Modern Anaesthesia Key To Surgical Advances

Press, Issue 31095, 25 June 1966, Page 20

Modern Anaesthesia Key To Surgical Advances

A specialist anaesthetist is a doctor who has elected to devote his professional life to specialising in this one branch of medical practice, which involves him not only in the administration of anaesthetics, but in pre«operative assessment and treatment of patients.

He is also involved in certain particular aspects of postoperative management, and many other activities for which his training and skills particularly fit him, such as participation in resuscitation, in the care of patients with all sorts of respiratory difficulties, with chronic severe pain, and other allied disorders.

Such a doctor in the United Kingdom is usually referred to as a “consultant anaesthetist,” and in the United States an an “anesthsiologist.” In this country he is called a “specialist anaesthetist.” It is through the tremendous strides made in anaesthesia in the last 20 years or so that many operations of a scope and complexity unimagined in the years before the last war have been rendered possible.

The specialist anaesthetist should be best thought of as the man who, while presenting the patient for surgery in the best possible manner

to facilitate the surgeon's task, is doing all he can to make the resulting disturbance of the patient’s normal physical function as small as he can manage. Early Examination Thus he would preferably like first to see the patient several weeks before the operation is due. This of course is not always possible, especially in urgent or semi-urgent cases, but is especially desirable when the operation is likely to be severe, when special techniques are envisaged or if the patient suffers from some other complaint likely to add to the risk of operation. At this time the anaesthetist will inquire into previous anaesthetics and operations, he will need to know what medicines, tablets or injections the patient may be having, or may have had recently, he will. assuredly ask the patient who smokes to give up smoking for three weeks before the operation, he may advise dental treatment to lessen the risk of respiratory infection or indeed of general infection, he may look for unsuspected anaemia or malnutrition, he may set the obese patient on a reducing programme, and finally but by no means least, may be able by explanation to assist the patient with particular misconceptions or fears. Above all, he can truthfully tell the patient that during a surgical operation, the patient is receiving direct personal care of an intensity which he is unlikely to receive in any other situation or at any other time of his life. By all these means, and if necessary with the assistance of colleagues in other branches of medicine, the anaesthetist endeavours to bring the patient to the day of operation as fit as possible, so that the operative and post-operative course may be made as free of complication as it can be. The Anaesthetic As to the anaesthetic itself, the specialist in this work now has at his command a large armamentarium, from which he will choose a technique best suited to the operation projected, taking into consideration the age and condition of the patient. Not only does the anaesthetist see to it that the patient remains asleep and free of pain for the duration of the operation, but he must put himself in the patient’s place and manage all those things the patient normally does involuntarily for himself. He ensures that the breathing is always adequate, and does not hesitate to manage this artificially by hand or by mechanical respirator should it be inadequate. He may even remove secretions from the lungs which the conscious patient would normally deal with by coughing. Special Techniques He is watchful of the state of the patient’s heart and circulation, not only by direct measurement of the blood pressure and pulse rate but by electronic apparatus if

need be, which continuously notifies the electrical activity of the heart or the state of the circulation in the extremities. If blood is lost, he replaces it. In short, again, he does all he can to minimise the inevitable bodily disturbance associated with a surgical operation. There are special techniques for special purposes which the specialist anaesthe-

tist may employ. After inducing anaesthesia, he may cool the patient’s body to many degrees below its normal temperatures to allow the surgeon to conduct certain procedures in safety; he may deliberately lower the patient’s blood pressure to certain fine limits to make some operations possible; sometimes he anaesthetises a patient so that certain procedures can be carried out in a pressure chamber where pressures of oxygen up to four times atmospheric are applied to the body.

Anaesthetists’ Training

In order to equip himself to deal with all problems and procedures which come his way, the specialist anaesthetist has undertaken postgraduate training in just the same way as other specialists. Having qualified in medicine, and having spent two years as a house officer in hospital, the budding specialist now applies to become a “registrar” in anaesthetics. It is at this time that he is launched into his own specialty. He now works intensively in anaesthesia often under the supervision of his seniors, and begins to prepare himself for examinations.

The specialist qualification sought overseas is the fellowship either of the Faculty of Anaesthetists of the Royal College of Surgeons (England), or of the Royal Australasian College of Surgeons. These diplomas are denoted by the

letters F.F.A.R.C.S. and F.F.A.R.A.C.S. respectively. Acquiring them involves the anaesthetist in similar preparation and examinations to those experienced by his colleague in surgery, who seeks fellowship of one of the Royal Colleges. That is to say, he must pass a “primary” examination in basic science—subjects such as anatomy, physiology, pharmacology and pathology—and then when he has had sufficient practical experience in a hospital or hospitals approved by one of the Royal Colleges, he must pass a “final” examination, a most searching test in his specialty, in medicine, surgery, physics and other related subjects, comprising written papers, and clinical and viva voce examinations.

Exacting Position

This point will be reached at the earliest, 11 to 12 years after the anaesthetist first embarked on his study of medicine as an undergraduate, and he is now able, in his early thirties, to set foot on the lowest rung of the ladder of his specialist career. As with all other specialties he must continue to keep abreast of all advances as the years pass, by reading, by attending meetings, and by travelling overseas to see and hear what his colleagues in larger countries are doing. It can be seen that the anaesthetist is a specialist who commands an exacting and onerous position, which demands years of training and experience. It can be fairly said that the vast strides made by surgery over the last few years have, in large measure, been rendered possible by the advancing ability of the anaesthetist. However, one great problem is facing the specialty of anaesthesia in this country and that is the question of hospital staffing. Relatively few newly qualified anaesthetists are prepared to return from overseas to work full time in New Zealand hospitals, conditions of hospital service being so much better elsewhere. The anaesthetic staffing situation in many of our New Zealand hospitals is grave and if it deteriorates further, may put in jeopardy the present high degree of surgical service provided.

This is the fifth of a series of articles about medical specialists written specially for “The Press'’ by officers of the Whole Time Senior Medical Officers’ Association of New Zealand.