Technology has made surgery much safer

It is the first stage of any surgery or operation. It is also one of the most important aspects of surgical treatment. Some patients undergo anaesthesia without fuss and remain calm while many are scared. One of the most important steps before any surgical procedure is to involve the patient and his family on the aspects of anaesthetic procedures and offer a thorough explanation. According to Dr Sadik Kodakat, head of anaesthesiology, City Hospital, Dubai, depending on the type of surgery, the degree of the medical problem and the urgency of the case, patients and families are given information and assurance specific to the case.

Much of the anxiety that was once associated with going under anaesthesia is a thing of the past, he says, thanks to the progress in medical technology. “Modern medicine is so safe,” says Dr Kodakat. “Professionals are highly trained and special computer-controlled anaesthesia machines and medicine pumps are used. We also have ultrasound-guided nerve simulators for accurately placing nerve blocks for example, procedures that are precision-managed by the machines.”

Once a decision to proceed for the surgery is taken, the anaesthetist steps up to the centrestage for the initial procedures. It is his job to ensure the patient is fit enough and prepared to undergo the anaesthesia and the surgery through pre-anaesthetic check-ups, ordering diagnostic tests and adjusitng the patient’s medications.

General anaesthesia - a state of full drug-induced complete unconsciousness - is required for most operations above the belly button, according to Dr Kodadat. “For surgical preocedures below the umbilicus, the patient has a choice of general anaesthesia or one or the other types of regional or local anaesthesia. For certain operations, as on the arm, I can numb just the arm (localised anaesthesia). There are a variety of techniques we use. many times we use a combination of local and general anaesthesia for keeping drug usage to the minimum as well as good post-surgical relief,” he says.

“For most adult patients, anaesthesia is given through intravenous medicine and maintained with a mixture of drugs and gas,” explains Dr Kodakat.

The drugs and gas take effect within two minutes and the patient is now ready for the operation. The most common drugs and gas used for general anaesthesia is Propofol, which is given intravenously, and Sevoflurane, a sweet-smelling, highly flourinated gas.

For children the procedure is different. “We try to avoid needles initially, so it starts with the gas and then is maintained with [intravenous] drugs. Even the gas is pleasant smelling now! Everything is now customised to individual needs, he says. “It is all very titrated. We do not treat children simply as small adults. There are specialised guidelines, specialised equipment for them, a different way of monitoring.”

Anaesthetising a patient, however, is not the end of the matter. An anaesthesiologist’s job is far from over at that point. In fact, he now shifts into another gear. As the surgeon is opening up the chest (for heart surgery, for example), the anaesthesiologist has to keenly watch the patient’s progress.

“The functioning of the brain has to be monitored to see if the patient is completely asleep or aware, and the anaesthesiologist has a direct link to the heart [through a cannula, a tube inserted from behind the neck] to measure its beat-to-beat pressure changes of the heart,” says Dr Kodakat

Once the patient is determined to be completely under sedation, preparation for the surgery starts.

Inside the operating theatre, the anaesthesiologist is in charge of several machines. These include the anaesthesia machine which provides the continuous supply of anaesthesia gas to the patient, a ventilator that moves oxygen in and out of the patient’s lungs, machines that deliver strong medicines at precise dosage to the blood, machines to keep the patient continously warmed or cooled as needed and machines to measure the heart rate, blood pressure, temperature and oxygen saturation.

Anathesiologists with special training for heart surgery are also experts in using echo scanning of the heart using sepcial sensors placed in the food pipe as surgeons work on the heart. This type of ‘live’ scanning has been shown to improve the results of the surgery.

“In an open heart surgery, there will be at least 25 pieces of electronic equipment in the theatre [with each specialist having to monitor his own set],” says Dr Kodakat. “It’s very technologically oriented. For example, the surgeon will be using four machines, the nurses two or three, the perfusionist has his machine (the heart-lung bypass machine that maintains oxygen-rich blood moving through the patient’s body when his own heart and lungs have been stopped). All the professionals in the operation theatre use the machines as per their role and resposbibility.”

As the surgery proceeds, the anaesthesiologists’s job is to continually monitor the condition of the patient. “Everything [the monitoring] is driven by precision.”

Once the surgery is done, the anaesthesiologist steps up to the fore again to perform a crucial function — revive the heart and bring it back to its beating rhythm. He has to check the vital signs for normal functioning and be satisfied that the patient is stable.

It is often a long, exacting schedule for an anaesthesiologist as most surgeries, particularly brain, neuro-spinal and heart, can take up to four hours or more depending on the patient’s case.

The success of a surgery is a combined effort of the team, says Dr Kodakat. “It’s a collaborative effort. The surgeon, surgical nurses and the perfusionist look at the technical side and we look after the medical part. We talk to each other at every stage [of the operation].”

The longest operation he was involved in at the City Hospital lasted a gruelling 16 hours. “Several other cases went on for 12 hours. The more complex the operation and the more sophisticated the machines, the more adept the people become,” he said. But he is not done yet. His role extends outside the operation theatre as well. “We help in resuscitation, pain relief and management of the fluid and blood requirement and the monitoring of post-operative progress in the ICU (intensive Care Unit). We also help very anxious patients undergoing simpler procedures like ensoscopy or nuclear scan. Providing painless labour and delivery using epudural is also one of our major workload. The role of the modern-day anaesthesiologist,” says Dr Kodadat, “is, wide, varying and satisfying.”

In the technology of the future, he wishes for a more simple and robust brain function monitor that is 100 per cent reliable. “That will make things more safer,” he says. “Experts are talking about closed-loop anaesthesia where the computer takes control of the body function and controls the medicines being administered,” he says. “In such a scenario, the anaesthesiologist’s role will be more of planning, setting up the equipment and monitoring. We have not reached there yet, but Inshallah [God willing], we will.”