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Johns Hopkins Medicine Suburban - Anesthesiology “Unmasked”

New Directions Summer 2013

Anesthesiology “Unmasked”

Date: July 1, 2013

Mark Vogt, MD
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Mark Vogt, MD

If you have ever had surgery, you know that a team of physicians, nurses, technicians and other hospital personnel work collaboratively to provide a safe and successful surgical experience.

There is one healthcare professional you may not be very familiar with: the anesthesiologist. He or she will play an integral role in your care and safety, beginning with your preoperative evaluation, continuing through the surgical procedure and post-anesthesia recovery, and often throughout your hospital stay.

Anesthesiologists are doctors of medicine who have completed four years of medical school followed by a minimum one year “internship” in internal medicine or surgery, after which they enter a rigorous three-year “residency” in the specialty of anesthesiology. Many anesthesiologists have also performed a fellowship or received post-residency training in a specialty area such as cardiac anesthesiology, pain management or critical care.

Anesthesiologists play a crucial role at Suburban Hospital. We asked four of the anesthesiologists from First Colonies Anesthesia Associates, who have been caring for Suburban Hospital patients for more than two decades, to explain how.


When will I meet my anesthesiologist?

Dr. Mark Vogt: Most patients will meet their anesthesiologist the day of surgery. Before this meeting, the anesthesiologist will have reviewed the patient’s chart and consulted with the surgeon. He or she will then discuss anesthesia options with the patient. These options are very much dependent on the type of surgery being performed. In some cases, it may be necessary to meet the anesthesiologist prior to the day of surgery. This meeting can take place at the hospital during pre-surgery testing. Patients can also call the anesthesiology office with questions.


Am I allowed to request a specific anesthesiologist?

Dr. Michael Peck: There are cases where a patient may wish to request a specific anesthesiologist, such as when the patient has had a previous surgery at Suburban Hospital. Whenever possible, those requests are honored. It’s important to remember, however, that all the anesthesiologists who work at Suburban Hospital have extensive qualifications and experience and all patients benefit from the depth of quality of the anesthesia service.


What should I tell my anesthesiologist?

Dr. Kathleen Leavitt: It’s important to tell the anesthesiologist about all medications and vitamin supplements you take, as well as the quantity of alcohol and tobacco you use. Some vitamin supplements have a “blood-thinning” effect, which can cause more surgical bleeding. Heavy use of alcohol, tobacco and recreational drugs can increase the required dose of many anesthetic medications. Pain medications that have been used for a prolonged duration (greater than one month) can produce a “tolerance” that may result in an increased requirement for postoperative pain medications.

Dr. Eligio Aguhob: The anesthesiologist must know about medical conditions being treated, especially heart disease, pulmonary problems such as asthma or COPD, and neurologic deficits from disease or a stroke, as well as a patient’s previous problems with anesthesia. We also encourage patients to let us know of any concerns or anxiety specifically related to the anesthesia or the surgery. We practice the science of medicine as well as the art of caring for the patient. We want to minimize the patient’s stress while ensuring that the patient experiences minimal pain, disorientation and nausea. We really try to hold our patients’ hands through the stressful process of surgery.


What should I expect from my meeting with my anesthesiologist?

Dr. Vogt: All patients should feel comfortable with the individual who will be providing anesthesia and with the anesthetic plan. Patients may want to inquire about how long the anesthesiologist has been practicing, if he or she has worked with the patient’s surgeon previously, and what to expect during and following surgery. It is my job to let patients know all the facts about their anesthesia, including how long they will be asleep, when and where they will wake up, how long they will be in the recovery room, what side effects they may experience from the anesthesia, and how we will manage postoperative nausea and pain. The more patients know, the more comfortable they will be with the whole procedure.


What are the different types of anesthesia?

