What are the different branches of a anesthesiologist?

Answer 1

Anesthesia

Summary: Although anesthesia related deaths and patient awareness during surgery has significantly decreased in the past two decades, it is still a main concern of doctors and medical researchers equivalently. It is believed that about two decades ago the anesthesia related Death Rate was one in ten thousand but today it had plummeted to one in two hundred fifty thousand.

Although anesthesia related deaths and patient awareness duringsurgery has significantly decreased in the past two decades, it is still a main concern of doctors and medical researchers equivalently. It is believed that about two decades ago the anesthesia related death rate was one in ten thousand but today it had plummeted to one in two hundred fifty thousand. The four main branches of anesthesia consist of: general anesthesia,conscious sedation, local anesthesia, and regional block anesthesia. Also, research has shown that pre-existing risk factors may be present in patients such as obesity, previous thrombopehbitis, type A blood, skin color

and concurrent sterilization. In addition to these risk factors, negligence in the operating room is on of the most considerable concerns of both the Anesthesia Patient Safety Foundation and the American Society of Anesthesiologists. Monitoring devices, such as theelectroencephalographmachine, can have an immense affect on how accurately an anesthetist will be able to perform his/her duty of keeping the patient safe. Newer devices, that are capable of reading brain waves, are being tested and will be used to help clarify whether a patient is aware of the surgery or not. On the other hand, the safety of the patient's life does not only rely on the monitoring devices used but training and clinical experience of the anesthetist conducting the procedure. Without these measures made to ensure the safety of patients, awareness and death from anesthesia would be much more common through out the medical world. With these many risk factors known to anesthetists, medical researchers and the Anesthesia Patient Safety Foundation will continue their engagement to improve the safety available to patients undergoing anesthesia.

One of the most common and frequently used anesthesias under major procedures is known

as general anesthesia; this type can be given through inhalation or by injection directly into the bloodstream usually through the IV that has already been connected. When a patient is under

general anesthesia he/she is entirely unconscious, the patient cannot feel, hear or recollect any part of the surgery. Even thoughgeneral anesthesia makes it achievable for the patient to undergo surgeries, such as triple bypass surgery, without any pain, sensitivity or memory amid the operation. One of the numerous disadvantages of general anesthesia is that it interferes with a patient's protective reflexes. Without these protective reflexes a patient can no longer sustain an open airway or handle secretions without aspiration, which augments the chance of obstacles duringsurgery. To provide general anesthesia an anesthesiologist or acertified registered nurse anesthetist, also called CRNA, will conjoin anesthetics, analgesics and muscle relaxants to ensure that the patient will remain unconscious, free of pain and suspended of movement throughout the excision. In the predicament that the patient may have a muscle twitch, the anesthetist would then supplement the IV with more anesthetics for a "deeper" anesthesia. One study of New Zealand researchers pertaining to the effects local versus general anesthesia has concluded that the usage of local anesthesia instead of general could perhaps minimize complications, deaths and awareness by approximately thirty percent.

Conscious sedation is a type of anesthesia where a patient is relieved of pain and

relatively lethargic but still sensible and capable of comprehending his/her surroundings. Besides calling it conscious sedation, other names such as monitored anesthesia, sedation analgesia ortwilight sleep are usually used as well. Additionally, the patient is able to

communicate to the physician whether or not he/she are experiencing any pressure or irritation, which is impossible undergeneral anesthesia. After the usage of conscious sedation it is not abnormal for the patient to experience amnesia and therefore they cannot recall the procedure clearly. Anesthesiologists are not the only physicians authorized to administer conscious sedationbecause of its impotence; dentists, oral surgeons and Certified Registered Nurse Anesthetist are capable as well. Conscious sedation is commonly used for minor operations like breast biopsy and vasectomy because patients can then have a much more accelerated recovery.

