An anesthesiologist is a physician who administers anesthesia to patients undergoing a surgical, obstetric, diagnostic, or therapeutic procedure. They carefully monitor the patient's condition and ensure the proper functioning of vital organs during the process. Anesthesiologists are skilled in diagnosing and treating various types of pain, including acute, chronic, and cancer-related pain. They also play a crucial role in resuscitation and medical management of patients facing critical illnesses and severe injuries.
Specialized training is required before achieving board certification by the American Board of Anesthesiology, which typically takes four years. Additionally, anesthesiologists have the opportunity to pursue subspecialty training for which they may obtain sub board certification.
One such subspecialty is Critical Care Medicine. An anesthesiologist specializing in this field diagnoses and treats patients with critical illnesses or injuries, particularly those with trauma and multiple organ dysfunction. These professionals provide extended care over a period of hours, days, or weeks, often in the intensive care unit (ICU) of a hospital. They collaborate with primary physicians, critical care staff, and other specialists to coordinate patient care effectively.
Definition and Scope of Anesthesiology
Anesthesiology is the division of medicine that deals with the use of pharmaceutical agents (anesthetic drugs) for sedation and pain management before, during, and after a surgical procedure.
Anesthesiology also involves nonoperative pain management and treatment of patients in surgical intensive care units [SICUs]. A medical doctor specializing in anesthesiology is known as an anesthesiologist. Anesthesiologists are responsible for the patient while sedated.
Anesthesiologists typically work as perioperative physicians. A few additional functions of an anesthesiologist include management of patients with acute and chronic pain, care of patients in a SICU, management of cardiopulmonary resuscitation and advanced cardiac life support when patients code as well as airway management and intubation.
There are three anesthesia types.
General anesthesia: A general anesthetic is used to induce unconsciousness (sedation) during a surgical procedure. The anesthetic agent can be administered either via a breathing mask/tube or through an intravenous (IV) line. General anesthesia is used for all major surgical procedures.
Local anesthesia: In local anesthesia, an anesthetic agent is used to temporarily block the sensation of pain in only one area of the body (localized small area). When local anesthesia is used during a procedure, the patient is conscious but cannot feel pain in the area where the anesthetic has been administered. Local anesthesia is usually used for minor surgeries. The anesthetic agent can be administered via an injection or by topical application.
Regional anesthesia: In regional anesthesia, an anesthetic agent is used to block pain in an entire portion of the body—a much larger part of the body than local anesthesia. Patients under regional anesthesia remain conscious but cannot sense pain in the region of the body where the surgical procedure is performed. For instance, a spinal anesthetic is used to block pain in the entire lower abdominal and pelvic region, along with the lower extremities.
Anesthesiologists must be knowledgeable about a broad spectrum of disease and injury states that may impact the ability to safely sedate and revive a patient. The skillful selection of anesthesia type depends on the patient’s overall health status and the kind of surgical procedure being performed.
Anesthesiology-Related Medical Specialities
Anesthesiology can be sub-divided into the following specialties:
General anesthesiology
Regional anesthesiology
Pain medicine
Pediatric anesthesiology
Obstetric anesthesiology
Cardiothoracic anesthesiology
Medical-Legal Cases Involving Anesthesiology
Most times, anesthesiology-related legal cases pertain to medical negligence, in which the physician’s failure to meet the standard of care causes patient injury or harm. An anesthesiology expert witness can provide relevant insight in the following types of anesthesiology-related medical negligence cases:
Failure to either administer the correct anesthetic agent or the correct dosage
Failure to check the contraindications of an anesthetic prior to administration
Failure to properly monitor the patient while unconsciousness
Failure to monitor oxygen delivery to the patient (e.g., hypoxia or anoxia)
Improper intubation of a patient
Delay in recognizing anesthetic complications during a surgical procedure
Medical negligence by an anesthesiologist can also cause injuries or induce harmful side effects. An anesthesiology expert witness can provide information about the following types of injuries and side effects:
Severe allergic reaction to an anesthetic agent
Permanent nerve damage following an anesthetic procedure
Laryngeal nerve damage during intubation, particularly by a cuff
Damage to the teeth during intubation
Formation of blood clots due to an anesthetic agent
Any bodily injury due to an anesthetic agent that causes death of the patient
Failure to initiate rapid sequence intubation
Failure to recognize an anaphylactic reaction to a medication
Improper positioning or padding that results in brachial plexus injury
Peripheral nerve injuries in diabetic patients
Failure to monitor respiration during Propofol administration (or while under other conscious sedation)
Anterior or posterior ischemic optic neuropathies
Mismanagement of perioperative perfusion
Failure to intubate into the lungs
Perioperative vagal nerve injuries
Failure to consider the impact of prescription and over-the-counter medications on anesthesia
Failure to consider how sleep apnea affects safe sedation
Failure to understand how hypovolemia, anemia, and clotting disorders impact anesthetizing patients
Anesthesia in renally and hepatically compromised patients.