The role of anesthesiology in modern medicine

Most people think that anesthesiologists are doctors who relieve pain and make patients unconscious through drug treatment. However, few people realize that the task of anesthesiologists in operating rooms today is not only to ensure the comfort of patients, but also to monitor and diagnose the changes of important life functions caused by various factors (anesthesia, surgery, primary disease, etc.). ) during the operation and anesthesia recovery period, and make corresponding treatment to ensure the safety of patients during perioperative period.

Anesthesiologists need extensive knowledge to be competent for this job, and they need to have basic knowledge of pathophysiology, pharmacology, internal medicine, surgery, women and children, anesthesia and other clinical medical disciplines. As an anesthesiologist, to relieve patients' pain, it is necessary to manage patients' vital signs, including breathing, heart rate, blood pressure, heart, nervous system, liver and kidney functions, etc.

Anesthesiologists deal with the medical problems of patients during perioperative period (during, before and after operation). Anesthesiologists judge the condition before operation, consider individual differences according to the patient's physical condition, and make treatment plans accordingly, and monitor the patient's life function with advanced instruments during operation. Anesthesiologists must rely on all kinds of complex and sophisticated instruments to make accurate diagnosis of diseases and maintain the lives of patients, some of whom are already very fragile.

At the end of the operation, the patient will be sent to the recovery room or intensive care unit (ICU), and then returned to the ward after anesthesia recovery. In addition to the operating room, the scope of work of anesthesiologists also includes intensive care and pain treatment.

What is the job of an anesthesiologist?

Anesthesiologists, also known as operating room doctors, are not only proficient in various anesthesia operation techniques to ensure the painless and smooth operation of patients, but also use advanced instruments to monitor the life function of patients at any time. If they find problems that threaten patients' lives due to surgery, anesthesia or patients' original diseases, they will take various treatment measures to maintain the stability of patients' life functions and ensure the safety of patients.

Generally speaking, the duties of the clinical anesthesiologist are: 1, and decide whether the patient can withstand surgical anesthesia together with the patient's attending doctor; 2, decided to use that kind of anesthesia and monitoring measures; 3. Anesthetize the patient; 4. Try to ensure the safety of patients during the whole operation; 5. Make the patient recover safely and smoothly after the operation; 6, postoperative pain treatment; 7. Treatment of chronic pain.

What is the anesthesiologist doing during the operation? An anesthesiologist's job is like that of an airplane pilot. Aircraft take-off and landing is equivalent to anesthesia induction and recovery, and autopilot used in flight is equivalent to anesthesia, muscle relaxant and mechanical breathing. During the operation, the anesthesiologist must continuously observe the patient, and the information obtained through the eyes, ears and hands constantly enters the central nervous system. After analyzing the monitoring data and forming some detailed and complicated judgment results, he will make some adjustments to the drugs (including anesthetics, muscle relaxants, liquids and hemostatic drugs, etc.). ) Try to keep the physiological function of the surgical patients stable, and carry out emergency resuscitation in case of emergency.

Hand: one finger is placed at the pulse beat, which is equivalent to several monitors. It can provide pulse rate and arrhythmia. It helps to keep the contact between the anesthesiologist and the patient. The feeling of patients' skin is very important: dry and warm skin indicates good clinical condition; Cold and moist skin indicates shock during the operation. By pressing or massaging the skin and paying attention to the refilling time of capillaries, we can know whether tissue perfusion is appropriate.

Eyes: You can observe the following aspects.

(1) Skin: cyanosis or pink indicates improper breathing or other reasons; Paleness and sweating indicate bleeding or shock.

(2) Head and neck: Eye movements indicate mild anesthesia; Pupil dilation (although dilated after atropine administration) indicates deep anesthesia, action of ganglion blockers, acute hypoxia and/or respiratory and circulatory failure.

(3) Chest: Chest movement refers to air entering the lungs. Is bilateral expansion symmetrical? If the patient is breathing spontaneously, the change of breathing rhythm is accompanied by the change of breathing depth. Tracheal traction shows that the effect of muscle relaxants has not completely disappeared; Contraction of intercostal muscles in the lower chest indicates airway obstruction.

(4) Abdomen: During laparotomy, observe the operation and judge whether muscle relaxation is appropriate. Is the patient nervous? Is there much bleeding? How much blood is there in the suction bottle? To what extent is the abdominal cavity polluted? (This is related to postoperative shock)

(5) Instrument: Does the rotor anemometer show proper airflow? Is the capacity of the measuring cylinder appropriate? Is the device of the volatilizer correct? Is there any anesthetic in the evaporator? Does the breathing valve need to be adjusted? Is it appropriate to inflate the breathing sac? If sodium calcium is used, what color is it? Did sodium calcium fail? Check the devices of the ventilator: inflation pressure, inflation speed and negative pressure. Can the ventilator enlarge the chest? Is the connection appropriate? Is the airflow speed appropriate? Check the amount and speed of intravenous infusion; During blood transfusion, check the number of blood bottles and the patient number to ensure the correct blood transfusion for the patient.

(6) Physiological monitoring: measure and record pulse and blood pressure every 5 minutes; If you use a heart monitor, you can also read the reading on the monitor or the flashing value on the pulse monitor. During the whole operation, the blood loss must be recorded.

(7) Did the homework go as planned or changed? What unexpected difficulties did the surgeon encounter? Did you lose much blood? If a tourniquet is used, is the pressure appropriate?

Ear: During the operation, the anesthesiologist almost unconsciously listens to the sound of gas exhaled by the valve with his ears, and even a small change can be heard quickly; The noise and rhythm changes of the ventilator can also be detected immediately. Even when talking, the pilot can notice the change of engine tone and rhythm equally skillfully and quickly. Stethoscopes are often used for anesthesia. It is necessary to put a stethoscope in the precordial area to monitor children's breathing and heart rate. Blood pressure can also be measured and recorded with a stethoscope. The nature of spontaneous breathing can provide information, and laryngeal spasm suggests mild anesthesia; Stopping breathing after exhalation means mild anesthesia, and stopping breathing after inhalation means deep anesthesia, accompanied by abdominal muscle relaxation. The heart pulse monitor can send out audio signals, but this monitor will be disturbed by temperature or other electronic instruments. If someone trips a wire or wire, the signal may be suddenly interrupted.

Ears must also be able to tolerate noise and irrelevant conversations. These noises will distract attention and cause excitement. The anesthesiologist has the right to ask for silence and even ask the staff to stop their activities. Some surgeons like to whistle, and never whistle during anesthesia induction in the anesthesia room.

The anesthesia room should be quiet and no talking is allowed. At some stage of anesthesia induction, patients can even hear whispers. During the operation, the surgeon can talk to the anesthesiologist. The anesthesiologist should be careful not to talk when the surgeon is performing fine surgery so as not to disturb him. However, in the lengthy operation process, saying a few words intermittently or even telling a joke can make people relax a little and temporarily relieve their persistent concentration.