Dr. Bala Arul V Krishnan Outlines the Major Anesthesiology Subspecialties

Anesthesiologists participate in 90 percent of the 40 million surgical procedures that are carried out each year in the United States, according to Medical News Today. Anesthesiology involves the administration of topical, injected, or inhaled medications allowing surgical and non-surgical procedures to be done entirely pain-free. For instance, anesthesia is used to ease patients into a deep sleep allowing physicians to perform aggressive surgeries like triple bypass, but can also be used for minor procedures, including routine dental work. Anesthesiologists start working before the operation takes place by carefully reviewing patients’ medical history to evaluate an individual’s ability to tolerate anesthesia and reduce the possibility of complications. During operation, they are responsible for monitoring patients’ vital signs, including heart rate, blood pressure, body temperature, and breathing. Finally, postoperative tasks involve watching for negative side effects and treating the patient as needed.

As one might assume, there is a big difference between administering anesthetics to a child, a senior undergoing cardiac surgery, or a patient with a brain tumor. Like all medical disciplines, anesthesiology is extremely complex and can be divided into several subspecialties. After graduating from medical school and completing a four-year residency, anesthesiologists can choose to specialize in a particular area of interest. Different surgical procedures and certain conditions call for patients to be anesthetized in various ways. Dr. Bala Arul V Krishnan is a well-respected Anesthesiology Specialist from Portland, Oregon and has more than twelve years of experience in his field. Dr. Krishnan notes the various anesthesiology subspecialties that exist and their importance to the medical field.

Cardiothoracic Anesthesia

Cardiovascular anesthesiologists are physicians that are highly trained in providing anesthesia care to individuals undergoing cardiac (heart), thoracic (lungs), or vascular (blood vessels) surgery. The ultimate goal for anesthesiologists is to provide high quality and safe clinical care to patients that need one of these complex procedures. Dr. Krishnan explains that surgeries of this nature may present problems that are not experienced in other operations. Anesthesiologists monitor cardiac patients using an ultrasound of the heart, which is a special probe that is placed into the esophagus after the patient is administered anesthesia. They may also use a heart-lung pump, known as a cardiopulmonary bypass, to do the work of the heart and lungs while the patient is being operated. The majority of individuals undergoing aggressive surgery will be given a general anesthetic to ease the patient into a deep sleep. Anesthesiologists may opt to use a regional anesthetic during or after surgery, which is injected into a part of the body to relieve pain. While these are only a few examples of how cardiac, thoracic, and vascular surgeries differ from other kinds of surgery, it is clear why their success requires specialized care.

Pain Medicine

According to the Institute of Medicine, chronic pain affects upwards of 100 million Americans. Chronic pain is characterized as debilitating pain that can drastically impact an individual’s quality of life. For instance, those that suffer from chronic pain may not be able to work, experience inadequate sleep, are limited in the types of leisure activities they can perform, and often experience strained relationships with family and friends. Some examples of chronic pain include back pain, osteoarthritis, frequent migraines, sciatica, muscle injuries, fibromyalgia, phantom limb, and more. Anesthesiologists that specialize in pain medicine focus on diagnosing and working with patients that experience chronic, acute, or cancer-related pain. This area emphasizes the use of regional anesthetic and long-term care of patients in an outpatient clinic. Specialists in this field may recommend a combination of medication, physical therapy, surgery, lifestyle changes, and complementary therapies like acupuncture or meditation.

Obstetric Anesthesia

Obstetric anesthesiologists provide patients with pain relief during labor and administer anesthesia to women that require cesarean deliveries. Dr. Krishnan states that while natural childbirth is still popular in some areas, the demand for epidurals has increased considerably over the last decade. The purpose of an epidural is to use anesthesia to numb the area between one’s navel and upper thigh. During labour, anesthesiologists will insert a needle and catheter into the lower part of the patient’s back. The needle is taken out, and the catheter stays in place to deliver the medication as needed. In addition to providing pain relief for the mother, an anesthesiologist must also ensure the safety of the unborn infant. Overall, Obstetric Anesthesiologists work hard to make the delivery process as positive and comfortable as possible, for mothers, families, and newborns.

