Do you really know me? An anesthetist’s ramblings

February 23, 2011

As an anesthesiologist or more famously known as anesthetist or even "mah sui", we are behind the scene all the time. Even my spouse wasn't aware what I really do until she came to the operation theatre and saw with her own two eyes what I really do.

My friend once asked me, after you give the "bius", what do you do? "So easy la your work", he lamented. Then, comes the anesthetists fee. Why do you have to charge so much? These question even comes from doctors who have left the clinical side for so long they have forgot what its feel like to be responsible for another person's life.

Yes, that is how a true anesthetist feels. We are holding the responsibility of guarding your life when you are vulnerable and unable to do it yourself. More accurately called perioperative physicians, anesthetist will take you through the whole process of pre (before), intra (during) and post (after) operation.

Before you go for an operation, you need to be assessed whether you are in good health or not. This will affect the risk of your operation from low to high risk. Basically going for an operation under General Anesthesia is like undergoing a high level of strenuous exercise and we want to know whether your heart will be able to withstand this stress.

Yes, when you are older your heart will be less able to withstand this stress and puts you at a higher risk of getting a heart attack during the operation. Also the type of operation is important in determining whether it is high risk for you or not. The field of anesthesia has evolved from using chloroform to using more safe and short acting gases that facilitates earlier recovery and faster return to normal activities.

To make you anesthetized, it is not a "one for all" drug. Each patient has their own dose at which they become unconscious without falling into the "deep end". Yes, every drug is poison! Only the dose determines whether it is medicine or otherwise.

The real work starts here. Contrary to popular belief, it's not all over for anesthetists once you are asleep. This is when you are at your most vulnerable point. Your breathing pathway will be blocked and you will be paralyzed to facilitate the surgery. We will put in a tube for the breathing and ensure that you are getting enough oxygen by use of machines that breathes for you. We will monitor your blood pressure and make sure that it is enough to pass the oxygen to the whole body. All this is done while making sure that you are fully unconscious and your brain not aware of what is happening. Don’t forget painkillers for good pain relief without compromising your breathing later.

Surgery is over! Now the whole process needs to be reversed and you need to be brought back as close as possible to the condition you were before the surgery. The tube for breathing is taken out; the gases that are going in are stopped so you regain consciousness. Drugs that reverse the effect of paralysis are given. Of course there will be residual effects. In some cases their care even is extended in Intensive Care because of their poor medical condition or major operation.

All goes well and you wake up in recovery. More pain killers are given until you are pain-free before sent back to the ward.

All in a day's work!

Dr. Mohamed Asri B Kader Ibrahim
Consultant Anaesthetist
Columbia Asia Hospital- Bukit Rimau