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Career as an Anesthesiologist



Who is an Anesthesiologist?

An anesthesiologist is a medical doctor who specialises in the administration of anesthesia and related issues. Anesthesiologists most famously work in the operating room, keeping patients unconscious and monitoring their vital signs during surgery, but these professionals can also be seen in other environments. For example, anesthesiologists can administer nerve blocks, epidurals, and other forms of pain management which are used outside the operating room.


What does an anesthesiologist do?

A physician anesthesiologist is responsible for the patient’s well-being before, during, and after surgery. An anesthesiologist will do the following:

•Determine if it is safe to proceed with the anesthetic and surgery or procedure.

•Devise an anesthetic plan with the patient. This is typically general anesthesia, sedation anesthesia, or regional anesthesia such as a spinal, epidural, or regional nerve block (usually accompanied by intravenous sedation).

•Ensure unconsciousness with general anesthesia, or the appropriate level of sedation with sedation anesthesia.

•Monitor and maintain normal vital signs, including respirations (breaths), pulse, blood pressure, and temperature.

•Monitor and maintain normal levels of oxygen in the bloodstream and carbon dio-xide gas in the lungs.

•Identify and treat any problem or emergency that may occur before, during, and after the procedure, such as an unexpected or allergic reaction to a medication, bleeding, or an unexpected change in vital signs.

•Minimize the stress response to the operation or procedure to allow the patient to make the best recovery.

•Control pain after surgery.

•Provide ongoing care after the surgery in the anesthesia care unit or intensive care unit.


Types of Anesthesiologists

The primary job in anesthesiology is called an anesthesiologist. The second job a person can find in this field is called a certified registered nurse anesthetist (CRNA). Both medical professionals work together to ensure that the patient remains comfortable and safe during the operation.


Cardiothoracic Anesthesiologist

This type of anesthesiologist has advanced training specifically dedicated to cardiac and thoracic anesthesia involving the heart and lungs, and whose responsibility it is to make the preoperative period both safe and comfortable for the patient.


Cardiothoracic anesthesiologists provide anesthesia for operations of the human chest, which may include bypass surgery (includes supervision of the bypass heart-lung machine), robotic surgery, minimally invasive surgery, and complex aortic sur-gery. They also keep an eye on the patient's bodily reactions to drugs during sur-gery.


Cardiothoracic anesthesiologists may also work with non-cardiac procedures, like performing ultrasound assessments for cardiac health, electrophysiology consulting for the reprogramming of pacemakers and implantable cardioverter-defibrillators (ICD), esophageal resection, and various types of video-assisted thoracoscopic sur-gery.


They often conduct research to help improve anesthesia and patient care during surgery and study medicines and ways for caring for heart patients before, during, and after an operation.


Critical Care Anesthesiologist

Some anesthesiologists pursue advanced training to sub-specialize in critical care medicine in both adult and pediatric hospitals. Because of their comprehensive training in resuscitation and in clinical physiology and pharmacology, anesthesiologists are particularly suited to administering to patients in the intensive care unit.


Critical care anesthesiologists are able to coordinate the medical assessment, diag-nosis, respiratory/cardiovascular support, and pain control needed by ICU patients - as well as provide airway management, advanced life support, and cardiac and pul-monary resuscitation in many emergency and trauma situations. They also play a vital role in stabilizing and preparing patients for emergency surgery.


Neurosurgical Anesthesiologist

Like other anesthesiologists, neurosurgical anesthesiologists provide anesthesia in the operating room, but specialize in the anesthetic management of patients with various conditions of the central nervous system, the brain, and the spine.

Anesthetic management is needed for aneurysms, head injuries, pediatric neurosurgery, spine surgery, arteriovenous malformations, intracranial tumors, stereotactic procedures, and neuroradiological procedures.

These types of procedures not only require having a solid understanding of neuroa-natomy and neurophysiology, but require the knowledge base to measure intracranial pressure, cerebral blood flow, and cerebral metabolic rate.


Obstetric Anesthesiologist

An obstetric anesthesiologist works closely with obstetricians, perinatolo-gists, midwives, neonatologists and labor and delivery nurses in order to give quality care for pregnant women and their babies.

Obstetric anesthesiologists serve in labor and delivery, ready to assist in the man-agement of pain of labor and delivery, to administer anesthesia for cesarean section, and to manage emergencies that may arise.

They discuss pain management options with the mother, and administer an epidural anesthetic if the mother decides that she wants it. They watch over the mother and if the labor is long, or the epidural wears off, they provide another dose.


Pediatric Anesthesiologist

Children are not small adults and no child is exactly the same. Pediatricanesthesiol-ogists focus on providing an individualized experience for each child, based on his or her needs. After surgery, pediatricanesthesiologists are involved in prescribing pain medication or recommending pain-relieving techniques for each child that is best for providing comfort and rest for optimal recuperation.

