Anesthesiology is one of medicine’s least-understood fields. Because it doesn’t deal with a certain organ, many people aren’t sure what it deals with at all. This World Anesthesia Day, we’ll show you what a day in the life of an anesthesiologist looks like so that you know what to expect if you ever need anesthesia. Today, let’s walk in the shoes of Dr. Guoxun Xu, who has been an anesthesiologist at Beijing United Family Hospital (BJU) for four years.
1) How many patients do you usually see each day?
It varies. An anesthesiologist’s workload largely depends on the type of surgeries that we encounter each day. If we have mostly simple procedures on a given day, then I may see five to eight patients within the operating room. On the other hand, if we have a more complicated surgery case, then I might spend the entire day (10 or more hours) with one patient. But, in the outpatient clinic, it can be more than 10 patients a day. These patients need pre-operative assessments before their surgeries.
Usually, we start off the day with pre-operative consultations. We go to the wards and evaluate our patients prior to surgery so that we can make safe and individualized anesthesia plans based on each patient’s clinical condition. Depending on the type of operation performed and patient’s condition, we may select general, regional, or local anesthesia. We would then prepare medications and all other monitoring equipment needed for the surgery. After the procedure, we will send patients to a recovery room and monitor them for an hour. If everything is fine, we’ll send them to their ward.
2) You mentioned there is an outpatient clinic for pre-anesthesia assessment. What types of patients do you usually see in the outpatient clinic and what are some common questions that you usually address with these patients?
During our pre-anesthesia clinic, we have a large portion of patients who are pregnant and are interested in labor analgesia. In China, people are not very familiar with analgesia during labor. They are concerned that labor analgesia (a common type is labor epidural) might adversely affect the labor and delay the labor process. In fact, epidurals are good for labor. Extensive clinical research data show that effective pain control during labor reduces physiological stress on both the mother and the baby, and therefore improves birthing outcomes and the birthing experience for the mother. However, labor epidural, similar to most other medical interventions, has associated risks including minor bleeding at the puncture site, hypotension, nausea and vomiting, headache, etc. Overall, it makes for a much better labor experience.
Some specific questions regarding epidurals that we would address during pre-anesthesia clinic include things like what an epidural is and how it is performed. We also explain the labor process and how an epidural fits into the process, what can you expect with an epidural in terms of pain relief, risks associated with epidurals, food and water intake prior to labor, and other concerns. We would try to address all relevant questions so that pregnant women feel prepared and have a birthing plan to make them feel reassured and less nervous.
We would also see patients who are planning to undergo other types of surgery that require some form of anesthesia. And one common question that we receive is whether general anesthesia causes harm to the body, especially for children. Currently, there is no definitive evidence demonstrating harm associated with receiving anesthesia. In general, anesthesia is relative given that an appropriate anesthesia method is utilized.
3) Is there anything else that anesthesiologists do outside the operating room?
Yes. For example, for patients undergoing endoscopy scans, we provide support to make the procedure more comfortable. For claustrophobic patients who need to get CT or MRI scans, anesthesiologists can supply medication to help them relax and do the procedure comfortably.
We also have a pain clinic where we do pain management for patients suffering from chronic pain. Pain management involves not only medication but also minimally invasive procedures such as nerve blocks or spinal cord stimulation to control chronic pain. Some people who suffer from shingles, for example, have such severe pain that wearing clothes is painful, so we can insert a temporary spinal cord stimulator to relieve their pain so that they can go back to their normal life.
4) What does an anesthesiologist do during surgery?
Our goal first and foremost is for patients to be safe and comfortable during the whole procedure and after the operation. Depending on the type of surgery, we give our patients analgesic medications (painkillers) to control the pain and anesthetic medications that will allow them to fall asleep or become unconscious (in the case of general anesthesia) and not remember the operation. Most people who are not familiar with anesthesiology are under the impression that anesthesiologists simply administer anesthetic medications and then stand around until the operation is done. In fact, in the operating room, the anesthesiologist is in charge of monitoring the patient’s vital signs, fluid inputs and outputs, and all other clinical indicators that might influence a patient’s clinical condition. We have to observe the process of the procedure. If something happens, you may need to give the patient more medication. If there’s some blood loss, the anesthesiologist pays attention to that.
After the surgery, we monitor the patient in the recovery room closely until the medication wears off and the patient is fit to be released to the ward. If the patient feels sick, we can give them anti-nausea medication. If they feel pain, we can give them painkillers. If it’s a big surgery that causes a lot of pain, we can give them a patient-controlled analgesic device to let them control their painkillers where they can press a button to get more medicine. Metaphorically speaking, anesthesia induction (start of anesthesia) and anesthesia recovery (waking up from anesthesia) are like an airplane taking off and landing. They are absolutely crucial for the success of the anesthesia process and the patient’s safety.
Having said that, some people think that, during a surgery, the atmosphere is very tense and serious. But it isn’t – when the procedure is very stable, we chat and make jokes. That’s when you know it’s the safest – when everyone is relaxed and in control!
5) Is general anesthesia dangerous?
It’s absolutely relatively safe. Deaths from anesthesia are very rare – one in every 200,000. If you’re in a taxi, that’s more dangerous! Not only are the medications better but, more importantly, the monitoring devices are much better than before, so you can monitor almost every aspect of the patient’s clinical status. Nowadays, we can monitor the anesthesia level and the blood pressure from within the blood vessels. This way, we can have real-time monitoring so we can keep track of the patient’s situation and act accordingly.
6) Are there people who can’t get general anesthesia?
There’s no contraindication for anesthesia because, in emergency cases where you absolutely need to receive a surgical intervention, it’s safer to use anesthesia than risk not doing the surgery. We can always plan the right level of anesthesia for you. If a patient just needs a skin biopsy, for example, local anesthesia might be enough. If you’re doing heart surgery or some other major surgery, general anesthesia will be planned. It may happen that elderly people have bad dreams or delirium. This is rare and it doesn’t last very long. The medications are now mostly short-acting, so you’ll usually wake up 10 minutes after the procedure.
7) What do you think about hypnosis for anesthesia?
I’m not very familiar with hypnosis, but I would say it’s completely different from anesthesia. With hypnosis, you might enter a trance-like state but, with anesthesia, we don’t just make you sleep – we prevent you from feeling pain. With hypnosis, if you are slapped or hurt, you would probably wake up. But, with anesthesia, you won’t wake up. With anesthesia, you would receive sedatives, muscle relaxants, analgesics … we put all these medications together to make your operation run smoothly.
8) Is there any part of your job you wish more people knew about?
I just want people to know that they don’t need to worry about anesthesia! It’s safe and it will help you get through your procedure. I know some parents get really worried if their kids need anesthesia. If their child needs a dental procedure, for example, they worry that anesthesia will be bad for them so they make the child do the procedure without anesthesia. The pain and discomfort can be quite distressing and even traumatic for the child, and so using anesthesia is a preferable alternative.
The second thing is that people can trust us and believe in us! Medicine is not perfect and doctors are not perfect. There may be some side effects from medications. This is normal, but we try to minimize the effects. We’re here to make you feel comfortable, and we do our best. Most people think they should feel no pain after the procedure. Our goal is to ensure patient safety and minimize discomfort, but it’s not always possible to control all pain.
Dr. Guoxun Xu is an anesthesiologist with over a decade of clinical experience. To make an appointment with him for pain-management issues, please call the BJU Service Center at 4008-919191.
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