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Introduction to Anesthesia
An anesthesiologist takes care of patients in the periods immediately before, during, and immediately after surgery, which are known as the preoperative, perioperative, and postoperative periods, respectively. In the perioperative period, the goals of an anesthesiologist can be broadly broken down into three components:
- 1.
Keeping the patient safe, above all else. This includes monitoring the patient’s vital signs and responding to changes that may be harmful to the patient, as well as anticipating any changes that may be brought about because of the specific stage of surgery.
- 2.
Ensuring patient comfort, which includes providing analgesia (a state of minimal pain) and amnesia (a state of minimal recall).
- 3.
Creating a favorable surgical environment for the procedurist (within reason). This typically involves ensuring immobility of the patient during the operation.
General Anesthesia vs Sedation
Anesthesia can be thought of as existing on a continuum, ranging from light sedation to general anesthesia, separated according to the patient’s ability to maintain respirations and responsiveness to verbal, tactile, and painful stimulation ( Table 6.1 ).
TABLE 6.1
Differing Depths of Anesthesia
| Minimal Sedation | Moderate Sedation | Deep Sedation | General Anesthesia | |
|---|---|---|---|---|
| Responsiveness | Unaffected | Intentional movements with verbal/tactile stimulation | Intentional movements with repeated tactile or noxious stimulation only | No intentional movements to repeated noxious stimulation |
| Ability to maintain airway | Yes | Yes | May require assistance (jaw thrust maneuver, inserting OPA or NPA) | Usually requires advanced airway (LMA vs ETT) |
| Spontaneous ventilation | Yes | Yes | May not be insufficient | Usually insufficient |
Differences among various depths of anesthesia, from light and moderate sedation to deep sedation and general anesthesia. ETT, endotracheal tube; LMA, laryngeal mask airway; NPA, nasopharyngeal airway; OPA, oropharyngeal airway.
(Modified from Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia, American Society of Anesthesiologists, 2019. Available at: https://www.asahq.org/standards-and-guidelines/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedationanalgesia .)
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