Pediatricanesthesiologists are also involved in caring for children during radiological imaging or scanning procedures, gastrointestinal procedures, and other non-surgical treatments that require a cooperative and motionless patient.


Other careers within anesthesiology (not physicians):

Nurse Anesthetist

A nurse anesthetist (or a certified registered nurse anesthetist (CRNA)), is someone who has completed graduate-level education and has been board certified in anes-thesia.

They are capable of administering anesthesia under the oversight of an anesthesiologist, surgeon, dentist, podiatrist or other qualified healthcare professional. Some nurse anesthetists hold credentials in fields such as respiratory care or critical care nursing, and some choose to specialize in obstetric, neurosurgical, pediatric, dental or cardiovascular anesthesia services.

They are independently licensed health professionals, and are often the sole providers of anesthesia services that offer surgical, obstetrical, and trauma stabilization services in rural hospitals and areas where it would otherwise not be possible.


Anesthesiologist Assistant

An anesthesiologist assistant (not to be confused with a nurse anesthetist) is a non-physician anesthesia provider who practices anesthesia under the medical direction of an anesthesiologist.

The assistant will operate anesthesia equipment, monitor patients, and provide quality anesthesia care. Anesthesiologist assistants accompany the patient before, during and after anesthesia to ensure quality and continued care. They are trained to assist in life-saving measures, such as CPR, and life support.


Types of Anesthesia’s

General anesthesia

You are put into a state of unconsciousness for the duration of the operation. This is usually achieved by injecting drugs through a cannula placed in a vein and maintained with intravenous drugs or a mixture of gases which you will breathe. While you remain unaware of what is happening around you, the anesthetist monitors your condition closely and constantly adjusts the level of anesthesia. You will often be asked to breathe oxygen through a mask just before your anesthesia starts.


Regional anesthesia

A nerve block numbs the part of the body where the surgeon operates and this avoids the need for general anesthesia. You may be awake or sedated (see below).

Examples of regional anesthesia include epidurals for labour, spinal anesthesia for caesarean section and ‘eye blocks’ for cataracts.


Local anesthesia

A local anesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anesthesia is numbing an area of skin before having a cut stitched.

Sedation

The anesthetist administers drugs to make you relaxed and drowsy. This is some-times called ‘twilight sleep’ or ‘intravenous sedation’ and may be used for some eye surgery, some plastic surgery and for some gastroenterological procedures. Recall of events is possible with ‘sedation’. Most patients prefer to have little or no recall of events. Please discuss your preference with your anesthetist.


Workplace and Environment of an Anesthesiologist

Anesthesiologists may work in a variety of settings, including hospital operating rooms and outpatient surgery facilities, as well as private practices, academic medi-cal centres and the military. Anesthesiologists also administer intravenous (IV) and spinal pain control, such as epidurals, during labor and delivery, in the intensive care unit (ICU) and for patients experiencing chronic pain. Anesthesiologists generally work in well-lit, sterile environments in hospitals or outpatient surgery centres. The temperature in the surgical environment is usually kept low for increased sterility.


Knowledge Areas to be Acquired

As a specialty, the core element of anesthesiology is the practice of anesthesia. Safe anesthesia requires in-depth knowledge of various invasive and non-invasive organ support techniques that are used to control patients' vital functions while under the effects of anesthetic drugs; these include advanced airway management, invasive and non-invasive hemodynamic monitors, and diagnostic techniques like ultrasonography and echocardiography.

Anesthesiologists are expected to have expert knowledge of hu-man physiology, medical physics, and pharmacology, as well as a broad general knowledge of all areas of medicine and surgery in all ages of patients, with a particular focus on those aspects which may impact on a surgical procedure. In recent decades, the role of anesthesiologists has broadened to focus not just on administering aesthetics during the surgical procedure itself, but also beforehand in order to identify high-risk patients and optimize their fitness, during the procedure to maintain situational awareness of the surgery itself so as to improve safety, as well as afterwards in order to promote and enhance recovery.


Skills-

Communication

An anesthesiologist must be able to clearly and effectively communicate with pa-tients and their families. Before surgery, the anesthesiologist must thoroughly ex-amine medical records, explain his role in the procedure, disclose any risks involved and try to ease patient stress. During this brief consultation, the anesthesiologist should show empathy and help the patient feel as comfortable as possible. During recovery, the anesthesiologist provides a recap of what took place, including details regarding patient response and whether additional anesthesia was necessary. So, it’s important that anesthesiologists have excellent communication and people skills and be a good patient advocate.


