has a specific role and function, but the anesthesiologist-intensivist is in charge of seeing the patient as a whole. We look out for conflicts and reconcile them across services."
Obstetricians are not the only doctors involved in the care of people giving birth - anesthesiologists also work in the maternity unit to administer anesthesia where desired or necessary and to work with obstetric surgeons if there are complications.9,10
Dr. Craig M. Palmer, professor of anesthesiology at the University of Arizona, Tucson, has described the work of obstetric anesthesiologists as 'life-saving'. In addition to helping expectant mothers with normal deliveries, the role of an obstetric anesthesiologist "often extends beyond merely being a 'pain reliever'." In a column written for KevinMD.com on behalf of the American Society of Anesthesiologists (Dr. Palmer is chair of its committee on obstetrical anesthesia), he says:11
"While most labors and deliveries go very smoothly, on occasion things can go wrong suddenly - the baby might get 'stuck,' the placenta may fail to deliver properly, or one of a dozen other complications may arise which can put the mother's and the baby's safety, and even life, at risk.
In these situations, the years of training anesthesiologists undertake can make a profound difference in the outcome of a delivery."
The following anesthetic procedures are the responsibility of anesthesiologists working in obstetrics departments:9
- Epidural - An epidural is a thin plastic tube that is placed in the lower back through which anesthetic medicines are given to lower the amount of pain felt from contractions. The same administration point can be used for stronger anesthetics that work well enough to numb the lower body completely during a surgery such as Cesarean section
- Spinal - the same effect as an epidural but given in a single injection of anesthetic medicines through a needle in the lower back, which is removed after administration. It works for the defined duration needed for a Cesarean section
- This is used in the event of an emergency caused by complications, or where a patient cannot receive an epidural or spinal regional anesthetic for a Cesarean section.
In the US, an epidural is the most commonly used method of labor pain management.12 Standard alternatives to epidural anesthesia include standard painkilling drugs administered by the obstetricians and midwives, with the following drugs often used during childbirth: fentanyl (Sublimaze), remifentanil (Ultiva), butorphanol (Stadol) and nalbuphine (Nubain).9
Other options for pain relief during labor are also available, while some patients opt to forego any type of pain-relieving medications. For example, many people make use of breathing techniques, massage, heat packs, and water baths to help with labor pain management.10
If the painkillers given by the obstetric staff are insufficient, anesthesiologists can administer medicines intravenously (IV). Such medications include morphine, fentanyl and others. The patient is typically given control of their pain management (under the anesthesiologist's supervision) through the use of an infusion pump which delivers additional analgesic medication whenever the patient presses the button.9
Some patients are given the option of inhaling nitrous oxide (also known as laughing gas) to help with pain relief during childbirth; this is a much more common practice in the UK, than in the US, where only a handful of centers offer it.12
A leading anesthesiology and perioperative pain medicine specialist from the Brigham and Women's Hospital at Harvard Medical School in Boston, MA, has produced a website detailing more options for women's pain control during childbirth.9
Dr. Bhavani Shankar Kodali, a leading anesthesiology and perioperative pain medicine specialist from the Brigham and Women's Hospital at Harvard Medical School in Boston, MA, has produced a website detailing more options for women's pain control during childbirth.10
See painfreebirthing.com, as recommended by the Society for Obstetric Anesthesia and Perinatology, for more information.