Anesthesiologists: Providing Safety And Comfort

On October 16, 1846, medical history was made at Massachusetts General Hospital in Boston when Dr. William T.G. Morton first used ether to anesthetize a man about to undergo surgery on his neck. This event changed surgical care forever.

Prior to the use of anesthesia, surgery was not just a bloody and dangerous act, it was also incredibly painful. Surgeons were praised for their speed as much as their technical skills. The advent of anesthesia provided comfort for the patient, giving surgeons more time to focus more on the procedure.

This ability to keep a patient comfortable during surgery also resulted in the birth of a new medical specialist: The anesthesiologist. Since then, the practice of anesthesiology has evolved into a highly specialized field that provides the ability for patients to have incredibly invasive and complex procedures.

Anesthesiologists are now at the forefront of health care, providing a safe and comfortable journey for surgical patients while contributing to creating a robust health system for today and tomorrow.

Educational Background
All anesthesiologists complete at least five years of education after finishing four years of medical school. During these years, anesthesia trainees, also known as residents, do a deep dive into the necessary medical content and acquire the procedural expertise required by this specialty. Some anesthesiologists choose to further specialize in a particular area of anesthesiology, a path known as a fellowship, which can take one-to-three years. This totals a combined six-to-eight years of post-medical school training!

Some anesthesia services can also be provided by family practice anesthetists (FP-As), family physicians who have received one additional year of anesthesia education. This extra year trains them to manage routine surgeries and procedures, including administering epidurals for routine pain relief during labour and providing anesthesia for caesarean sections. Other common surgeries that a family practice anesthetist may be involved in include removal of appendixes and gallbladders and joint replacement surgeries. 

Roles Inside & Outside the OR
Anesthesiologists are best known for their role in the operating room (OR) where they are responsible for the administration of anesthetic drugs to “put people to sleep” and more importantly, make sure they wake up comfortably after surgery. There are different forms of anesthesia, with the best known being “general anesthesia,” which is when the patient is made completely unconscious. This is accomplished with a carefully monitored combination of medications administered throughout the surgery. Other types of anesthesia include sedation and regional anesthesia, which involves blocking pain from a specific part of the body. We’ll take a deeper look at general, and other forms of anesthesia in a future blog post.

Once a dangerous act, modern-day anesthesia—in qualified hands—has evolved to be incredibly safe. Extensive training and support systems have decreased the chances of a healthy person dying to somewhere between 1 in 200,000 and 1 in 400,000. In the days or weeks leading up to an operation, the anesthesiologist may meet the patient to help prepare them for surgery. The type of surgery, combined with the patient’s overall state of health, will determine if they need to be seen in advance to ensure the appropriate bloodwork and tests are completed and that the operating room is properly prepared for any special circumstances. 

For straightforward procedures where a preoperative meeting is not required,  the anesthesiologist will always introduce themselves to the patient prior to the start of surgery. For many patients, the last person they see and speak with before being “put under” is the anesthesiologist. Anesthesiologists appreciate the privilege of being part of what is often one of the most intense and emotional moments of someone’s life, and strive to be a source of comfort and calmness during this time.

During the surgery, the anesthesiologist is responsible for the stability of the patient and continuously monitors the patient’s vital signs including heart rate, blood pressure and breathing. As the surgery takes place, they are constantly adjusting the anesthetics with medications to ensure a smooth operative journey. Finally, once the procedure is complete, the anesthesiologist wakes up the patient, ensuring they do so with minimal pain and discomfort.

Anesthesiologists are often compared to pilots, where take-offs and landings are critical and they must be ready at all times for any type of intraoperative emergency, or turbulence! Thankfully, their extensive training prepares them to safely manage these rare, but critical events. 

Following surgery, the anesthesiologist continues to monitor the patient until consciousness is regained. The anesthesiologist is then often involved in post-surgery pain management.  

Some anesthesiologists focus on intensive and critical care and specialize in caring for patients who have had recent serious trauma or illness, such as the effects of a severe infection or life-threatening accident. This care includes intensive monitoring and the administration of an assortment of IV medications to keep patients alive as their bodies recover. Anesthesiologists are also airway experts and are called upon to place a tube in someone’s airway when they are unable to breathe on their own, a procedure known as intubation. During the COVID-19 pandemic, anesthesiologists played a crucial role as airway experts, leading airway teams and intubating patients’ airways so they could be placed on a ventilator. Putting these patients in a deep sleep and taking control of their breathing gave them a chance to rest and recover. 

Another common task performed by anesthesiologists is administering epidurals to labouring women. Did you know that in Canada, nearly 60% of births involve the use of an epidural, a safe and effective procedure for reducing pain in childbirth?

Anesthesiologists can also be found outside of ORs and delivery rooms. Because of their background in pain management, some specialize in chronic pain management and primarily work in clinics dedicated to that field. With chronic pain being a growing problem—Health Canada anticipates its prevalence will increase by 17.5% between 2019 and 2030—we anticipate that anesthesiologists will continue to lead this field.

Some physicians also focus on scientific research. Because anesthesia covers so many aspects of the human body, the subject matter studied can be quite varied. Recently, Ontario anesthesiologists have researched such topics as medical cannabis, the impact of chronic obstructive pulmonary disease (COPD) on surgical patients,  and whether the sex of your surgeon impacts your surgery’s outcome.

Anesthesia is a specialty that requires collaboration and diplomacy along with excellent communication skills. Given that, it’s not surprising that some anesthesiologists find themselves in leadership and administrative roles in the health-care system. A great example of this is Dr. Alika Lafontaine, an anesthesiologist from Grande Prairie, Alberta, who in 2022, became the president of the Canadian Medical Association.

Currently, nearly 1,500 anesthesiologists provide care to Ontario’s population of roughly 15 million people. These physicians are represented by us, Ontario’s Anesthesiologists, a Section of the OMA.

Safe, timely and accessible anesthesia care is a crucial component of a strong health-care system. Ontario’s Anesthesiologists is committed to working with various interested parties to ensure that all Ontarians have access to the anesthesia care they need. 

Do you have a question about anesthesia care in Ontario? Let us know!