The Department of Anaesthesia is one of the most indispensable departments in medical science today. This department plays a pivotal role for patients who undergo surgery, in pain management and in various other medical conditions. Anaesthesia is a medical speciality that plays a crucial role in ensuring patient comfort, safety, and pain control during surgical and medical procedures. The core element and speciality of the department are to prevent and mitigate pain and distress to patients by monitoring patients’ vitals throughout the pre-operative and post-operative periods. This department has evolved into an advanced and skilled domain, which today extends to palliative care as well.
The core element of the department is to ensure that medication administered to the patient will induce loss of sensation, which is temporary in nature, allowing the surgeon to complete the planned procedure. The doctors in this department need a sound knowledge of invasive and non-invasive procedures. An Anaesthetist adopts various techniques to administer anaesthesia to patients; this also depends on the surgical procedure, time for the surgery, complexities involved, other comorbidity that exists in patients, and any other medications that the patients are taking. Various types of anaesthesias are used for patient administration. It has been categorised as General, regional Anaesthesia, local, and sedation (sometimes called monitored anaesthesia care).
During general anaesthesia, medications are given so patients are unconscious (“asleep”) and unable to feel any pain during the surgical procedure. Some of these medications are given through an IV, and others are gases mixed with oxygen and administered through a breathing mask or tube. Some of the side effects of general anaesthesia include nausea, vomiting, sore throat, muscle aches, shivering and confusion. General anaesthesia is the most common type of anaesthetic administered.
Regional anaesthesiology entails injecting a local anaesthetic (numbing medicine) near nerves to numb a portion of the body. There are several types of regional anaesthetics, including spinal anaesthesia, epidural anaesthesia and various specific nerve blocks. Regional anaesthesia can be used by itself or combined with sedation or general anaesthesia, depending on the surgery and the patient’s needs.
Epidural Anaesthesia involves the injection of a local anaesthetic, usually with a narcotic, into the epidural space. The epidural space is outside of the spinal cord. Epidural anaesthesia is most often administered via a pump through a small catheter (tube), which allows for a long duration of pain control (the anaesthetic does not wear off until the pump is turned off and the catheter removed). This type of anaesthesia is commonly used in labour and delivery and for procedures of the lower extremities. Occasionally, we place epidurals for post-operative pain control for extensive abdominal surgeries.
Spinal anaesthesia also involves the injection of a local anaesthetic, with or without a narcotic, into the fluid that surrounds the spinal cord. This type of anaesthesia is commonly used for Cesarean sections, pelvic surgeries, hip and knee replacements, and other procedures of the lower extremities.
Nerve block agents are used to block pain at a specific site. By injecting a local anaesthetic into or around a specific nerve or group of nerves, pain relief can be localised to the site of surgery. This type of anaesthesia provides pain control during and after a procedure. It is associated with minimal side effects. Examples of nerve blocks include an adductor canal nerve block for knee surgery, an interscalene nerve block for shoulder surgery, and a supraclavicular nerve block for arm and hand surgery.