Dr. Leavitt: There are three different types of anesthesia. Intravenous sedation is used for minor procedures such as eye surgery, some types of hernia repair, breast biopsy and colonoscopy. It is considered a semi-conscious state and involves the use of a combination of medicines given by vein so that the patient is comfortable, relaxed and often has no recollection of the events that occur during the procedure. Regional anesthesia involves the use of epidural, spinal or regional nerve blocks, often in combination with intravenous sedation. The goal of regional anesthesia is to target the anesthesia to the surgical site, thus avoiding some of the side effects associated with general anesthesia (prolonged grogginess, nausea). Often, these nerve blocks are used to provide pain relief that continues into the postoperative period. General anesthesia utilizes a combination of intravenous medications and inhaled anesthetic gases that produce an unconscious state. General anesthesia usually requires an airway device or “breathing tube” to support respiration.


How does the doctor decide which type of anesthesia is best for me?

Dr. Leavitt: The decision about the best type of anesthesia to use is based on the type of surgery, including the complexity and duration of the procedure, and the patient’s underlying medical condition. The goal is to provide the best anesthesia to ensure the patient’s safety and a positive surgical outcome.


What does my anesthesiologist do during surgery?

Dr. Peck: Intraoperatively, the anesthesiologist serves as the internist, the critical care physician and the pharmacologist all rolled into one. We continue to administer medications while monitoring the patient’s vital signs, including blood pressure, heart rate and respiration rate. Postoperatively, the initial acute management is performed under the guidance of the anesthesia service in the recovery room. We ensure that the patient’s physiological state is well controlled and the patient is as comfortable as possible.


How is the process of anesthesia different for cardiac surgery patients?

Dr. Vogt: Within the group of anesthesiologists who practice at Suburban Hospital, there is a subgroup of seven physicians who practice cardiac anesthesiology. These physicians have all received post-residency training and certification in cardiac care. There is a tight familiarity between Suburban Hospital’s cardiac surgeons and our cardiac anesthesiologists.

Dr. Aguhob: In addition to the concerns we address in general surgeries, cardiac surgery involves more-invasive monitoring of the patient. Because most cardiac surgery patients are placed on a heart-lung machine during surgery, special monitors are inserted in the neck and the esophagus to provide real-time assessment of heart function, which then guides our anesthetic management and gives the cardiac surgeons valuable information.


How is anesthesia different for same-day (outpatient) surgeries?

Dr. Aguhob: For outpatient surgery, we use shorter-acting drugs and rely more on nerve blocks and regional techniques whenever possible in an effort to minimize pain without the use of narcotics, which have more side effects. We want these patients to wake up faster with less pain. Before the patient is discharged, we will make sure the patient’s mental state has returned to its preoperative level; pain and nausea are controlled; and provisions are in place for the patient’s safety at home, which includes a ride home with a responsible adult.


What is the role of the anesthesiologist in pain management?

Dr. Leavitt: The anesthesiologists who are members of Suburban’s Pain Service have additional training and expertise in acute and chronic pain management. The Pain Service provides comprehensive pain management not only to patients who have undergone surgery, but also to patients admitted to the hospital because of the new onset of a painful condition or for chronic pain conditions that have gotten worse. Since most chronic pain patients are managed outside the hospital by a pain doctor, the hospital anesthesiologist will work with the outside physician to manage the patient’s condition. Suburban Hospital also has an oncology unit, and we are often asked to help optimize a patient’s cancer pain regimen. At times, we collaborate with the hospital’s palliative care physician to care for patients who are nearing the end of life.


How has anesthesia become safer over the past decade?

Dr. Peck: Anesthesiologists today are caring for older and sicker patients. The good news is that patients are benefiting from the research done by organizations such as the Anesthesia Patient Safety Foundation. This research has resulted in improved outcomes, not just for elderly patients, but for all patients.

Dr. Vogt: Advances in our anesthesia delivery systems and monitoring capabilities, longer-acting nerve blocks and better medications have all made anesthesia safer and more effective today than ever before.