Anaesthesiologists are specialists who are trained for the safe and smooth conduct of all surgeries. In India, candidates undergo training for three years after completing their MBBS and acquire an MD or DNB in anaesthesia. During their training they have a very elaborate curriculum: they are taught about everything from a premature child to a centenarian: their normal physiology, possible associated abnormalities, diseases, the ensuing medications, drug interactions, organ reserves, as well as the patient’s internal milieu gauged with the help of blood, radiological and genetic tests. This in-depth knowledge is essential to build a personalised, procedure-specific anaesthesia plan that would result in a good outcome.
The importance of assessment
It is extremely important that every patient who needs to undergo a surgery is diligently assessed by the anaesthesiologist before the surgery, to formulate the ideal anaesthesia plan. This also gives the medical team an opportunity to rectify and normalise existing clinical conditions like high blood sugar, high blood pressure and breathing ailments like asthma, while also assessing kidney and liver function, essential for metabolising drugs used during surgery such as the anaesthesia drugs, antibiotics, pain killers, blood thinners and intravenous fluids. Whether it is an elective or emergency surgery, it is vital for patients to to get the opinion of an anaesthesiologists and seek their expertise to pre-habilitate, a process to bring them to near optimal health. This is the first and a crucial step to ensure good outcomes.
Advancements in anaesthesiology
Once the appropriate pre-habilitation targets are achieved, the patient is admitted for the surgery. Currently, several surgeries are being performed as daycare procedures, where the patient is discharged on the same day of surgery with clear instructions to report back if there are any possible complications. This has become a possibility because of advancements in anaesthesia and surgical techniques.
Ultra short-acting anaesthesia drugs that leave the body early; advanced monitoring techniques including the depth of anaesthesia that aid in using minimal doses to produce adequate anaesthesia for a painless surgery, and allow the patient to regain consciousness immediately at the end of surgery and ultrasound-guided nerve blocks that block only the nerves carrying pain from the surgical site (at times these have become the only form of anesthesia used) so that the patient remains awake during surgery and is able to walk, drink and eat immediately after the surgery, are some of the advancements in anaesthesia. Advancements in surgery that allow for early discharge include minimally invasive surgeries such as laparoscopic surgeries, precision surgeries using robotics and techniques that minimise blood loss during surgery.
Recently, a new form of anaesthesia called intravenous anesthesia has evolved. Here, AI-enabled infusion pumps are used to accurately deliver drugs through the veins into the blood to the target site, the brain — this is called Target Controlled Infusion. When this form of anesthesia is administered, there is no need to use traditional anaesthesia drugs, which are essentially inhaled by the patient: most people know of this as “Chloroform Anaesthesia”. A note about chloroform however: it is no longer used as safer drugs like Desflurane and Sevoflurane have replaced this erstwhile drug.
The role of the anaesthesiologists
Anaesthesiologists are also extensively trained in advanced monitoring that help them in major surgical procedures for critically ill patients, for instance, those who need organ transplantations including liver, heart, kidney and lung. The anaesthesiologists monitor the changes taking place inside the body every millisecond, are therefore equipped to take steps immediately to prevent any complication. They administer anesthesia using an advanced machine called the anaesthesia workstation, which looks somewhat like the cockpit of an aircraft, and with which every breath of the patient is analysed in terms of adequacy of breathing, and the anesthesia drugs inhaled by the patient are measured accurately too.
Anaesthesiologists keep a close watch on several parameters including the patient’s pulse, blood pressure, oxygenation, blood loss, urine output, heart pumping and body temperature. These high standards of monitoring have revolutionised surgical outcomes and have made many surgeries very safe.
Anaesthesiologists play a crucial role immediately after surgery in the postoperative period, as they have the power to prevent pain, using several groups of pain-relieving drugs and using ultrasounds to block the pain that arises from injured tissues from reaching the spinal cord and the brain, where the pain is perceived. They also closely monitor changes happening inside the patient’s body using bedside ultrasound devices called POCUS, the Point of Care Ultrasound, to detect possible causes of decline in oxygen levels, declining blood pressure etc.
The path ahead
Super-specialists are now emerging in the field of anaesthesia, who undergo a further three years of training after their MD for a DM. They specialise in cardiac, neuro and paediatric anaesthesia or for organ transplantation, trauma and onco-anaesthesia. These advancements in education, research and advocacy have made huge impacts in outcomes. The Indian Society of Anaesthesiologists, a professional body with nearly 50,000 anaesthesiologists across the country, is striving to percolate these advancements in the field to every anaesthesiologist in the country via novel training methods including the use iof SIMMAN, a simulator that mimics the human body. Sim labs have now become a part of several teaching institutions.
The World Federation of Society of Anaesthesiologists (WFSA), is the largest global body, with 150 member countries as its members. WFSA strives to enhance patient care worldwide by working collaboratively to create, develop and strengthen anaesthesiology education and training worldwide.
Anaesthesiologists have now emerged as pivotal specialists in preoperative optimisation, intraoperative care and postoperative care and rehabilitation.
(Dr. J. Balavenkatasubramanian is a senior consultant anaesthesiologist, Ganga Medical Centre, Coimbatore and national president, Indian Society of Anaesthesiologists.drbalavenkat@gmail.com)
Published – June 25, 2025 04:29 pm IST