Composure

Another essential skill is superior composure. Anesthesiologists work in stressful environments, so they must have the ability to work well under pressure. There is a potential for so many different things to go wrong, and they should be able to analyse the situation, proactively collect data and act accordingly. They must remain calm during emergencies in order to prioritize, think and act quickly, and make good decisions very quickly.


Dexterity

Great motor skills are also highly prized, according to the AAMC. Anesthesiologists must be ready to successfully issue pain medicine in all phases of surgery – pre-operative, intra-operative and post-operative. They need good hand-eye coordination and the stamina to handle multiple patients simultaneously and for prolonged periods of time, if necessary. Excellent physical and mental dexterity enables them to remain nimble and work quickly and accurately.


Attention to Detail

Extreme attention to detail is one of the most important skills an anesthesiologist should possess because the administration of an inappropriate dosage amount can lead a patient to experience severe pain or even death. From accurately reviewing patient medical records prior to surgery to meticulously monitoring vital signs during surgery to thoroughly examining the patient during recovery, attention to details plays a major role in the patient’s well-being.


A Typical Workday

On a daily basis, Anesthesiologists record type and amount of anesthesia and pa-tient condition throughout procedure. They decide when patients have recovered or stabilized enough to be sent to another room or ward or to be sent home following outpatient surgery.


A typical day for an Anesthesiologist will also include:

•Position patient on operating table to maximize patient comfort and surgical accessibility.

•Examine patient, obtain medical history, and use diagnostic tests to determine risk during surgical, obstetrical, and other medical procedures.

•Monitor patient before, during, and after anesthesia and counteract adverse reactions or complications.

•Administer anesthetic or sedation during medical procedures, using local, intravenous, spinal, or caudal methods.

•Coordinate administration of anesthetics with surgeons during operation.


Personality Traits

The Thinkers and The Builders:

People who are suitable for this job tends to like working with ideas, and require an extensive amount of thinking. They like searching for facts and figuring out problems mentally.

They also like work activities that include practical, hands-on problems and solutions. They like working with plants, animals, and real-world materials like wood, tools, and machinery.


Anesthesiologists need to be very attentive to their patients' medical condition. Dur-ing surgery, they diagnose and treat the body with a careful balance of anesthetic medication, ensuring all vital functions remain intact. Monitoring a number of activi-ties, including heart rate and rhythm, blood pressure, body temperature and breath-ing, anesthesiologists need to be proficient at multitasking. However, their activities are not only restricted to the operating room. Chronic pain management is another area requiring the expertise of anesthesiologists. A good bedside manner is helpful in providing these patients with exceptional care during clinical visits.


Education

To pursue anesthesiology, one needs a strong background in Physics, Chemistry, Biology and Mathematics. Like any other physician, Anesthesiologists too require a long period of medical training. After 10+2 one has to apply to medical colleges to pursue MBBS degree, admission to which is based on scores of entrance test and marks of plus two. Next step after MBBS is one-year house surgency followed by M.D in anesthesiology which is usually of 2 years duration.

Besides anesthesiology, an anesthesiologist must also study cardiology, critical care medicine, internal medicine, pharmacology, and surgery. An anesthesiologist may choose to specialize in a particular field, such as neuro surgery, cardiac and thoracic surgery, maxillofacial surgery and so on. They need to continuously update their knowledge and skills through professional seminars and continuing educational courses.


Job Outlook

Career prospects for anesthesiologists are always booming, since every hospital will require a team of anesthesiologists who are experienced and dedicated.

As long as there is a demand for surgery and relief from pain, there will be need for qualified anesthesiologists. Anesthesiologists are needed in doctor's offices, hospit-als, health Clinics, and anywhere where patients are in pain. Most anesthesiologists work in hospital operation theatre, while others work in outpatient surgery centres, medical offices, dental clinics etc. Some work in emergency rooms, where they handle victims of heart attacks, shock, drug overdoses, traumatic injuries, and other serious health problems requiring immediate care. Other opportunities may exist in urgent care centres, academic medical centres, and the military. For those who opt for a field other than medical practice, can choose to work as lectures in medical colleges. Those who are specialists in the sector may also work as visiting Anesthesiologists and may charge on hourly basis. Some may move on to administrative and supervisory roles within the medical sector. Yet another group can enter into research field.


Salary

The salary ranges according to the geographic region, experience and sub-specialty. In India, an Anesthesiologist may start his career with a minimum pay scale of Rs 20,000 to 30,000 per month depending upon the medical organization they work for. Generally, pay is much more in corporate hospitals than in government hospitals. After being established in the field, one can work on an hourly basis too, and in this case, pay is much lucrative.


Frequently Asked Questions:

What hours do anesthesiologists work?

As with most other medical careers, anesthesiology work requires long and hectic hours. Most anesthesiologists work up to 60 hours a week or more.


