In response to public outcry, Anthem Blue Cross Blue Shield announced on December 5th, canceled the plan That would put limits on health insurance payments for anesthesia treatments in certain states. However, this brief uproar shed light on an often-ignored but central element of surgical treatment.
“Anesthesiologists don’t just make people suffer,” says Amy Vinson, a pediatric anesthesiologist and welfare specialist at Boston Children’s Hospital. It also monitors a person’s vital signs and pain levels before, during, and after surgery. If a crisis occurs, such as a sudden drop in blood pressure or heavy bleeding, the anesthesiologist will administer important fluids and medications.
“There may be [nurses and surgeons] These are people coming out of the operating room,” Vinson said. “But what really remains the same are the anesthesia team members, who are right by the patient’s side from the moment anesthesia care begins preoperatively until it ends in the recovery room.” During the procedure. Their presence means anesthesiologists often become the de facto support person for patients, Vinson added.
Alopi Patel, an anesthesiologist and pain physician at RWJ Barnabas Health in New Brunswick, N.J., says putting time limits on anesthesiologists, and by extension surgeons, can make people in the operating room feel rushed. They say it could pose a threat to patient safety.
Everything from a patient’s individual physiology to unforeseen events in the operating room can affect how long a surgery takes (SN: July 28, 2015). “It is possible to average the surgical time, but it is not so easy to say that it is the standard. [procedure] It will take 2 hours, so I will only allow 2 hours this time. Every patient is different,” Patel said. science news In his capacity as a member of the Communications Committee of the New York State Society of Anesthesiologists in New York City.
science news Vinson said she spoke to Dr. Patel to better understand the role of anesthesiologists, an area that even many doctors don’t fully understand, and their comments are her own. It is said that it reflects a personal opinion. Vinson and Patel’s comments have been edited for length and clarity.
SN: Many people don’t really know what an anesthesiologist does. Could you explain your job?
Vinson: If your surgery requires pain management or sedation, we will care for you before, during, and after your surgery. We provide medicine, fluids, and blood to patients.
That’s a huge responsibility. We are hijacking someone’s entire physiology. We manage their blood pressure and breathing. If their heart rate increases, we can lower it. If it goes down, you can pull it up. So is their blood pressure. We manage their ventilation and necessary medications. The muscles are temporarily paralyzed to allow the surgery to proceed.
We have a friendly and joking nature. A lot of that is intentional because when you’re in a room, you have to actually control that room. When a crisis occurs, immediate attention is required. He is a very friendly person in the operating room. I often joke. We talk a lot. The moment I sound serious, everyone will notice.
SN: Why do you think it’s a bad idea to put a time limit on anesthesia?
Vinson: Anesthesiologists are paid in a way unique to the medical industry. We are paid by the hour. That’s because we have no control over how much time the surgeon spends, and we intend to stay with the patient until the surgery is completed no matter what.
[Automated systems] Based on past cases, surgeons estimate how long a particular surgery will take. A simple procedure may work in most cases. But that’s average. Some steps will be faster and some will be slower. Time limits penalize sicker patients. That would penalize surgeons who treat sicker and more complex patients. This, in turn, is a disservice to the treatment and anesthesia teams caring for these complex patients.
SN: What factors increase the expected length of surgery?
vinson: Everyone’s body is slightly different. Suppose a surgeon performs heart surgery on a person who has previously undergone heart surgery. The breast cannot be reopened because of the scar tissue. We don’t want the surgeon to just come in and rush through all of this to finish the prescribed amount of time this surgery will take, causing a lot of blood loss and harm to the patient.
Or suppose a surgeon is operating on a morbidly obese person. it would be a very different approach to surgery [than the average patient]Not only the actual surgical time but also the patient’s position is taken into account.
Or, when you go to have the tumor removed, you may find more than you expected. Imaging doesn’t tell everything. And sometimes bad things happen. Allergic reactions may also occur.
SN:Could you tell us more about the interpersonal aspects of your job?
Vinson: We meet people facing the scariest moments of their lives. These are operations they have been waiting for, or operations that have been launched as an emergency. They are often very scared in the pre-surgery area. They have a lot of questions, but we have never met before. 5 to 10 minutes of focused conversation with the patient. During that time, we have to explain everything we will do to keep them safe and gain their trust to take over their body functions while they sleep. So what they have in us in that moment is tremendous trust.
SN: Can you give an example of a specific patient interaction that describes the work of an anesthesiologist?
Patel: There was a patient who needed emergency surgery. At the hospital, she was found to have a blood clot in her lung. So, like with any other type of anesthetic, we had to be very careful because the blood clot could move forward and basically reduce blood flow to the rest of her heart. . Everyone was working quickly to complete the surgery because they knew it was an emergency.
I could see that she was very nervous. I put on the monitor, explained the situation to her, and said, “We have to move quickly, but we also have to administer the anesthesia very carefully.” I asked her what kind of music she wanted. She asked for Yani, the keyboard player. When I held her hand, she was able to focus on what was basically meditative music. Afterwards, she thanked me for being there for her and for being a human being next to her and not just a doctor looking down on her in a mask and scrubs.
