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From time immemorial healthcare professionals have played an important part in the lives of individuals and society, their significance has never been more recognized than during the recent COVID-19 pandemic. Modern healthcare requires a close-knit team of doctors, nurses, and multiple specialists to unify multiple layers of support into a seamless bundle of care. However, most of the patients remain blissfully unaware of who takes care of them during the most critical stages of their illness. They consider broad specialists like surgeons and physicians along with superspeciality services to be the leitmotif of a tertiary care facility without realising the importance of anaesthesiology and intensive care as the bedrock for any edifice of advanced healthcare.
It was customary to answer that anaesthesiologists are "friendly gas-passers" who are experts in putting people to sleep during surgery or giving injections to relieve pain. Their presumed duty was limited to delivering anaesthesia to patients so they don't experience pain during surgery, but their actual work is much more daunting and extensive. They are skilled in providing ventilatory support, preservation of optimal blood circulation, pain control, inducing sedation with balanced anaesthesia and placing devices and catheters for advanced monitoring of physiology. They have a very imp ortant role to play in the postoperative period for a successful outcome.
An intensivist, on the other hand, is a professional who is responsible for looking after the critically ill who needs advanced life-support for failing organs due to multiple underlying medical conditions. During critical illness, they often spend hours at the patient's bedside, evaluating clinical indicators and watching monitors like a hawk for subtle changes in physiological parameters and instituting appropriate interventions. Their prolific understanding of Ventilators and providing timely advanced supports like ECMO and CRRT come in handy for the revival of the sickest of the patient and coordinating timely treatment with other specialities.
It took a pandemic to acknowledge the importance of these lesser-known professionals who shared the burden of physicians during the unprecedented global health crisis. When the rest of the world was practising social distancing, these soldiers dealt with highly infectious patients in close quarters, intubating with the inherent risk of transmission, dealing with hypoxic patients with rationed oxygen and limited ventilator availability during a global resource crunch. Handling highly contagious patients and treating the most critical cases admitted to ICUs risking their own lives, to state the obvious, was an arduous heroic task accomplished with elan.
The role of an anaesthetist begins far before the surgery and continues well afterwards. They work with both the patient and the surgeon to assess the patient's medical history, perform a focused physical examination, and review test results to establish a viable surgical plan that is both safe and successful. During the surgery, Anaesthesiologists monitor vital functions, such as heart and lung function, breathing rate, oxygen saturation, body temperature and fluid balance among many others. They continue a close vigil while regulating the patient's level of consciousness and ensuring a pain-free operation without recall and taking steps to reduce any post-operative pain.
All ICU patients deserve high-quality round-the-clock care as life-threatening situations don't follow a predictable pattern and there is always an element of uncertainty throughout the stay. Any hemodynamic perturbation or respiratory distress may signal the beginning of a downward slide and the Intensivist needs to act swiftly to reverse the physiological trespass and prevent an uncontrollable downward spiral of shock and multi-organ dysfunction. Appropriate and timely bundles-of-care need to be established in a protocol-driven approach to control physiological derangements and put the patient back on recovery mode. Beyond the boundaries of an ICU, Intensivists are now accountable for saving patient's life inwards by providing CPR and Rapid response teams in outreach programmes. Their wide rim of expertise and a penchant for multi-tasking helps in improving resource utilization throughout the hospital; bridging the quality chasm, enhancing multi-disciplinary coordination and improving overall patient outcomes.
Anaesthetists and intensivists are the primary caregivers in critical care and are the backbone of all surgical disciplines and perioperative medicine. They ensure that the patient is as safe and comfortable at every step of the clinical trajectory as possible. In addition to the difficult clinical responsibility, these professionals are expected to maintain a high level of composure under duress even as the clinical drama unfolds into unexpected twists and turns; maintain excellent communication between the specialities and provide timely updates to an anxious family member with utmost fidelity and empathy.
The article is authored by Dr Abdul Samad Ansari, Director, Critical Care Services, Nanavati Max Super Speciality Hospital, Mumbai.
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