What are the top 10 colleges and universities offering anesthesiology as a course in India?

•All India Institute of Medical Sciences (AIIMS), Delhi

•Post Graduate Institute of Medical Education and Research (PGIMER), Chandi-garh

•Christian Medical College, Vellore

•Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

•Amrita Vishwa Vidyapeetham, Coimbatore

•Banaras Hindu University, Varanasi

•Kasturba Medical College, Manipal

•Jawaharlal Institute of Post Graduate Medical Education & Research (JIPMER), Puducherry

•Institute of Liver and Biliary Sciences, Delhi

•King George’s Medical University, Lucknow


Will you advise an MBBS to choose Anesthesiology as his specialty? What are the benefits?

Anesthesia is an excellent branch. One gets plenty of opportunities to learn not only acute care and emergency medicine but also specific bedside skills like endotracheal intubation, central venous catheterization and intensive care including airway management.

There is a demand for good anesthesiologists. Someone who is punctual and prag-matic with the right attitude, has quick reflexes coupled with the courage to accept challenging cases and wouldn't bother the surgeon too much with his own con-straints and limitations when the surgeon is struggling at the surgery.

A well-trained anesthetist has tremendous opportunities as an intensivist, a cardiac anesthesiologist and pediatricanesthetist.


What qualities should a person possess to be successful in this career?

To be successful in anesthesiology, it goes without saying that you must excel aca-demically, but also an anesthesiologist has to be incredibly detailed-oriented, skillful at procedures, calm in stressful situations, and warm and caring to ease patient’s anxiety.


Is there a difference between anesthesiologists and CRNA?

•A CRNA is a registered nurse (RN) who specializes in anesthetics, while an anesthesiologist is a medical doctor (MD) who specializes in the same field.

•An anesthesiologist acts as the supervisor of the CRNA in a collaborative work set-up.

•The anesthesiologist typically earns more than twice more compared to the CRNA.


What are some complications an anesthesiologist might face during surgery?

Anesthesiologists often see side effects to all of the drugs that they use. These may be a lowering of blood pressure and a change in the pulse. Most anesthetic drugs depress the breathing stimulus, and the anesthesiologist must be prepared to sup-port the patient's breathing. Rarely, the patient may experience significant changes in temperature, allergic reactions to drugs, damage to teeth due to the breathing tubes being placed in the trachea, bleeding problems, bronchospasm in the lungs, aspiration of stomach contents, or injury to nerves when nerve blocks are used. While this list may seem long, these reactions are very uncommon, especially in the healthy patient, but the anesthesiologist must be prepared not only to recognize any problem, but also, he or she must know how to manage the problem.


Is anesthesiology an art or a science?

Anesthesiologya branch of medical science dealing with anesthesia and anesthetics.


Is it worth becoming an anesthesiologist?

Before anesthesia was first administered by Dr. Crawford W. Long in Jefferson, Georgia in 1842, the surgical treatment of diseases and trauma was extremely rare. On those rare occasions, patients suffering from gangrene of a leg or a serious frac-ture would be drugged with alcohol or morphine, and then restrained while a fast surgeon would perform the procedure. The accounts of these operations are horrify-ing. It is amazing how Dr. Long's discovery of ether as an anesthetic and the first public demonstration of an anesthetic by Dr. William T.G. Morton at Harvard in 1846 revolutionized the treatment of life-threatening ailments. Today’s surgeries are im-possible without anesthesia.


What are the related degree options for an anesthesiologist?

Physician Assistants

Physician assistants are medical practitioners who work under the supervision of a physician. These professionals receive extensive training to provide care of a thera-peutic, diagnostic and preventative nature to patients. Although they are not medical clerks, they often record patient medical histories. Physician assistants must complete a formal education program and pass a national licensing exam. The education programs usually last about two years. Most physician assistants have a college degree and complete their training as an assistant after college.


Certified Registered Nurse Anesthetist

Certified Registered Nurse Anesthetists or CRNAs provide a similar level of care to patients that is provided by anesthesiologists. CRNAs provide therapeutic care be-fore, during and after surgical procedures. They may also administer pain manage-ment medicines when necessary. While registered nurses need either an associate's or bachelor's degree, CRNAs must complete an extensive master's degree program. Many university nursing programs now offer these as additional programs in their nursing schools. Nurse anesthetists must complete coursework in a variety of areas such as pathophysiology, pharmacology and principles of anesthesia.


Surgical Technologist

Surgical technologists are largely responsible for preparing the operating room prior to surgery. They then play an integral role as part of the surgical team along with the surgeons and nurses on staff. Surgical technologists must take a formal education program. These usually last from nine to 24 months.


Any other information or advice for someone interested in this occupation?

If you are interested in medicine, find a mentor and visit a doctor for the day. GOOD LUCK!


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