Most people understand that anesthesiologists are the doctors who administer medications which reduce anxiety and keep them from feeling pain.  However, few people realize that beyond ensuring the patient's comfort, today's anesthesiologists' primary role in the operating room is to make informed medical judgments to protect and regulate the patient's critical life functions that are affected by the surgery being performed.  The activities of the anesthesiologist are seen by few people outside of the surgical and nursing team.  Even the patients themselves are unable to recall much of their involvement with this vital specialist because most of the anesthesiologist's critical work is done while the patient is anesthetized!

Anesthesiology is a medical specialty

Your anesthesiologist is the perioperative physician ("peri-" meaning "all-around") who provides medical care to each patient throughout his or her surgical experience.  This includes medically evaluating the patient before surgery (preoperative), consulting with the surgical team, providing pain control and support of life functions during surgery (intraoperative), supervising care after surgery (postoperative) and medically discharging the patient from the recovery unit.  In some instances, an anesthesiologist assistant or nurse anesthetist may participate in anesthesia care under the direction of the anesthesiologist.  However, it is the anesthesiologist who is responsible for planning and providing appropriate and safe anesthesia care.

Anesthesiologists possess a wide range of knowledge about medications, how body systems work, and their responses to the stress of surgery.  Anesthesiologists are responsible for administering anesthesia to relieve pain and for managing vital life functions, including breathing, heart rhythm, blood pressure, and brain and kidney functions during surgery.

As physicians, they manage any medical problems which may be present before surgery or that may develop during or immediately after surgery.

Your anesthesiologist is responsible for specifying and providing the three following perioperative phases of anesthesiology care:

• Preanesthetic evaluation and treatment
• Intraoperative medical management of patients and their anesthetic procedures
• Postanesthetic evaluation and treatment

Preanesthetic Evaluation

Prior to surgery, anesthesiologists evaluate the patient's medical condition and formulate an anesthetic plan for each individual patient taking into consideration that patient's physical status.  Those patients who have received medical evaluations or treatment from their primary care physicians before surgery must have that same medical care continued during surgery.  As the physician specifically involved in medical management during surgery, the anesthesiologist is the best person to develop and discuss options for anesthesia care.

In the operating room

An estimated 40 million anesthetics are administered each year in this country.  Anesthesiologists provide or participate in more than 90 percent of these anesthetics.  In the operating room, they are responsible for the medical management and anesthetic care of the patient throughout the duration of the surgery.  During surgery, advanced technology is used to monitor the body's functions.  Anesthesiologists must interpret data from these sophisticated monitors in order to appropriately diagnose, regulate and treat the body's organ systems while a personalized, very delicate balance of anesthetic medications is administered.

The role of the anesthesiologist in the operating room is to:

1. provide continual medical assessment of the patient;
2. monitor and control the patient's vital life functions -- heart rate and rhythm, breathing, blood pressure, body temperature and body fluid balance; and
3. control the patient's pain and level of unconsciousness to make conditions ideal for a safe and successful surgery.

In addition to direct patient care, the anesthesiologist is often responsible for managing the resources of the operating suite, including the efficient use of operating rooms, supplies, equipment and personnel.

In the postanesthesia care unit (recovery room)

This is where patients awaken after surgery.  Patients emerge from the effects of the anesthesia under the watchful eyes of skilled nursing personnel with anesthesiologist evaluation immediately available.  Just as  safety is the foremost priority during surgery, it is also of utmost concern that the patient be monitored and continually assessed while fully recovering from the anesthesia.  In the hospital setting, the anesthesiologist determines that a patient has been stabilized sufficiently to be moved to a regular room in the medical facility or should be transferred to an intensive care unit.  In the outpatient setting, the anesthesiologist decides when the patient has recovered adequately and may be sent home following surgery.