Every time I visit a dental clinic, I say a little prayer of gratitude for Dr Karl Koller, the man who discovered local anaesthesia.
Koller, an Austrian ophthalmologist and a colleague of Sigmund Freud, experimented with cocaine as a local anaesthetic for eye surgeries. He had earlier tried using morphine, bromide and chloral hydrate for local anaesthesia in laboratory animals, but failed.
His experiment with cocaine was conducted on a frog. One of its eyes was treated with cocaine solution. The cocaine solution started to work a minute after it was administered. The frog did not show any signs of discomfort when Koller touched the cornea of its eye treated with the cocaine solution. But when he tried to touch the other eye, it got agitated.
Koller repeated the tests on a rabbit and a dog, too, and the results seemed promising. He found that cocaine had pain-killing as well as tissue-numbing properties. Thereafter, cocaine was used as a local anaesthetic in different types of surgery. Cocaine, however, is no longer used as an anaesthetic, as it can damage the cornea and can be addictive. Today, there are a variety of anaesthetics that are being used in surgeries and procedures, which can be administered through inhaled gas, injected via shots or intravenously, applied topically in liquid form or as a patch or through a spray. And, in the right hands, they put patients at ease, numbing their pain, and let surgeons and specialists work in peace.
But those hands are rarely noticed, despite the fact that it requires high precision skill to administer anaesthetics. Anaesthesiology is among the most high-pressure specialities in medicine, says Dr Sreeja Menon, associate director and head of the department of anaesthesia at Max Hospital, Gurugram. “All our drugs act on various organ systems and need to be fine-tuned according to the patient and surgery for optimal results or can end up creating a disaster,” she says. “High-level skills are needed for an ideal outcome. A patient’s life is practically in the hands of the anesthesiologist during surgery. Even after 22 years, I must be very alert on the job, with no room for error.”
We check the anaesthesia machine every day for its proper functioning... We use a lot of checklists, very similar to how pilots use checklists while flying. Muralidhar Thondebhavi S., consultant, anesthesiology and pain medicine, Apollo Spectra Hospital, Koramangala, Bengaluru
There are different types of anaesthesia, including local anaesthesia to numb a small section of the body (generally used during cataract surgeries or dental procedures); regional anaesthesia to block the pain from a larger section, say, a limb or below the hip (for example, epidural during a caesarean); and general anaesthesia to put the patient in a sleep-like/ unconscious state (used during invasive surgeries). People usually associate anaesthesiology or anaesthetists with operation theatres. Their job, however, begins way before the surgery and at times continues even after the patient leaves the operation theatre.
An anaesthesiologist’s job starts when the surgeon sends a patient for surgery. He or she meets the patient and does a pre-anaesthetic check, which involves getting to know the patient in detail. “We try to understand whether the patient had any surgeries or anaesthesia issues in the past,” explains Muralidhar Thondebhavi S., consultant, anaesthesiology and pain medicine, Apollo Spectra Hospital, Koramangala, Bengaluru. Anaesthesiologists also take a look at the patient’s medical history, the medicines being taken and allergies, if any. They also check if any family member reacted badly to anaesthesia in the past. “Following this, we do a physical examination of the patient, which includes an examination of the mouth and oral cavity,” says Thondebhavi. “After that, we tell the patient what type of anaesthesia is given and what to expect after the surgery. This patient interview generally ends with obtaining an informed consent.”
On the day of the surgery, the anaesthesiologist reviews the patient again. “We also need to prepare the operation theatre,” says Thondebhavi. “We check the anaesthesia machine every day for its proper functioning. We have to load all the drugs that are to be administered to the patient. We use a lot of checklists, very similar to how pilots use checklists while flying. The WHO surgery safety checklist is another valuable tool, which is used just before anaesthesia is given. We have checklists for checking the machine as well. The use of checklists enhances safety.”
But not many are aware of the work that anaesthetists do, and several myths abound. One of the common myths people have is that anaesthesiologists are technicians. This is far from the truth. Anaesthesiologists are qualified doctors. They must finish the four and a half years of medical school (MBBS), followed by three years of specialisation. Next, they must pass the university or national board exam to become a certified specialist anaesthesiologist, says Dr Yash Javeri, critical care, anaesthesia and emergency medicine, Regency Superspecialty Hospital, Lucknow. After passing the exam, one can pursue a super specialisation in a field of his/her choice —cardiac anaesthesia, paediatric anaesthesia, neuro-anaesthesia, intensive care, chronic pain management and emergency medicine.
Many unforeseen complications or events happen during the course of anaesthesia. Failing to address the situation at the right time could have grave consequences. Dr Madhujeet Gupta (above), senior consultant, anaesthesia, PSRI Hospital, New Delhi
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