Behind every successful surgeon is an anesthesiologist

MANILA, Philippines - Patients usually know their personal doctor and surgeon well, but not their anesthesiologist. It’s about time we got to know them a lot better as they are such a critical member of the surgical team at Makati Medical Center.

“There’s a common misconception about anesthesiologists being just the assistant who injects you with medicine that will put you to sleep before an operation,” says Rosario Cloma, MD, Anesthesiology chair of MakatiMed. “They don’t realize that we are licensed doctors, too, with a vital medical specialization.”

Remedios Suntay, MD, who served as MakatiMed’s Anesthesiology Department’s chair from 2002 to 2009, recalls what the landscape was like back when she was just beginning to practice as an anesthesiologist. “At the time, there were only a few anesthesiologists,” she relates, adding that she graduated from medical school in 1953. “There were only about three or four. I trained for anesthesiology for a year and a half here in the country, then went to the States for further training in 1956 until 1961. When I came back, there were still only a handful of anesthesiologists. Maybe 10. The country needed more.”

At the time, as well, she continues, anesthesiologists used simple equipment.  “It was so simple. We started with an open drop ether. The patient wears a mask with a metal mesh, and we will drop ether on the mask until the patient goes to sleep. That takes a long time.”

Dr. Suntay was exposed to the use of advanced equipment when she went to train in the United States. Local hospitals eventually ordered the same equipment to upgrade their facilities, and Dr. Suntay, together with the late Paz Fores, MD, a pioneer anesthesiologist in the Philippines, trained resident anesthesiologists in MakatiMed when they came back to the Philippines. Dr. Cloma was one of the trainees.

The main goal of anesthesiology is to relieve the patient of pain in surgical care. “But what many don’t realize is that we provide total care before, during, and after surgery,” Dr. Cloma points out.

Only after a thorough assessment of the patient’s medical background can he/she be medically cleared for surgery. “However, there are cases where patients are at high risk to be anesthetized,” reveals Dr. Cloma, adding that these are usually patients who are overweight or morbidly obese, have systemic diseases such as uncontrolled diabetes, hypertension, and asthma, or have anatomic abnormalities such as scoliosis and airway problems.

Dr. Cloma notes that patients with OSA or obstructive sleep apnea are the most problematic. “That’s why we often ask if the patient snores.  Snoring seems such a trivial question, but it really could have a serious impact on the patient. Snoring indicates airway obstruction that makes it risky — even dangerous — if they are put to sleep for the surgery,” she explains. “Overall, it’s a combination of the anesthesiologist being able to extract all this necessary information from patients and, in turn, gaining their trust so that the patients disclose everything doctors need to know for their own safety and well-being.”

Inside the operating room, Dr. Cloma says, anesthesiologists are trained to be vigilant. “We have to monitor multiple things all at the same time to make sure that the surgeon is able to operate smoothly,” she muses.

Anesthesiologists closely monitor and manage the patient’s vital signs, including body fluid balance, temperature, blood pressure, carbon dioxide, and oxygen saturation — all throughout the procedure.

She points out, “Vigilance is a must-have characteristic of every anesthesiologist. Aside from being mentally equipped with medical knowledge, we also have to maintain grace under pressure. We have to maintain a calm demeanor at all times.”

Dr. Cloma also points out the big advantage of MakatiMed as it is well-equipped with more modern tools and devices to make it easier for them to monitor vital signs. “Our ears have to be sensitive to the pitch tone of the monitor or the machine that indicates the patient’s heartbeat and oxygenation. If the beat drops or changes, we have to determine the cause right away — but in a calm and controlled manner. The surgeon and the entire team depend on us, so we can’t be panicky,” she says.

Dr. Suntay also stresses the need to be alert and attentive — and the importance of staying on your feet. “You have to meticulously check on the equipment before the surgery, and watch your patient closely,” she stresses. “I always tell the residents I train not to sit but to observe what the surgeon is doing. After putting the patient to sleep, you can’t just sit down and text or whatever, without paying attention to what’s happening inside the operating room. Observation and vigilance are very important.”

Finally, the anesthesiologist sees through the patient’s recovery, post-surgery. “We make sure that the patient is in as fit a condition he was in before the operation. That means all vital signs are normal, and that he is fully awake and functioning well,” says Dr. Cloma.

Anesthesiology also plays a role in palliative care and cancer care by improving the quality of life of patients dealing with chronic pain. Anesthesiologists use their knowledge in administering powerful medicines, their skill in monitoring, and their interpersonal abilities, in order to relieve suffering in patients with severe or life-threatening illnesses.

Dr. Cloma concludes that serving a patient for them is like “treating them like our own loved ones. We are gentle and compassionate in everything we do, from drawing out their medical concerns and history to putting them to sleep during surgery.” She adds, “It’s fulfilling when a patient acknowledges what you’ve done for him. When a patient has had a really good ‘sleep,’ experiences no complications during the surgery, and wakes up feeling better, then we have done our part of the job well.”