You’re being wheeled into surgery – a journey some 53 million Americans will make sometime this year. As you roll down the hallway you might be thinking your life is now solely in the hands of God and your surgeon.
You’d be wrong.
There is a second set of mortal hands just as important as your surgeon’s and they belong to your anesthesiologist.
Dr. Geoffery Wolf, a physician anesthesiologist and chair of the anesthesiology department at the Indian River Medical Center, says surgery is far more of a team effort than many folks realize – while the man or woman with the scalpel may get the bulk of the credit for a successful operation, it’s probably your anesthesiologist who will have kept you alive during the procedure.
The anesthesiologist’s job, according to Wolf, is much more than just administering drugs that put you to sleep and wake you up when surgery is over. He or she must also provide continuous assessments and updates to the rest of the surgical team, including the surgeon, on your body’s vital signs and functions, including your heart rate, blood pressure, body temperature and breathing rate, while simultaneously controlling your pain.
He or she must also be able to instantly intercede with breathing tubes, mechanical ventilators or resuscitation drugs should anything goes wrong. It takes about 12 years of schooling and between 12,000 to 16,000 hours of clinical training to become an anesthesiologist so since January 11 to 17 was National Physician Anesthesiologist Week, Vero Beach 32963 sat down to ask Wolf some questions.
Q: I understand IRMC uses only physician anesthesiologists in its operating rooms while some hospitals choose to use nurse anesthetists. What, in your opinion, are the benefits of using physician anesthesiologists?
A: Well, to begin with, physician anesthesiologists have a lot more education and training than nurse anesthetists do. That isn’t to belittle nurse anesthetists. They work very well in a lot of places but we have used a different practice here for years with only physician anesthesiologists and that means that everyone who goes to sleep here has a physician with them from the start of an operation to the finish . . . which is rare. You don’t see that very often.
The public and the media, they don’t realize that patients have a choice. Patients can ask, “who’s going to be taking care of me when I’m asleep? Is it going to be a nurse or a doctor?” We encourage patients to go ahead and ask those questions. They have a choice.
Q: Are there any other benefits to having a physician anesthesiologist in the OR?
A: There is a wealth of information that the physician anesthesiologist can give the patient to make their experience safer and better. When you share your medical history with your anesthesiologist [he or she] is going to go ahead and tailor your anesthetic plan to your individual needs.
If you have had a bad experience before, for example, you may have certain options that are available to you. There are lots of different ways to put someone to sleep. There’s not just one way to do it. Just as much as your surgeon is going to do a medical history and a physical to come up with a plan on how to do your surgery, your anesthesiologist is going to go ahead and craft a plan to optimize for your condition.
If you have a respiratory problem, you may benefit from lung medications that will help improve your breathing prior to surgery. If you have a cough or are wheezing or your blood pressure is a little bit high – these are things that we as anesthesiologists will help to modify a little bit if we need to.
We work in conjunction with your primary care doctor to change a few things if we need to.
Q: Does Vero Beach’s senior population present any specific difficulties when it comes to administering anesthesia?
A: Sure. Our geriatric population here presents a different set of challenges than a lower age group. We treat those patients, oftentimes, with different kinds of anesthetics and often with different quantities of anesthetics.
People in this age group have more problems with blood pressure and respiratory problems. So, sometimes a regional anesthetic is better for these patients because it can minimize some of the side effects or hazards associated with general anesthetics.
With general anesthesia the big thing to worry about in this age group is “post-operative cognitive dysfunction” which is basically delirium or confusion after surgery. It can last for a day or it can last for weeks.
Often times just a little anesthetic for someone over the age of 75 can make them very confused. By doing a regional anesthetic like a spinal or an epidural it gives them, essentially, nothing that is going to make them sleepy or confused and the brain, therefore, really doesn’t see the effects of a general anesthetic at all and is clearer after surgery.
Q: So, would you say that regional anesthesia is now more popular than general anesthesia?
A: I think if you were really going to narrow it down, the most frequent type of anesthesia is still general anesthesia.
However, general anesthetics have become shorter acting in the past 10 to 15 years and they cause fewer side effects. We are always trying to promote lowering risk, lowering complications and improving safety.
It’s our top priority at the American Society of Anesthesiologists. We preach it all the time.
Q: I read a term I didn’t really understand connected to anesthesiology and Webster’s wasn’t much help: the term was ‘titrate.” Can you explain?
A: It’s “adjusting.” So, in the past 10 or 15 years, we would give something (a drug) that would last two hours no matter what. Now we are able to give drugs that last a minute or two.
So, if I want to, I can go ahead and shut things on and off like a light switch. If I want you to be in this position asleep for 15 minutes, I can give you exactly this amount of drug that is going to wear off in 20 minutes.
I couldn’t do that 20 years ago.
Q: I know the American Society of Anesthesiologists’ (ASA) slogan or motto is “when seconds count, physician anesthesiologists save lives” so I dug around and found out that in the past 25 years anesthesia-related deaths with physician anesthesiologists have plummeted from two in every 10,000 surgeries to fewer than five in every one million surgeries. Is that what the slogan means?
A: Very good. You’ve done your research. I’m impressed. That’s exactly right. For a healthy person the quote is about five in a million or about one in 200,000 so that’s pretty small.
