Anesthesiology is the branch of medicine specializing in the use of drugs or other agents that cause insensibility to pain. Anesthesiology may also be defined as continuity of patient care involving preoperative evaluation, intraoperative and postoperative care. The subspecialities within anesthesiology include cardiothoracic anesthesiology, critical care, neuroanesthesia, obstetrical anesthesiology, pain management, pediatric anesthesiology, and ambulatory anesthesia.
Anesthesia has traditionally meant addressing the condition of having the feeling of pain and other sensations blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience.Today, the term general anesthesia in its most general form can include:
- Analgesia: blocking the conscious perception of pain;
- Hypnosis: producing unconsciousness;
- Amnesia: preventing memory formation;
- Relaxation: preventing unwanted movement or muscle tone; and
- Obtundation of reflexes, preventing exaggerated autonomic reflexes.
An anesthesiologist is trained to provide pain relief and maintenance, or restoration of a stable condition during and immediately following an operation, an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient's condition prior to, during and after surgery. They provide medical management and consultation in pain management and critical care medicine. There is a major distinction between an anesthesiologist and an anesthetist. An anesthesiologist is a physician (or, less often, a dentist) who is specialized in the practice of anesthesiology while an anesthetist is a nurse or technician trained to administer anesthetics.
Patients undergoing surgery usually undergo preoperative evaluation by an anesthesiologist. It includes gathering history of previous anesthetics, and any other medical problems by the anesthesiologist MD, physical examination, ordering required blood work and consultations prior to surgery. The level of anesthesia achieved ranges on a continuum of depth of consciousness from minimal sedation to general anesthesia. The depth of consciousness of a patient may change from one minute to the next.
There are several forms of anesthesia. The following forms refer to states produced by anesthetics working on the brain:
- General anesthesia: "Drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation." Patients undergoing general anesthesia often cannot maintain their own airway and breathe on their own.
- Deep sedation/analgesia: "Drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation." Patients may sometimes be unable to maintain their airway and breathe on their own.
- Moderate sedation/analgesia or conscious sedation: "Drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation." In this state, patients can breathe on their own and need no help maintaining an airway.
- Minimal sedation or anxiolysis: "Drug-induced state during which patients respond normally to verbal commands." Though concentration, memory, and coordination may be impaired, patients need no help breathing or maintaining an airway.
The following refer to states produced by anesthetics working outside of the brain:
- Regional anesthesia: Loss of pain sensation, with varying degrees of muscle relaxation, in certain regions of the body.
- Spinal anesthesia: also known as subarachnoid block. Refers to a Regional block resulting from a small volume of local anesthetics being injected into the spinal canal.
- Epidural anesthesia: Regional block resulting from an injection of a large volume of local anesthetic into the epidural space.
- Local anesthesia is similar to regional anesthesia, but exerts its effect on a smaller area of the body.
Medical Opinions Associates is fortunate to have highly-qualified Board-certified Anesthesiologists on its panel of reviewing experts. One such Anesthesiologist is expert in the fields of anesthesiology, pharmacology, and intensive care. He is a Director in the Department of Anesthesiology at a large New York City hospital and a Professor of Anesthesiology at Cornell Medical College. He is also expert in Pediatric Anesthesiology. Another medical expert is Board-certified in Pain Management as well as Anesthesiology and has managed pain clinics in several hospitals. He is also Associate Clinical Professor of Anesthesiology at two Pittsburgh area medical schools. Medical Opinions also has available the services of an Anesthesiology expert with sub-specialization in Neurosurgical Anesthesia. He is presently an Attending Anesthesiologist at a major New York medical center and Assistant Professor of Anesthesiology and member of a Neuroanesthesiology group in New York.