Pediatric Anesthesia

Pediatric Anesthesiologists are responsible for general anesthesia, sedation, and pain management of children and infants due to illness, injury, or disease. Children, especially infants, have differences in anatomy, physiology, pharmacodynamics, and behavioural development that create challenges when administering anesthesia. Dr. Krishnan notes that most generally trained anesthesiologists aren’t comfortable treating infants because it calls for near-perfect dosage and treatments designed for adults are usually not feasible for infants. Anesthesiologists are often present in the operating room when surgeons are performing procedures on children. They are involved in developing treatments, delivering anesthesia, regulating pain through the use of intravenous medication, and sedating children who require an MRI, CT scan, or radiation therapy. All in all, these specialists are more than qualified to deliver care to children suffering from complex medical issues that affect multiple parts of the body.

Critical Care Anesthesia

Critical Care Anesthesiologists specialize in caring for patients who have experienced trauma, serious infection, or recently undergone invasive surgery. If a critical care patient requires anesthetic, the individual will undergo a diagnostic assessment that determines their ability to endure the stress of the surgery and anesthesia. Dr. Krishnan states that specialists may need to consult family members if the patient is near death, are likely to need to be resuscitation, or can only survive with the aid of machines. Patients who are in critical care have access to specialized anesthesiologists who monitor them heavily throughout the day. In addition, these individuals have an entire care team, including surgeons, consultants, and nurses who work together to provide patients with a full range of treatment.

Neurosurgical Anesthesia

Another anesthesiology subspecialty is neurosurgical anesthesia. Neuroanesthesiologists are trained to care for people with diseases pertaining to the central nervous system, including the brain and spine. They are experts in the physiology of the brain and spinal cord and have extensive knowledge regarding associated diseases. Patients they deal with may suffer from brain tumors, blood vessel malformations, aneurysms, occluded arteries, trauma, or spinal injuries. These specialists are accountable for maintaining patient’s unconsciousness during procedures, adequate brain blood flow and oxygen levels, and pain management throughout the procedure. Dr. Krishnan discusses how some anesthesiologists may need to customize a patient’s anesthesia to meet the needs of the surgery. For example, if a surgeon needs the patient to be awake to follow commands, anesthesiologists may need to create a special mixture of sedatives to allow this to happen. As a result, these specialists are highly qualified in creating custom solutions and dealing with challenging situations in and out of surgery.

Orthopedic Anesthesia

Musculoskeletal disorders or repetitive motion injuries is the largest category of workplace injuries in the United States, according to the U.S. Bureau of Labor Statistics. Orthopedic anesthesia involves the anesthetic management of individuals suffering from disorders of the bones, joints, ligaments, tendons, and muscles. Common disorders include carpal tunnel, tendonitis, ligament sprain, herniated disc, hip dysplasia, osteoporosis, and more. Dr. Krishnan advises that while various types of anesthesia can be used for orthopedic procedures, the type of anesthesia chosen depends of the nature and duration of the surgery. Highly invasive surgeries generally require a combination of general and regional anesthesia. In contrast, smaller and shorter procedures are usually completed with local anesthesia, which removes sensation from a particular part of the body. For knee replacement surgery, anesthesiologists can provide peripheral nerve blocks to reduce the pain patients experience after surgery. Consequently, several different agents may be used in the treatment of musculoskeletal disorders.

Anesthesiologists require a strong foundation in medicine, surgery, physiology, and pharmacology to deliver safe and effective patient care. Many anesthesiologists opt to pursue a subspecialty in the field of anesthesiology. To obtain this level of expertise, anesthesiologists must complete a four-year residency followed by a one-year fellowship program. Dr. Krishnan encourages aspiring anesthesiologists to do additional research into the various anesthesiology subspecialties to find the best fit for them.

This article does not necessarily reflect the opinions of the editors or management of EconoTimes.