Nowadays most patients come to the hospital on a day before their operation and are seen by the anesthesiologist in the pre-anesthetic assessment clinic. They will review your medical history, examine you, and order any necessary laboratory tests. He or she will also make sure that any medical conditions, which might complicate your anesthetic, are being treated as well as possible. The different types of anesthesia appropriate for you will be explained, and any questions you have answered. You will be told which of your regular medications, if any, you should take on the day of surgery.

Occasionally, the anesthesiologist will request an opinion from another specialist, such as a cardiologist, to help in your assessment. Very rarely, your operation may be postponed or cancelled because of the risks involved.

The anesthesiologist who is assigned to look after you on the day of your operation will review this information and make the final decision with you about the details of your anesthetic. If you are physically fit and are having straightforward surgery, there may be no pre-arranged visit to the clinic. You will receive your pre-anesthetic assessment on the day of surgery. Sometimes, patients are admitted to hospital one or more days before surgery and they are assessed in the hospital.

Anesthesiologist - Who are They and What Do They Do?
Before your operation you will meet an important specialist physician. This doctor has the critical responsibility for your welfare when you undergo surgery - your anesthesiologist. A vital member of the surgical team, the anesthesiologist is responsible for keeping you safe and comfortable during and after your operation.

Canadian anesthesiologists are physicians who have completed a university pre-medical program, followed by medical school and then five or more years of specialized (residency) training in anesthesiology. During their residency, anesthesiologists are extensively trained in human physiology (how the body works), particularly the brain, heart, lungs, kidneys and liver. They become experts on the drugs that are used in anesthesia and intensive care medicine. Anesthesiologists give more intravenous drugs than all other types of physicians combined, and are the only physicians with expert knowledge of the extremely potent drugs used to anesthetize people.

Anesthesiologists become familiar with all the different medical conditions and their implications for patients undergoing a wide variety of surgical procedures. They gain experience in the provision of anesthesia for all surgical procedures, on patients of all ages and in any state of health. They spend a year working in such internal medicine areas as cardiology and respirology. At least six months are spent in critical care units, such as coronary care, neonatal, pediatric and adult intensive are. By the end of their training they have become experts on anesthesia, resuscitation, critical care, and pain management. They then have to pass the specialty examinations of the Royal College of Physicians and Surgeons of Canada to become certified specialists in anesthesia.

A considerable portion of most anesthesiologists' work is in providing anesthesia in the operation room. However, in modern hospitals they also work in many other areas. They are specialists in perioperative medicine, critical care and pain management. You will find them in the intensive care units, the maternity unit, the pre-admission clinic, the radiology department, the pain clinic, and on the wards.

Perioperative medicine is the term used to describe your medical care before, during and shortly after you operation (as opposed to your surgical care, which is provided by your surgeon). It includes the preoperative assessment of your medical status, the provision of anesthesia, and the supervision of your recovery until you are transferred from the post anesthesia care unit.

Why is Preoperative Assessment By An Anesthesiologist Necessary?
Numerous factors influence the effect of the drugs used to provide anesthesia. Age, weight, pregnancy, race, alcohol, tobacco , prescription medication, street drugs, kidney and liver disease are just a few of these factors. In some instances, certain anesthetic drugs should not be given at all.

Many medical conditions increase the risk of anesthesia. Heart disease is a common example. Malignant hyperthermia is a very rare example, where the reaction to certain anesthetic drugs may be fatal unless handled appropriately.

Anesthesia and surgery may affect all the major systems of your body. Your anesthesiologist must know about any medical problems that you may have, so that anesthesia may be provided in the most appropriate way to maximize your safety and comfort.

Types of Anesthesia

General Anesthesia
General anesthesia may seem like being asleep but it's quite different. During general anesthesia, your anesthesiologist keeps you in a state of carefully controlled unconsciousness with a mixture of very potent drugs, so that the operation is painless. Many people think that this involves the injection of just one drug. Actually, most general anesthetics require the administration of somewhere between three and 15 different drugs, depending on the complexity of the case.

A typical general anesthetic given for gallbladder removal might involve the intravenous injection of a drug to make the patient unconscious, followed by a mixture of narcotics and anesthetic gases to keep the patient unconscious. A muscle relaxant is given to relax the muscles. This helps the surgeon perform the operation. Oxygen is administered constantly, initially with a mask over the face, and then through a breathing tube inserted through the mouth into the windpipe, after the patient is unconscious. A mechanical breathing machine, called a ventilator, is attached. All the patient's bodily functions are carefully controlled and monitored. At the end of the operation, the effect of the muscle relaxants is reversed with two other drugs, and the anesthetic gases discontinued. When the patient is conscious and able to breathe without help, the ventilator is stopped and the breathing tube removed. All intravenous drugs and anesthetic gases are administered in appropriate amounts so that the patient is completely unconscious during the surgery, but awake and pain free at the end.

Regional Anesthesia
Regional anesthesia involves injecting local anesthetics through a needle, which the anesthesiologist places close to the nerve or nerves supplying the region of the body involved in the operation. The skin and tissues that the needle goes through are also numbed with local anesthetic so that there is minimal discomfort associated with placement of the needle. Local anesthetic drugs stop nerves from working temporarily, so that no sensation and/or movement in the area of the body supplied by the nerve(s) occurs. This type of anesthesia is also called a nerve block.

The most common type of regional anesthesia is spinal anesthesia. This can be used to anesthetize the abdomen and legs. Many other regions of the body, such as an arm, can be safely and comfortably anesthetized. Different local anesthetics have different durations of effects, so the length of the anesthetic can be tailored to your operation. You may remain completely awake if you wish, but usually your anesthesiologist will administer a drug to make you relaxed and drowsy. At the end of the operation patients are transferred to the post anesthetic care unit awake, relaxed and pain free. They are usually very pleased with this type of anesthetic.

Local Anesthesia
Local anesthesia refers to temporarily numbing a small area by injecting local anesthetic into the skin so that minor procedures, like stitching cuts, can be done painlessly.

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