| Surgical
Specialties |
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Anesthesia |
Essential to Central Maine Medical Center's Surgical Services
Department is its anesthesiology staff, a group of physicians
and nurses who care for patients during surgery, and provide
other important services as well.
Early accounts of surgical procedures at CMMC depict anesthesia
as the process of dripping ether onto a cloth draped over
the patient's nose and mouth. Ether was an effective general
anesthesia agent, but had some unpleasant side effects. It
left patients with a hangover effect that included nausea.
Sometimes the person giving the anesthetic also became sleepy.
Clearly, ether had limitations as an anesthetic agent.
Over its first 100 years or so, anesthesia underwent a number
of innovations, the most notable being the development of
equipment to deliver anesthetic gases and oxygen for inhalation
and to absorb exhaled carbon dioxide. Still, up until the
early 1980s most patient monitoring was done by observation.
Patients breathed spontaneously or were assisted by the anesthesia
provider. Blood pressures were taken manually; the heart was
monitored by a stethoscope or a finger on the pulse.
Today anesthesia management and monitoring is done with the
assistance of high-tech equipment. Every anesthesiology machine
has an electrocardiogram and a blood pressure monitor. Each
is equipped with a ventilator that provides detailed information
on the adequacy of ventilation. Each machine measures the
amount of oxygen in a patient's blood, how much anesthetic
agent is being given and how much is being exhaled. Pumps
are available for administering intravenous agents. Such technology
gives the anesthetist precise information, allowing the provider
to give anesthesia more safely.
The anesthetist's role in pain relief extends to the Post
Anesthesia Care Unit (PACU) and to the Critical Care Unit.
Anesthetists evaluate the typical surgical patient to determine
factors that may impact anesthesia management. During this
interview, options for anesthesia are discussed and patients
can ask questions. Often medication is ordered to help the
patient relax or treat some pre-existing medical condition.
The anesthesiologist may consult with the patient's surgeon
or primary care provider.
When the patient arrives in the operating room, monitors
are applied to check on his or her status throughout the surgical
procedure. An anesthetist may prepare patients for postoperative
pain management by inserting an epidural catheter prior to
surgery. The epidural catheter is placed outside the covering
of the spinal canal and can be used in the postoperative period
to administer pain medication.
After a patient has been prepared for surgery, the anesthetic
is administered. There are essentially two types of anesthesia:
general anesthesia that keeps the patient deeply asleep and
regional anesthesia that numbs the operative area. In any
case, the anesthesiologist or nurse anesthetist never leaves
the patient.
Following surgery the patient is monitored in PACU by registered
nurses. An anesthesiologist is always available to deal with
any problems that arise in the immediate post-operative period
and to determine when the patient may be safely transferred.
The anesthetist's work is not limited to administering anesthesia
in the operating room and alleviating post-operative pain.
The anesthetist may provide invaluable help to patients coping
with many acute conditions.
Epidural catheters
An epidural catheter delivers pain medications very close
to the pain receptors on the spinal cord. The procedure can
offer better pain control in some instances with less systemic
effect than conventional system in which the medications are
administered orally or intravenously.
Patients receiving epidurals for post-operative pain at Central
Maine Medical Center are provided with a pain management provider
(PMP) pump that permits them to dose themselves with pain
medication. The pump, which is controlled by a device that
prevents over-medication, delivers pain medication directly
to the pain receptors and maintains the appropriate level
of medication.
Epidural pain management can result in shorter hospitals
stays, quicker recovery, and reduced post-operative complications.
The technique is most often used for post-operative patients,
especially those who have had major surgery. The technique
is also useful in helping cancer patients manage pain. The
PMP pump is portable, allowing patients greater mobility.
Critical care
Many anesthesiologists are involved in critical care beyond
the immediate post-operative period. Problems seen in critical
care patients are often like those in surgical patients: unconsciousness,
the need to monitor body functions closely, the need to control
respiration, and so on. The anesthesiologist can play a central
role in the care of the critically ill patient.
Obstetrics
The anesthetist can make an important contribution to obstetrical
care. Although many women deliver their babies with little
or no pain medication, others benefit from pain relief. To
diminish the discomfort of labor, anesthesiologists at CMMC
may administer intrathecal narcotics. By placing pain medication
within the spinal canal at pain receptors, immediate pain
relief can be delivered. Although the woman can feel uterine
contractions, the associated pain can be alleviated. In patients
who need a cesarean section, the anesthetist provides the
necessary anesthesia.
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