Dr Julio C Gonzalez Gutierrez speaks on pre and post Operation anesthesia care
Dr Julio C Gonzalez Gutierrez, Consultant Anesthesiologist and Medical Director of Trustanaesthesia Services (Pty) Ltd. affiliated with Bokamoso Private Hospital talks to SunHealth about the continuous medical care anesthesiologists provide before, during and after an operation to permit the surgeons to perform surgeries. Despite being an integral part of modern surgery, most people know very little about the process that sends them to sleep before their operation. Explain to us what anesthesia is? What happens to the patient? Is it literally like going to dreamland or it’s a total blackout? Good question: Anesthesia is combination of unconsciousness, muscle relaxation and pain free status. A person can be under general anesthesia for many hours, as long as the anesthesia is conducted by a properly qualified and well-experienced Anesthesiologist. For the patient it is like a total blackout yes. What type of education did you have to pursue to become an anesthesiologist? And why did you decide to become one? Anesthesiologist are Medical Doctors (6 years) first and then after concluding the post-graduate or community service they officially begin training in Anesthesiology specialty (4 year) of which concludes with board examinations and certification or equivalent. The duration of study is 10 years. It is after all this time that the real experience begins. In my case particularly, I decided to become a Doctor because I love and wanted to be that Doctor that keeps patient alive and safe during surgical procedure and that Doctor is the anesthesiologist. What services does your practice offer? We at “Trustanaesthesia Services” are involved in the preoperative period of the patient meaning (before/during and after the procedure). We play a pivotal role in the critically ill patient at the intensive care unit in particular, and provide chronic pain management service to selected patients. An anesthesiologist also plays a role in a hospital or clinic emergency room and in the MRI/Tomography room as well for selected patients as well. What do your daily duties entail as an anesthesiologist? Well our duties start the day or few days before surgery by consulting/examining and reviewing the patient. We look at conditions, Laboratory results, Radiological films and optimizing treatment if necessary, all this geared to tailor make the anesthetic plan for the particular patient and surgery that can yield the best results. No patient should be anesthetized without first being seen by the anesthesiologist to be able to evaluate the risk and possible complications during and after the procedure. A person’s life depends on that during the operation. Anesthesia is one of the safest specialties in medicine but usually direct anesthesia complications are lethal. A typical day for you would be... ? As explained before, we do clinical work during the procedure and also office work preparing or planning for the surgeries the following day. We also drink lots of coffee. One little-known fact about anesthesiology is... We are safety advocates in the OR suite. I have read that patients who snore and those who are obese tend to be the most problematic when they are put under. Why is that?That is very true. Obesity brings a huge risk for the patients due to their massive size; everything becomes much more difficult to attain. To secure airways is extremely challenging because standard instruments are designed for normal size people and their cardio-respiratory reserves are limited. Obese patients are challenging from the pharmacology point of view due to their large surface area and concomitant diseases associated to obesity and last but not least in the recovery period, obese patients are at higher risk of respiratory complications compared to normal size patients. The anesthesia for these types of patients is always modified and very challenging. There are cases where some patients wake up too early or worse never wake up at all. What would have happened?Well to answer this question we need to look at the history of anesthesia many years ago. Yes in those years lack of adequate instruments, lack of monitoring, un-purified drugs and poor training made anesthesia sometimes dangerous but today we can monitor everything during the course of anesthesia and detect anomalies early enough before the complication is evident. Training is more standardized and practices thrive for clean safety records. Nonetheless in emergency situation that cannot wait the risk of poor outcome is much higher. Also the type of patients sometimes make surgery very risky; for example: a 90-year old patient that had MI last month and is known to suffer from renal failure now presented with stroke and acute appendicitis that needs to be operated - the risk is very high for complication from surgery and anesthesia during the peri-operative period. Now if a patient wakes up and awareness is detected during the anesthesia, probably the anesthetic gases would have run out and the patient became slightly conscious (situation that is easy to correct) without a bad outcome for the patient. Dying on the table is rare these days unless the surgery is done on high risk patients under emergency circumstances. What do you say to people who fear being put under? Is that fear justified? Not at all, not in today’s modern Anesthesia. I would recommend seeing a consultant anesthesiologist before the surgery and rest assured she or he will put the patient’s mind at ease before the surgery and anasesthesia. I particularly don’t like to anesthetize frightened patients except where critical. What are the tools of the trade that you use the most? Anesthetic machine, Laryngoscope, syringes and medications especially designed for the anesthesiologist to use but the most used tool of the trade is your ability to think and take corrective decisions under pressure. In this case your tools are your brain and training. Does it bother you that despite the critical role anestheologists play in the operating room, they hardly ever get any recognition?That is very true especially in the modern medicine, but it doesn’t bother us because we know who have the patient’s life literally in their hands. We also know our involvement is brief but intense; we don’t expect you to remember us. Why do you think there are so few anestheologists in the country? Well, not only in the country but also in the whole world there are a few qualified anesthesiologist. I think it is possible that all the things mentioned earlier and the stress and pressure of the specialty have a role to play in the numbers. Here in Botswana anesthesiologist services are poorly recognized and hence poorly remunerated unlike in developed countries. In industrialized countries anesthesiologists are some of the highest paid specialists. What do you find the most rewarding about the work you do? Knowing that your prompt and effective interventions help safe patients. It is also in the way we make extremely complicated surgeriespossible. And the challenges? Time management and trying to convince your colleagues that your thinking in outcomes is not in the technicalities of the procedures. On a basic level, what skills does your job demand? Vast knowledge of how the body works (Physiology); vast knowledge of the disease of the patient (Pathophysiology); and vast knowledge of how medications work at cellular level. Anesthesia is a procedure-oriented specialty like the surgery; that is why they are intricately related - and last but not the least, it needs a cool and calm head under stress or pressure. How is the job market/demand in the anesthesiologist field? How do you think it will develop over the next five years? The market is ever growing and so are the demands for anesthesiologists in Botswana and the world over. New surgeries and techniques with better and safer instrumentation are being developed but at the end anesthesia has to be given by a human being, not by a machine.