By John “Jack” Hoyt Esq.

When most of us think of the perils that present themselves during surgery or hospitalization, we think of surgeons who may make cutting mistakes, or leave objects inside of us. We think of nurses who may give us the wrong medications, or unsanitary conditions that may cause severe infections. But it is entirely possible that the greatest danger lurking within the walls of the hospital is anesthesia.

It is an oversimplification to think that anesthesiologists simply render a patient unconscious at the beginning of the surgery, and then wake him up at the end of the surgery. Their job is much, much more complicated and involved. It takes years of training and experience to become a qualified anesthesiologist, and the field is constantly changing.

Most anesthesiologists are members of the American Society of Anesthesiologists (ASA). The ASA formulates and promulgates guidelines by which anesthesiologists assess each patient before administering any anesthesia. Factors such as age, weight, overall health, diabetes, smoking history, heart function, etc. are all carefully weighed and analyzed and the patient is then given an ASA classification. The classification corresponds to the anesthesia risk that patient presents. If the risk is too great, the patient is not a candidate for surgery because he cannot undergo anesthesia. Every patient should insist upon discussing anesthesia risk with his anesthesiologist several days before surgery occurs. Do not wait to discuss anesthesia until you are lying on a gurney outside the operating room just before surgery.

The doctor’s selection of anesthesia agents is critically important as is the means by which anesthesia is administered. For example, it has been shown that in elderly surgical patients, inhaled anesthesia agents (as opposed to intravenously-given agents) may aggravate dementia and contribute to long-term postsurgical memory loss. Isoflurane is particularly perilous in older patients, and it can cause the pathology of dementia by itself. Well-informed patients should always discuss with the anesthesiologist the agents he or she is going to use and why. One should also discuss whether anesthesia will be administered by inhalation or intravenously.

At the beginning of surgery, an anesthesiologist does not simply knock the patient out and wait to wake him up at the end of surgery. Once the patient is rendered unconscious, the anesthesiologist should carefully monitor many levels and body functions. Body position must be monitored and the patient must be moved periodically. Oxygen saturation of the blood must be carefully monitored to because tissue can die when it is deprived of oxygenated blood flow. For example, patients undergoing low back fusion surgery have emerged blind because the flow of oxygenated blood to their optic nerve is compromised. Likewise, body fluid inflow and outflow must be carefully monitored. Anesthesiologists administer fluids called crystalloids or colloids intravenously during surgery; often in large amounts. If there is not a corresponding outflow of fluid (principally by urine) the lungs can completely fill, or the area around the heart can fill with very dire results. For these reasons, levels of body fluids are carefully monitored, as are blood pressure, respiration rate, body temperature, glucose levels of the blood, etc.

Unless anesthesia is properly administered and the case is properly overseen, various grave complications can result including aspiration (liquid or objects into the lungs), heart attack, stroke, hypothermia, paresthesia, etc.

In recent years, Certified Registered Nurse Anesthetists (CRNAs) are often brought into the operating room to fill in where anesthesiologists exclusively used to function. In fact, in several states (New Jersey amongst them) legislation is pending which would allow CRNAs to essentially replace anesthesiologists. CRNA’s are nurses, not medical doctors. All patients should inquire of their anesthesiologist pre-surgically whether he or she will actually be there during the entire surgery or whether he is intending to be replaced by CRNA during part of the surgery.

In general, any patient contemplating surgery should carefully select the anesthesiologist who will work on him during surgery. A board-certified anesthesiologist is best. The patient should meet and carefully discuss anesthesia several days before the surgery is to occur. Rather than waiting until just before surgery when the doctor may be rushed, or the patient may be disoriented, a calm and detailed discussion should take place.