An anesthesia that countless people have come into contact with and probably have not

realized, is known as local anesthesia, or topical anesthesia.Topical anesthesia is a branch of local anesthesia that can include sunburn sprays, sore throat lozenges and other ointments that may be used on areas of the nose, throat and the eye. This type of local anesthesia lasts a considerably short time and there have been very few fatal risks associated

with it other than allergic reactions which are also infrequent. The second type is known as local injections which still are merely effective for approximately an hour. Local

injections are usually administered for minor procedures like skin biopsies, dental

reconstructions, stitching of wounds, and other various procedures. Just as in general anesthesia, the amount of time the patient remains unconscious depends on the type and amount anesthesia used. An abundance of new research states that, if possible, local anesthesia should be considered over general anesthesia because it has been associated with less risk factors, complications and deaths.

Regional anesthesia, or regional block, is essentially a type of local anesthesia because it occurs when local anesthetics are injected directly into a nervous tissue. This injection of anesthetics only numbs a certain part of the body it is distributed to, which leaves the patient conscious and in control of the rest of his/her body. Regional anesthesia also includes both epidural block, which is given through a catheter during labor, and pudendal block, a less popular type, which numbs the birth canal. In addition, spinal block may also be used during labor, where the anesthetics are injected into the spinal fluid. Spinal block is more rapid acting and lasts longer than epidural, which wears off faster and takes longer to be

effective. Although these disadvantages of epidural block exist, advantages such as the fact that the deepness of the patient's sleep can be descended deeper by adding more anesthetic through the catheter continuously during the surgery.Whereas during spinal

block the amount of anesthesia cannot be modified to better maintain a patient that is pain free.

Under general anesthesia, a patient commonly loses his/her protective reflexes, which is the ability to handle secretions without aspiration or to be able to preserve and uphold an open airway without the help of a breathing machine. In addition to the loss of protective reflexes, a patient may also lose the ability to feel othersensations such as pain and certain pressures. During abortions, under general anesthesia, there is a greater chance of risk of cervical laceration, perforation and hemorrhage. A vast amount of abortionists prefer that their patients choose local anesthesiarather than general because the patient can interact with the abortionist and declare any pain or strange pressures she is feeling to abstain from any further serious injury. Also, another reflex that is afflicted under general anesthesia is the gag reflex, which is not affected under local anesthesia. Warren Hern, an abortionist and writer, also articulates, "It is preferable to have a patient who is comfortable but able to tell me what she is feeling and if she feels a strange new abdominal pain, then to have a patient who is quiet comfortable because she is dead."

Patient awareness under general anesthesia occurs when the patient is conscious of their

surroundings and sensations during the surgery but cannot move or communicate this to the

surgeon because of the muscle relaxants. Any cases of patient awareness is something

momentous to anesthetists because they understand that it can be an excruciating and atrocious experience which can cause immense anguish and psychological dilemmas for both the patient and his/her family members. Usually, in emergency circumstances, awareness is more likely to occur because it is hazardous for the patient's safety to be put in such a deep sleep with the body still being unsteady. Patient awareness presents itself because different people may affected more or less severely than others to an equal amount of anesthesia,

technical failure and/or negligence or error of the anesthetist. Although new monitoring devices, that could reduce the chance of awareness, are being analyzed and evaluated they still have not undergone the review process to be approved of. To avoid awareness, it is suggested that the patients should inform their anesthesia provider of issues such as: their current health, medications they are currently taking, whether or not they smoke or drink alcohol, medication and food Allergies, any former anesthesia experience that was displeasing and the last time the patient ate.

There have been a substantial amount of studies performed that have shown that pre-existing risk factors in general anesthesia can intensify the jeopardy of the patients' lives and mental states. Any allergies to food or medications a patient may have can contribute to complications during surgery. Smoking, current or previous drug abuse and alcohol use can also prove to be threatening because the anesthetic may perform less or more intensely in the patient's body. The last time the patient ate is of importance because the during the procedure the patient could throw up and then the anesthetist needs to have his/her stomach pumped. Another risk factor that has not been studied eminently but still is being researched is the color of the patient's skin. This is

because it is more unyielding to tell if a darker colored patient has cyanosis which has a dark bluish purple color that results from hypoxia. Hypoxia is the absence or near absence of oxygen in arterial blood and/or the tissues of the human body, which can be fatal.

Other than the average side effects known and the risk of immediate death from anesthesia

there is also the chance that these side effects may persist for a year or perhaps even longer than that. A professor of anesthesiology at Stanford University School of Medicine, Dr.

