Most people think of an anaesthesiologist (pronounced ana-stee-see-olo-jist) as the person who puts you to sleep before you go into surgery. That’s not completely wrong, but an anaesthesiologist’s job is quite a bit more involved than that – as their price tag might suggest.
We spent a day with an anaesthesiologist to find out what they do while you are sleeping.
On a raining May morning, I meet Dr Dirk van Zijl at Cape Town’s Kingsbury Hospital at 6:30am – the time Van Zijl starts work to be ready for the first surgery at 7:30am.
“I actually start preparing for an operation the day before. I read the doctor’s report to familiarise myself with the patient’s condition and meet them to discuss any concerns, and to talk about rates and payment,” says Van Zijl.
According to the National Health Act, anaesthesiologists are required to discuss fees with patients before surgeries. Anaesthesiologists charge about R3000 per hour. Most medical schemes don’t entirely cover these fees, which leaves patients footing the rest of the bill.
Anaesthesiologists are doctors who’ve completed the six-year degree, followed by at least another four years of study to specialise in anaesthesiology.
South Africa only has about 1000 anaesthesiologists, and more than 800 of these work in the private sector. Fewer than 200 qualified anaesthesiologists service the 40 million South Africans who use public health facilities. In many cases where anaesthesiologists aren’t available, anaesthesia is administered by regular doctors who receive basic training in anaesthesiology.
Getting ready for action
While most people are having their morning coffee, Van Zijl prepares the theatre for surgery – checking equipment, selecting a playlist for the surgery (apparently surgeons like that), and preparing the patient’s drug cocktail.
“Anaesthesiology is sometimes called ‘the stiff profession’ – because you are either bored stiff or scared stiff”
This consists of a muscle relaxant to prevent you from moving (you wouldn’t want a twitch to cause the surgeon to cut into a vital artery when he’s supposed to be removing your appendix); medication to control pain and nausea after the operation; and antibiotics to fight infection.
“This is what killed Michael Jackson,” said Van Zijl, measuring out a dose of the powerful anaesthetic Propofol. Schedule 6 and 7 medication – mostly pain medication, anaesthetics and stimulants like ephedrine (also used to make tik) –are kept in the theatre’s locked metal cabinet. These drugs are fare for anyone looking for a high from cleaning staff to doctors and theft is not uncommon, hence the extra security measure.
“Anaesthesiology is sometimes called ‘the stiff profession’ – because you are either bored stiff or scared stiff,” Van Zijl gaffes. “A routine operation can turn into an emergency when a person’s heart starts beating irregularly, they have an allergic reaction, there are complications during surgery, or the patient goes into cardiac arrest (the heart stops beating).”
Anaesthesiology’s greatest dangers are allergic reactions to medication and drug interactions. That’s why anaesthesiologists need to know everything about drugs – and not just those they administer, but any drug that could interact with the anaesthetic.
Once the theatre is prepped and the surgeons are ready, the anaesthesiologist collects the patient, gets them into position on the operating table, and puts them to sleep.
“Anaesthesiology is often compared to flying: a dramatic take off, a stable flight, and a dangerous landing. We are busy before and at the start of surgery, then things calm down during surgery, and the most dangerous part is waking the patient up – that’s when most of the complications happen,” Van Zijl tells Health-e News.