Following public outcry, Anthem Blue Cross Blue Shield announced on December 5 that I left the plan behind This would have placed time limits on health insurance payments for anesthesia care in certain states. But that brief commotion shone a light on an often neglected but key component of surgical care.
Anesthesiologists don’t just make people suffer, says Amy Vinson, a pediatric anesthesiologist and wellness expert at Boston Children’s Hospital. We will also monitor the individual’s vital signs and pain levels before, during, and after surgery. If a crisis occurs, such as a sudden drop in blood pressure or severe bleeding, an anesthesiologist will deliver essential fluids and medications.
“There might be [nurses and surgeons] These are the people coming out of the operating room,” Vinson says. “But the most constant is the member of the anesthesia team who is with the patient – from the moment preoperative anesthesia care begins until it ends in the recovery room.” The presence of an anesthetist throughout the procedure means that the anesthetist often becomes the patient’s de facto support, Vinson adds.
Placing time limits on anesthesiologists, and by extension surgeons, can cause people in the operating room to rush, says Alopi Patel, an anesthesiologist and pain physician at RWJ Barnabas Health in New Brunswick, New Jersey. And she says this could jeopardize patient safety.
Everything from a patient’s individual physiology to unexpected events in the operating room can affect surgical time (SN: July 28, 2015). “We can average out surgical times. But the standard doesn’t allow us to say that. [procedure] It will take two hours, so now I will only allow two hours. Every patient is different,” says Patel. science news He serves as a member of the Communications Committee of the New York State Society of Anesthesiologists Inc. in New York City.
science news We spoke with Vinson and Patel to better understand the role of an anesthesiologist. This is an area that even many doctors don’t fully understand, Vinson says. His opinions reflect his personal views. Vinson and Patel’s comments have been edited for length and clarity.
phone number: Many people do not know what an anesthesiologist does. Could you describe your job?
Vinson: We provide care to patients who require surgical pain management or sedation before, during, and after surgery. We are the ones who provide medicine, fluids and blood to patients.
It’s a huge responsibility. We are in charge of someone’s entire physiology. We are managing their blood pressure and breathing. If their heart rate goes up, we can bring it down. If it goes down, we can raise it. The same goes for blood pressure. We are taking care of ventilation and necessary medications. The muscles are temporarily paralyzed to allow the surgery to proceed.
We have friendly and joking personalities. A lot of that is intentional. Because when you’re in a room, you have to be able to actually control that room. When a crisis occurs, it requires full attention immediately. I am a very friendly person in the operating room. I joke a lot. I chat a lot. The moment I sound serious, everyone will pay attention.
phone number: Why do you think placing time limits on anesthesia is a bad idea?
Vinson: Anesthesiologists are paid in a unique way in the field of medicine. We get paid based on time. That’s because we can’t control how long the surgeon will take, and we’ll stay with you until the surgery is done, no matter what.
[Automated systems] Generates surgeon time estimates for specific procedures based on previous cases. A simple procedure will probably work in most cases. But that’s average. Some processes may be faster and some may be slower. Time limits disadvantage sicker patients. This disadvantages surgeons caring for sicker and more complex patients. And it puts the medical and anesthesia teams caring for these complex patients at a disadvantage.
S.N.: What are the factors that prolong the expected period of surgery?
vinson: Everyone’s body is a little different. Let’s say a surgeon is performing heart surgery on someone who has previously had heart surgery. The breasts cannot be reopened because of scar tissue. You don’t want the surgeon to just go in and go through all of that, causing a lot of bleeding and harm to the patient, just to meet the predetermined amount of time that this surgery will take.
Or, let’s say a surgeon is operating on a person who is morbidly obese. It would be a very different approach to surgery [than the average patient]It helps with positioning the patient as well as the actual surgery time.
Or, when they go in to remove the tumor, they may find more than expected. Imaging cannot see everything. And sometimes bad things happen. Sometimes allergic reactions occur.
S.N.: Can you tell me more about the interpersonal aspect of your job?
Vinson: We’re meeting people at some of the scariest moments in their lives. This is a task they have been waiting for or one that is approaching them as an emergency. They are often quite scared in the pre-operative area. They have a lot of questions, but we’ve never met them before. You will have about 5 to 10 minutes to have a focused conversation with the patient. During that time, we must explain to them all what we will do to keep them safe, and gain their trust so that we can take over how their bodies function while they sleep. So it’s a huge amount of trust they’re placing in us at that moment.
S.N.: Can you give an example of a specific patient interaction that exemplifies the work of an anesthesiologist?
Patel: There was a patient who needed emergency surgery. At the hospital, she learned she had a blood clot in her lung. So we had to be very careful because, as with any type of anesthetic, the blood clot could move forward and basically reduce blood flow to the rest of the heart. Everyone was working quickly to get the surgery done because they knew it was urgent.
I could tell she was very nervous. I turned on the monitor, explained the situation, and said, “We need to move quickly, but the anesthesia needs to be done very gently.” I asked her what music she wanted. She asked for keyboardist Yanni. While I held her hand, she was able to lose herself in the music, which was meditative in nature. She later thanked me for being there for her and being a human being rather than a doctor looking down on her in a mask and scrubs.
