University of Iowa Health Science Relations and
Michael Todd, MD
Professor of Anesthesia
First Published: 1998
Last Revised: 2002
Peer Review Status: Internally Peer Reviewed
You're scheduled to have a surgical procedure but you're not too
worried. You've met with the surgeon, who is skilled and experienced
in this type of procedure. But what do you know about the
"An anesthesiologist is usually the unknown person behind the
mask," says Dr. Michael Todd, professor of anesthesia at the
University of Iowa College of Medicine and a staff physician at UI
Hospitals and Clinics. Most people think that the anesthesiologist
'puts you to sleep' and then leaves, but in reality, he or she is
present during the entire surgical procedure. Most of the
anesthesiologist's time is spent keeping your heart rate, blood
pressure, and other vital functions normal. "With general anethesia,
it's less a matter of keeping patients unaware and pain free as it is
maintaining vital functions and keeping them healthy," Todd says.
Because anesthesia is a controlled drug-induced coma and has
nothing to do with sleeping, it can pose a greater risk than the
surgical procedure itself. "Most people worry about not waking up
after surgery, which isn't a surgical concern, it's an anesthetic
concern," Todd notes. Surgeons carry out the technical aspects of an
operation and cannot pay attention to monitoring blood pressure and
heart rate, he adds.
Although you won't be selecting the anesthesiologist yourself, it
is important to speak to the anesthesiologist before the procedure.
Ask how long the anesthesiologist has been at that hospital and if he
or she is certified by the American Board of Anesthesiology. A
practitioner should be certified or in the process of completing
certification if he or she is in the first year or two of practice.
Ask what experience the person has with procedures like the one
you will be undergoing, particularly for complex operations. Usually
hospitals assign anesthesiologists to cases in their area of special
expertise, but with some simple procedures, any competent
anesthesiologist can do the job, he says.
Ideally, the anesthesiologist will come to see you in the hospital
the night before your procedure, explain what will happen, and get an
idea of your general health. With the trend in admitting patients the
morning of surgery, however, this is becoming less common. "You might
only meet the anesthesiologist just before your surgery," he says.
Depending upon your general health and the type of surgery that
will be performed, you may have a choice between receiving general
anesthesia so you are fully unaware, and regional anesthesia, where
you are awake, but the area of the body to be operated upon is
anesthetized. Most doctors prefer regional anesthesia whenever
possible, Todd says. "Many patients are afraid of having regional
anesthesia. It's common to have patients who want to be fully
'asleep' even if it's not the best way to do it." The regional method
can be better because it leaves the patient in control of breathing
and other vital functions, which is not the case with general
anesthesia. The post-operative period is often shorter and smoother
as well, he adds.
Before undergoing surgery try to discuss all your options with the
surgeon and the anesthesiologist.