The term “anaesthesia” is derived from the Greek word ‘an’ meaning ‘without’ and ‘aisthesis’ meaning ‘sensation’. The term anaesthesiology describes the field of medicine, which deals with anaesthesia and the specialist are known as ‘anaesthesiologists’ or ‘anaesthetists’.
Anaesthesia services in Nepal was first started by Dr Bhawani Bhakta Singh at Bir Hospital in 1962, who was the first specialist in the country to receive an specialist degree, Diploma in Anaesthesia, (from Bombay) in 1955 when there were no other qualified surgical specialists. After Dr Singh, there were a couple of other ‘first generation’ anaesthetists, trained from abroad who then provided anaesthesia services in the country. In the late 1960s, with the increasing number of surgical patients and evolvement of many surgical specialities, the number of anaesthetists (6) was clearly overburdened by the number of surgical specialists (80).
Considering this demand, with the help of some Canadian anaesthesiologists, a one year post-graduate specialist training program, Diploma in Anaesthesia (DA), was started in 1985 at Institute of Medicine (IOM). This program produced around 46 ‘second generation’ anaesthetists in the country. Furthermore, MD anaesthesiology training program was started in 1996 by IOM, Tribhuvan University and today almost every medical college has postgraduate MD anaesthesiology training program, producing the ‘third generation’ anaesthesiologists in the country.
“Society of Anaesthesiologists of Nepal (SAN)” was formed in 1987 with the goal of uplifting anaesthesia services, to promote the education and training in anaesthesiology and for better patient management and care.
But even now, if we ask anyone, ‘what do you understand by an anaesthetist?,’ more than half of the population imagine that when they go for surgery, some person in the operating room (OR), comes to you and puts something around your face and gives you some unpleasant gas and puts you to sleep. But sorry to say, this is completely wrong and occurs only in movies. That sort of practise used to be only during the days of Dr Morton, Dr Singh or the first generation anaesthetists. Many anaesthesia procedures now a days do not even use gas and almost more than half of operative procedures are done without making the patient unconscious through the practise of various ‘regional anaesthesia’ techniques.
Your anaesthesiologist is an academically qualified specialist doctor who has post-graduate training in anaesthesia and has to be certified by Nepal Medical Council to provide anaesthesia services and to take care of you when you are heading toward a painful surgery or procedure. Your anaesthesiologist takes care of your vital body functions like your heart beat, respiration and blood pressure, thus providing optimal operating condition for the surgical specialist to operate upon; controls your pain and makes you comfortable during and after the surgery so that you do not feel pain; maintains your body fluid balance and supports you with blood and blood products during the surgery; supports your breathing and also puts you in a breathing machine, if necessary; and also takes care of you in the intensive care unit (ICU) if you happen to require the ICU care.
Your survival after any critical event depends upon the presence, knowledge and experience of your anaesthesiologists and their skills to handle such a situation.
So, your anaesthesiologists plays an important role in your surgical outcome and they will be the one who will be supporting your life in the event of critical events and cardiac arrests, when the surgical specialist may be having a hard time trying to identify the source of bleeding from a torn vessel or a slipped ligature inside your abdomen. And, needless to mention, your survival after any critical event depends upon the presence, knowledge and experience of your anaesthesiologists and their skills to handle such a situation.
Apart from the operating room services, anaesthesiologists also manage patients in ICUs. In fact, most of the ICUs around the world are run by anaesthesiologists or physicians with further subspecialty training in critical care medicine and are called as ‘Intensivists’ or ‘Critical Care Physicians’. But, till now, ICUs in Nepal are being managed collectively by physicians and anaesthesiologists.
Anaesthesiologists also provide treatment and perform various interventional procedures for patients with chronic pains, e.g. back pain, cancer pain, trigeminal neuralgias. Anaesthesiologists also play an active role in the resuscitation of patients after a cardiac arrest or trauma victims and form the core member of the resuscitation or rapid response teams of most of the hospitals.
With the increasing number of anaesthesiologists in the country, it is really a shame to come across anaesthesia related deaths in Nepal because of unqualified non-anaesthetists providing anaesthesia services. Some of the foreign-funded institutions are promoting training of anaesthesia assistants for providing anaesthesia services in rural areas of Nepal, which is just a criminal act as these institutions are there just to show that they are ‘doing something’ in order to preserve their funding.
Furthermore, more than 60 percent of such trained anaesthesia assistants are currently concentrated in urban areas. Anaesthesia assistants are to help the anaesthetists provide better care to patients and not to provide anaesthesia service by themselves. This problem has to be taken seriously by the Ministry of Health and also by the SAN. SAN should provide explicit guidelines on anaesthesia services, which must be endorsed by the Nepal Medical Council.
To conclude, if you are being scheduled for any procedure or a surgery, be prepared and ask yourself: ‘Do I know my anaesthesiologist?’
The writer is Clinical Fellow, Department of Critical Care Medicine, University Health Network (UHN) and Mount Sinai Hospital, University of Toronto, Canada
subhash.acharya@uhn.ca
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