Understanding Anesthesiology - The Global Regional Anesthesia ...

SECTION 4
Anesthesia Outside the Operating Room
In This Section
1. Anesthesia Care in Remote
Locations
As diverse and ever-evolving as operating room
practice is, anesthesiologists also have many opportunities
to expand their practice outside of this
realm. The ensuing discussion will look more
closely some these challenging roles.
Anesthesiologists may provide conventional anesthetic
services in locations remote from the operating
room, such as radiology, burn center, endoscopy
unit, lithotripsy unit, electrophysiology lab,
or cardiac investigation unit. The anesthesiologist
is often requested to monitor and sedate patients
in order to render interventional procedures safer
and more palatable to the patient. General anesthesia
outside the operating room poses unique problems
for the anesthesiologist and certain risks for
the patient. Nonetheless, with adequate preparation
and appropriate care, general anesthesia can
be carried out almost anywhere.
As an expert in airway management, vascular access
and fluid resuscitation, the anesthesiologist is
a key member of the trauma team. The team resuscitates
the patient, establishes the extent of injury
and carries out appropriate investigations. These
initial steps are followed by definitive therapy,
when necessary. The anesthesiologist’s involvement
in the care of the trauma victim does not
end in the emergency room. Often, these victims
arrive in the operating room urgently, where resuscitation
is vigorously continued before and during
the anesthetic.
Many anesthesiologists spend a proportion of
their clinical time working in the intensive care setting.
With the use of sophisticated physiologic
monitoring, ventilatory care, pharmacologic support
and acute pain management, critical care
medicine is a natural extension of the anesthesiologist’s
role in the operating room. Many anesthesiologists
pursue specialty training in critical care
after their residency training.
Most hospitals have an Acute Pain Service (APS)
run by the Anesthesia departments, for postoperative
surgical patients. The APS initiates and
supervises various pain management therapies
such as patient-controlled analgesia (PCA) and
epidural analgesia. These interventions are intensive
and brief; they require constant and ongoing
assessment to ensure safety and effectiveness.
Acute pain management requires a special set of
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