Keeping Patients Awake During Surgery? Anesthesiologists’ Vital Roles in All Anesthetic Procedures
Think anesthesiologists only keep patients “asleep” during surgical procedures?
It isn’t always necessary to be under general anesthesia – for some procedures it is much better to be “awake,” or alert and aware with the ability to communicate with the surgical team.
You may have heard of situations where patients are awake, including “awake craniotomy,” during surgical procedures. These instances challenge the common notion that patients are asleep during all major surgical procedures.
In awake craniotomy and similar procedures, patients are anesthetized but are not always under general anesthesia, making them active participants in their own operations and able to respond to requests from the surgical staff who map key areas of the brain.
During these procedures it is the anesthesiologist who keeps a patient comfortable, awake and alert.
“It is a delicate balance to keep a patient still, comfortable and calm while at the same time to get him or her comply with what can be very sophisticated neurologic testing. It’s a very delicate balance,” said Keith J. Ruskin, M.D., professor of anesthesiology and neurosurgery at Yale University School of Medicine.
“At any time during these ‘awake’ procedures, we have to be ready to treat a variety of emergencies, from pain and agitation to bleeding, seizures or respiratory arrest,” said Dr. Ruskin.
An anesthesiologist is involved in the surgical process from the beginning, where they meet with patients in a preoperative visit and assist in planning the procedure.
Anesthesiologists remain patient focused before, during and after a procedure. On the day of surgery, the anesthesiologist applies monitors to the patient, works to position the patient comfortably and administers a combination of drugs and verbal reassurance- coaching the patient through the procedure. The anesthesiologist works with the surgeons during the procedure to relax the brain and improve the surgeon’s field.
In the operating room, anesthesiologists provide continual medical assessment of the patient. They monitor vital life functions, including heart rate, breathing, blood pressure, body temperature and fluid balance, and control the patient’s pain and levels of consciousness to make conditions ideal for a safe and successful surgery.
Their role is not confined to the operating room, however, as the anesthesiologist will also transport the patient to the ICU following surgery.
Dr. Ruskin added, “Throughout all procedures and into recovery, anesthesiologists continuously monitor a patient’s vial signs and are ready to notify and assist if any problems arise.”
