Who are Anaesthetists?
Who are Anaesthetists?
Anaesthetists are doctors who have completed a full medical training. As graduate doctors they choose to complete further training to become an anaesthetist. Anaesthetists form the largest group of hospital based specialists, although, as this article will explain, there is a wide range of sub-specialties which make up the overall specialty of anaesthesia.
Medical students complete around 5 years of study and training jointly based in a University and a hospital. They graduate as doctors with the basic medical degrees. All doctors then complete a further two years of Foundation Stage training. Foundation Stage doctors work under close supervision in a range of different specialities. This provides a wide grounding and allows them to discover where their main strengths and interests lie.
Doctors who wish to train in anaesthesia enrol on a training programme in anaesthesia which lasts a further 7 years. At first a new anaesthetist works under direct supervision, with a Consultant anaesthetist by their side. As the trainee passes competency assessments and gains experience, the level of supervision is very gradually reduced. Workplace assessments take place and anaesthetists are required to achieve well defined standards set by the Royal College of Anaesthetists. There is In addition there is a two part exam called the Fellowship of the Royal College of Anaesthetists (FRCA). This is a also a challenging exam in two parts which the trainee must pass before they can progress to the third and fifth years of training respectively.
The standards of training in the UK are very high. The Royal College of Anaesthetists has a duty to set and monitor standards of training. Hospitals which do not provide facilities to train anaesthetists according to these standards will have their right to train withdrawn.
Anaesthetists work in many different areas of the hospital. Basic anaesthetic skills are learned in the first few years of training, but after that many anaesthetists develop a particular expertise. Here is a list of just a few of the specialties within anaesthesia:
- Intensive Care Medicine. These anaesthetists work on an intensive care unit to look after critically ill patients suffering from a wide range of serious illness including major cancer surgery, major trauma, and conditions such as heart attack, kidney failure or life- threatening infections.
- Paediatric anaesthesia. Some anaesthetists specialise in the care of children including tiny babies who have surgical and medical problems from birth.
- Obstetric anaesthesia. Anaesthetists work on the labour ward providing pain relief and anaesthetics for childbirth. They also work alongside obstetric doctors in the assessment and care of women with difficult pregnancies, or who become ill during pregnancy.
- Pain relief anaesthesia. A very different type of anaesthetic care is provided by anaesthetists who care for patients suffering long term pain. Patients are referred to pain relief clinics where a full pain assessment is followed by injections, specialised use of pain relief medicines and/or psychological techniques and support. The quality of life for patients with long term pain can be greatly enhanced.
- Neuro-anaesthesia. Many types of modern brain surgery would be less successful if it were not for sophisticated anaesthetic techniques which help to keep the brain in good condition while the operation is done. Neuro-anaesthetists have received additional training in this area and can provide specific expertise.
- Cardiac anaesthesia. The anaesthetist in the operating theatre for open heart surgery is a key member of the team. After open heart surgery, the heart often does not beat well at first and the anaesthetist and surgeon work together to re-establish an effective blood flow. This requires additional training and a great deal of experience.
- Emergency care and resuscitation. Anaesthetists work closely with Emergency Department (ED) doctors to look after the sickest patients as they arrive in the hospital. For example, people seriously injured in an accident is cared for by the “trauma team” which includes anaesthetists and surgeons as well as the ED doctors. The team ensures that the right care reaches the patient very quickly. Some anaesthetists are also trained in the fairly new specialty of pre-hospital care. These anaesthetists travel by helicopter or road to the scene of major accidents to give life saving care.
What is ‘anaesthesia’?
The word ‘anaesthesia’ means ‘loss of sensation’.
- Anaesthesia stops you feeling pain and other sensations.
- Not all anaesthesia makes you unconscious.
- There are several types of anaesthetic including local, regional and general.
- Local and regional anaesthetics can be directed to different parts of the body.
Drugs that cause anaesthesia work by blocking the signals that pass along your nerves to your brain. When the drugs wear off, you start to feel normal sensations again, including pain.
A local anaesthetic numbs a small part of your body. It is used when the nerves can easily be reached by drops, sprays, ointments or injections. You stay conscious but free from pain.
Regional anaesthesia is when local anaesthetic drugs are injected near to the bundles of nerves which carry signals from that area of the body to the brain. The most common regional anaesthetics (or 'blocks') are spinal and epidural anaesthetics. These can be used for operations on the lower body such as a Caesarean section or hip replacement. You stay conscious but free from pain. However, sedative (sleepy-making) drugs can also be given to ensure you are calm and relaxed during the operation.
General anaesthesia is a state of controlled unconsciousness during which you feel nothing. Some operations can only be done with a general anaesthetic. Anaesthetic drugs are injected into a vein, or anaesthetic gases are breathed into the lungs. They stop the brain recognising messages coming from the nerves in the body. As the anaesthetic drugs wear off, consciousness will return.
These three types of anaesthetic can be used individually or in combination to achieve the best and safest anaesthetic for each patient.
Anaesthesia: a process
Your anaesthetist is responsible for:
- Assessing your health and advising you on which type of anaesthetic is suitable for your surgery. They will then agree with you a plan for your anaesthetic
- Giving you the anaesthetic and keeping you safe and well during surgery. Your anaesthetist, or a qualified colleague, stays with you all the way through your operation. They will use modern monitoring equipment to assess your condition continuously throughout your operation and they will give you drugs and fluids as required, to keep you safe and well.
- Planning your pain relief and making sure that you are as comfortable, nausea free and healthy as possible in the recovery room immediately after surgery.
- Looking after you, or ensuring that a qualified colleague looks after you, in the intensive or high dependency care unit after your operation.
- You can find out more about the process of anaesthesia by reading the booklet Anaesthesia Explained.
Anaesthesia: enabling modern surgery
The modern speciality of anaesthesia has come a long way since its earliest days. Early anaesthetics were given by dripping a liquid anaesthetic agent such as chloroform onto a piece of gauze held over a patient’s face. The effects were unpredictable and quite unsafe. Monitoring consisted of a feeling the patient’s pulse, and watching for the rise and fall of the chest.
Modern anaesthetists have a detailed understanding of physiology, bio-chemistry and physics. They are trained in the use of some of the most sophisticated monitoring equipment in medicine. For a typical straightforward anaesthetic in the UK, the anaesthetist will use at least eight different electronic monitors which give information about basic body functions. In addition, advanced monitoring equipment can give information about heart function, circulation, and breathing. Highly adjustable ventilators (breathing machines) are set to exactly suit the needs of the patient.
Anaesthetists today do not need to use the dangerous and often flammable anaesthetic gases of the past. Dozens of modern drugs are available to blend together to give exactly the effect required, according to the operation, and the general health of the patient.
Many modern surgical techniques would not be possible without the anaesthetic drugs, the techniques and the equipment that anaesthetists use today. However the foundation of safe anaesthesia is the high level of training which underpins the specialty. Patient safety is central to everything that anaesthetists do, and this allows us to bring patients safely through the most challenging operations.
Careers in Anaesthesia
Doctors who are interested in a career in Anaesthesia should visit our Careers Section.
Anaesthetists in the UK are doctors, but there are a number of career opportunities for non-medically trained staff who are interested in working with anaesthetists inside and outside the operating theatres.
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