Anaesthesiologist Dr. Rajesh Tope of Apollo Hospitals in New Delhi relates an interesting story told to him by a cardiac surgeon once. The surgeon's car was taken by his wife and he had to rush to the hospital in an auto rickshaw to operate on a patient in emergency. During the surgery, he related to fellow doctors how he huffed and puffed to the hospital and had no change in hand to pay the rickshaw driver.
The surgery was successful and the patient, on waking up, profusely thanked the surgeon saying that he knew what trouble he underwent to reach the hospital on time that day. “The surgeon was taken aback! It meant the patient was listening to all the conversations happening in the operation theatre, which also included deliberations on his body parts, blood flow, etc., something that can cause psychological trauma in a patient. Ideally, it should not have happened,” says Tope. A specialised field that anaesthesia is, it is important to know who your anaesthetist is, he states. For, a too little or a too high dose of anaesthesia has its ill effects on you, sometimes life-taking.
“Keeping a patient asleep through surgery is a delicate process. Excessive dose of anaesthesia can lead to cognitive dysfunction like long term dementia, and even death, but too light a dose can result in awareness leading to extreme distress and temporary paralysis, the after-effects which can linger for a long term,” says Tope. He says the mortality rate due to overdose of anaesthesia during a surgery in an otherwise healthy person is one in a lakh, it is much more in complicated surgeries, like liver transplant, cardiac surgery, etc. “In a simple surgery like a gall bladder operation, the standard risk factor we take into account is one in a lakh patients. But the risk factor runs high during complicated operations which take many hours to do, it runs even higher if the patient is in coma or on ventilator already.”
Usually, for operations, a surgeon depends on the experience and confidence of an anaesthetist. But in complicated surgeries, specific monitors are now used to continuously check the condition of the patient. “During a simple operation, we check the usual parameters like blood pressure and heart rate, etc. But for complicated operations, we need to continuously monitor many things, including the rate at which the heart is pumping out blood, the pulse pressure, etc. To do that, we insert a one metre long tube well into the heart, we call it cardiac output monitor. An expensive equipment that it is, very few hospitals have it in India,” says Tope. Nurses, technicians and anaesthetists go through special training to handle such machines.
Yet again touching upon physiological trauma undergone by a patient due to improper dose of anaesthesia, he says, “You may not have pain during a surgery but that you are aware of what is being done to your body can lead to trauma in some patients. That you can't talk, can't breathe properly, can cause psychological distress, which makes the role of an anaesthetist vital during a surgery.”
To be on the safer side, a patient should try meeting his/her anaesthetist before surgery, he says. “Most patients hardly question their credentials, equipment, training and safety record.” Something that we all should do before going under the knife.
