We Care When You Are Not Aware

Anaesthesia

Any patient posted for surgery is more afraid of anaesthesia than of the surgical procedure itself. In the 20th century, patients had one query “I won’t feel much will I? “In sharp contrast to patients today whose main query is, “I won’t be too deep will I? I will surely wake up after surgery wont I?”

Anaesthesia as a specialty has come a long way from the days of force-feeding alcohol or striking a patient on the head to render him/her unconscious. The one agent which displays prominence in the late 1800s is chloroform. From the end of the 19th century to the beginning of the 20th century anaesthesiologists used various agents in succession to arrive at the one agent that reliably caused both unconsciousness and pain relief- Ether. However, it was not without its perils. Depth of anaesthesia was often difficult to control and it was not a very pleasant anaesthetic to inhale and ether as a substance was extremely inflammable. This agent also caused wide swings in blood pressure and heart rate. Recovery also was not smooth as was often accompanied by extreme restlessness and discomfort with severe nausea and vomiting.

Towards the end of the 20th century as shorter acting narcotic agents and anti-anxiety drugs were developed, anaesthesiologists arrived at a consensus that rather than use a single agent to achieve all the end points desirable in anaesthesia, several agents will be used in small aliquots to abbreviate all the aforementioned adverse effects. The end points in anaesthesia are- Relief of anxiety, relief of pain, unconsciousness and muscle relaxation. Let us all bear in mind that surgery as a specialty has progressed to the advancement that it is at today only because of safe anaesthesia. Surgeons in the modern era dare to perform surgeries that were unthinkable in the past, from surgeries on foetuses to surgeries in the extremely elderly.

 All technicalities aside, how safe is “safe”? Let’s talk numbers. It is believed that the first case of death related to anaesthesia happened in 1847, as a consequence of breathing difficulty caused by administration of brandy to treat an issue caused by chloroform. During the first 16 years of chloroform anaesthesia, there were 393 deaths and 48 were reported due to ether. Mortality rates vary from country to country. In developed countries, there are fewer than 20 deaths per 10,000 anaesthetics and in developing countries there may be as many as 19 to 51 deaths per 10,000 anaesthetics. Overall, the crude mortality rate after major surgery varies from 0.5% to 5%. Why is there a sharp difference in mortality between developed and developing countries? The answer lies in the availability of medical resources at the grass root level.

We have certainly come a long way since the 1800s. For instance, even to the common mind it sounds ludicrous that brandy was used to treat an issue caused by chloroform. They were also administering drugs and having patients die without even realising why. The number of deaths due to chloroform and ether does not seem to have a denominator, which is  possibly due to the fact that all this is historic data, that usually tends to be inaccurate. The importance of statistics itself was not recognised until much later.

Everyone knows clearly what the surgeon does, but it’s quite hazy in anyone’s mind as to what an anaesthesiologist does. We make sure you fall asleep safely, monitoring every breath, heartbeat and blood pressure from the time you are awake to the time you are woken up after the procedure. Just like the popular song.. “Every breath you take…Every move you make”, we watch you and the surgeon’s knife like a hawk and initiate measures to keep you in the pink of health. We are the only wall standing behind you ensuring that blood loss is under acceptable limits, ensuring that your blood sugars and all the other hundreds of molecules circulating within you are in optimum balance. We can exactly monitor how awake or how asleep you are by monitoring your brain waves and act accordingly. An experienced anaesthesiologist will often be able to predict what will go wrong before it does. Safety is top priority for every anaesthesiologist. All certification exams in this specialty centre around how safe you are as a caregiver, not your novelty or your creativity. Suffice it to say that we steer you to safety from the cockpit. That being said, mishaps do occur but they are few and far in between. So, next time you wake up after a surgery and cannot remember the anaesthesiologist’s face, it’s good to bear in mind that the drugs we used, eased you into forgetting what would have been any 17th century man’s nightmare of a lifetime.

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