David Gaba states, "We don't know whether the things we do really have an effect that lasts out to a very long period of time, but there is enough evidence to suggest it might. Even if it's a subtle and fairly uncommon phenomenon, it could affect an awful lot of people." (Roan 1).

Swedish researchers have shown that time spent under anesthesia related to the chance of death

one to two years after the patient's obvious wounds have completely healed. This research of

deaths of patients' years afterwards suggested that anesthesia is somehow connected to later

heart attacks and deaths relating to cancer. In the second research conducted, by Duke University

researchers, also had results that pointed to predominantly heart attacks and cancer a year after the surgery. Many hypothesizes have been reported such as, that anesthesia forces the extrication of stress hormones which results in the inflammation of the body responses which diminishes the immune system's ability to protect itself from diseases.

The infrastructure of the standards relating to anesthesia initiated in 1984 at Harvard; these standards comprised of the basic building blocks of the American Society of Anesthesiologists guidelines. For example, the anesthetist is obligated to reside in the room with the patient continuously, it is also necessary that there is sufficient supervision of the oxygenation, ventilation and the blood pressure of the patient. Since then, there have been numerous guidelines and standards that have been included by the American Society of Anesthesiologiststo better ensure anesthesia patients' safety. It is also mandatory that all facilities and hospitals administering anesthesias keep all records, perform patient screening and testing and have trained and adequate personnel in the room monitoring the patient. Different standards are applied and utilized for the diverse types of anesthesia used but the basic standards are practiced

in all kinds of anesthesia. Although ambulatory surgical centers are permitted to use local,

general or regional anesthesia, they should apply the same guidelines set by the American

Society of Anesthesiologists as hospitals do. In addition to these guidelines, the manufacturers' of the anesthetics recommendations should also be used as guidelines to the amount that has to be taken and the safety precautions that should be used.

One of the most preventable reasons of anesthesia related death and awareness is negligence of the anesthetist in the operating room and the monitoring of the patient afterwards. Whether it is complete negligence, human error or carelessness of the lives that are put in the anesthetist's hands, it is strongly put down by the American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation. Deaths have resulted from the lack of unqualified and unauthorized

personnel providing the anesthesia and sometimes monitoring after the surgery. Facilities'

absence of emergency equipment can also be quiet fatal for the patient and deficiency of certain

alarms of the machines may interfere with the anesthetist's ability to perform the procedure

adequately. Failure to monitor the patients afterwards and watch for any fatal side affects that other unqualified personnel may not notice is also an exceedingly careless mistake made by

anesthetists. Also, the physicians inability to resuscitate the patient or clear the airway after a patient has vomited is considered to be human error more than actual negligence. With the research that has been provided by scientists, all types of these negligent acts can be easily prevented wit proper training of all personnel, surplus amount of sufficient equipment and anesthetists being more careful of their actions and decisions made.

In the past ten to fifteen years many new steps have been taken to better guarantee the safety of the lives of patients all over the United States. Two indispensably important devices developed were the pulse oximeter and the capnograph which started being used approximately two decades ago. The pulse oximeter measures the amount of oxygen that is in the blood and is connected to the patient's fingernail; the capnograph measures how much the patient's lungs are expelling carbon dioxide. Advanced anesthetics being invented are more effective because they have been made to prevent allergic reactions to foods such as albumin from eggs. Anesthesia machines have been created with carbon dioxide alarms, oxygen and nitrogen flow control assembly and vaporizers. Medical training in school and in residency programs have became progressively more rigorous to help prevent any further cases of human error in the operating room. Even though the morbidity rate of anesthesia related deaths is now only one in two hundred fifty thousand, that one death can be prevented through further precautions and steps to assure the safest route for patients undergoing anesthesia for their

surgery.

In conclusion, there have been many types of prevention methods used to help reduce the

death and awareness rate of anesthesia. Organizations such as, the American Society of

Anesthesiologists and the American Association of Nurse Anesthetists have been researching

and working continuously to make that rate decline to zero deaths. Local anesthesia is associated with less complications than general anesthesia, therefore it is considered to be safer to be put under local anesthesia, conscious sedation or regional anesthesia over general anytime possible. Also, patients should take their own precautions that they can to help out the anesthetists better the patient's safety during surgery.