Surgery While the Patient is Awake




The Anesthesiologist’s Role When the Patient Is Awake for Surgery

Not all surgery requires the patient to be fully “asleep.” Anesthesiologists will sometimes decide it’s better to keep the patient awake or alert so he or she can communicate with the surgical team.

One example is the “awake craniotomy,” in which patients are not under general anesthesia and can respond to requests from the surgical staff while they map key areas of the brain. During this procedure and other “awake” surgeries, the anesthesiologist keeps the 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,” says Keith J. Ruskin, MD, 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,” he says.

An anesthesiologist is involved in the surgical process from the beginning, meeting with the patient for a preoperative visit and assisting in planning the 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 also transports the patient to the intensive care unit following surgery.

“Throughout all procedures and into recovery, anesthesiologists continuously monitor a patient’s vital signs and are ready to notify and assist if any problems arise,” Dr. Ruskin says.

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The ASA does not employ physician anesthesiologists on staff and cannot respond to patient inquiries regarding specific medical conditions or anesthesia administration. Please direct any questions related to anesthetics, procedures or treatment outcomes to the patient’s anesthesiologist or general physician.