The Mysterious World Of Anaesthesia

1.
The thought of undergoing surgery sends shivers down the spine of every one, be it
poor or downtrodden or rich and mighty. Only difference is some people express it very
explicitly and surgical team has a tough time controlling them on operation table while some
control their fears quite rationally, but that fear is there lurking behind. If we analyse some
common fears, they are:(a)
(b)
(c)
(d)
(e)
(f)

I will not become unconscious.

I will never wake up.
I will wake up in middle of the surgery.
I will have lot of pain.
I will die.
I will end up being a vegetable for life.

2.
Almost all if not all of these fears of patients are tackled by your Anaesthesiologist.
He conducts a thorough Pre Anaesthetic check-up and assesses all your systems and if
required optimises your system to perform at their best before he agrees to take you up for
surgery. Under Anaesthesia all the protective reflexes of the body are knocked off by the
Anaesthesiologist to make the surgery possible and then he takes over those protective
actions himself to sustain life. The patient is made unconscious, he is paralysed so that
Surgeon can get access to the abdomen or any other part required. He then has to take over
the vital function of respiration to sustain his life and also take measures to ensure stomach
contents dont get into respiratory track and lungs and endanger his life. Depending on the
type of surgery he has to control the temperature, blood pressure, circulation and many other
systems as the requirement arises. For example in open heart surgery, all the blood of the
patient is diverted to a heart-lung machine bypassing the heart, body temperature is lowered
to reduce the metabolic demands of the body, heart is then stopped and operated upon and
then body temperature is raised again, blood is diverted back to the heart and heart is coaxed
to start beating again and gradually the support of heart-lung machine is withdrawn. During
surgery especially under General Anaesthesia, Anaesthesiologist has to practically live the
life of the patient for him/her during the surgery till he is in a condition to live it
himself/herself. The only time in life when an individual is more dependent on someone else
for his life is probably when a baby is in her mothers womb.
3.
Over the years the field surgery has made lot of advances. Earlier organ transplants
were restricted to only Eyes (Cornea) and Kidneys but now so many organs are added to this
list like liver and even Heart and Lungs. Surgery could not have advanced to the extent it has
if Anaesthesia services didnt advance to keep pace and support the rising demands made on
the patient by the complex surgeries. The life of a patient can be taken as a spectrum, one end
of which has bright light with fully conscious individual with all systems functioning
optimally and the other end has total darkness and death. Anaesthesiologist takes the patient
to the twilight zone before the darkness of death, keeps him there during the surgery and
brings him back to the sunshine of life after the surgery. This expertise of the
Anaesthesiologist which he practises daily during surgery is also utilised in critically ill
patients in the ICU where patients come after reaching this twilight zone because of their
illness. Next time when you go to see your Anaesthesiologist, go with the knowledge that you
are actually going to give your life to him for safe keeping during the surgery and he will be
your guardian angel during the surgery.

4.
There are mainly two types of Anaesthesia. General Anaesthesia and Regional
Anaesthesia. The General Anaesthesia has been described briefly above. We know that most
of the nerves of the body are transmit the motor and sensory signals to and from the brain
through the spinal cord passing through the vertebral column at the back. When local
anaesthetic drug is injected around these nerve bundles, it blocks the transmission of signal
transmission through them leading to anaesthesia of only the part/region being supplied by
that nerve bundle. This is Regional Anaesthesia. The major advantage is that patient is not
unconscious, he is breathing on his own, his protective reflexes are not knocked off i.e. he
continues to live his life himself leading to greater safety. Although it demands more skill
from the Anaesthesiologist.