World anaesthesia day – October 16: Wrong dosage of anaesthesia may prove fatal
2010 By Syed Akbar Hyderabad: Little did the family of Raghavendra Rao, 44 realise that he would not return home whenhe was admitted to NIMS for a minor ankle problem. Raghavendra Rao slipped into coma andfinally death after he was administered anaesthesia for a simple surgical procedure.Though Raghavendra Rao is an extremely rare case study for doctors, the incident hasnevertheless raised several issues including the expertise of our anaesthetists and howwell trained they are to handle critical cases. As the world remembers Boston dentist William Thomas Green Morton, who on October 16,1846 assisted surgeon John Collins Warren in removing a tumour from the neck of a patientin what has become the first known case of surgery without pain (an, without; aesthesia,sensation), city doctors emphasise the importance of quality training for anaesthetistsand updation of knowledge and skills at regular intervals. In memory of Morton’sassistance in painless surgery, October 16 is observed as World Anaesthesia Day. Not many patients or their attendants know that an anaesthetist is one of the mostimportant persons in any surgical team. Often the role of an anaesthetist becomes moreimportant than that of a surgeon. It is no wonder then that after Raghavendra Rao’s sadepisode, many patients are insisting on well-qualified and well-trained anaesthetists tobe part of their surgical team. After all, it’s a matter of life and death for the patient. “An anaesthetist has a crucial role to play both at the time of surgery and duringrecovery post surgery,” points out Dr N Somasekhar Reddy, senior orthopaedics surgeon.“The role of an anaesthetist doesn't end with surgery but is crucial for controlling painafter surgery”. Dr Somasekhar however argues that with modern equipment and anaesthetic drugs, especiallythe regional anaesthetic techniques, have cut down complications associated withanaesthesia. The State, for that matter the country, has an acute shortage of well-trained andwell-qualified anaesthetists. The shortage is such acute that an anaesthetist has tooften run across hospitals to administer anaesthesia to surgical patients. This leaves alittle time for the anaesthetist to tend more time to any of his patients. Lack of propermonitoring of patients post surgery often leads to severe complications associated with anaesthesia. As Dr Ratnam Naidu, consultant anaesthetist of Apollo Hospitals, says an anaesthetist hasa “significant role in defining the patient care” in terms of pre-operative assessmentperi-operative and post-operative management. The role of an anaesthetist is not restricted to operating rooms any more. “His servicesare important in emergency rooms to cath labs. Anaesthetists play significant role inpain management in cancer wards and in Obstetrics wards too,” he clarifies. But what becomes important for an anaesthetist is “better understanding ofpatho-physiology of disease process, fluid and blood transfusion therapy”, as Dr Ratnamsays. He, however, does not want to attribute anaesthesia complications to doctors.“Unsuccessful outcomes do occur, not due to negligence, but due to expected risk ofanaesthesia and surgery and the fact that humans practice medicine, not computers”. On the other hand, Dr Aftab Ahmed, specialist in internal medicine, argues that“anaesthesia, given appropriately after proper assessment of patient, in a right dose isthe most effective method in conducting painful procedures including surgery.” However, if given without considering the patient’s over all medical condition,anaesthesia can sometimes cause life threatening complications affecting heart, lungs andbrain. “It’s a double edged sword, to be used very cautiously by an anaesthetist,”cautions Dr Aftab. -------------------------------- Anaesthesia complications -------------------------------- Serious complications associated with anaesthesia are generally rare, though often theymay lead to even death. Doctors classify complications as normal, rare and extremelyrare. It is the extremely rare complications that create major trouble to patients aswell as doctors attending them. Here are some of the broad complications associated with anaesthesia: 1. Nausea and dizziness 2. Back ache 3. Short term loss of memory 4. Respiratory problems 5. Damage to nervous system 6. Muscle pain and blurred vision
------------------------ Types of anaesthesia ------------------------ Anaesthesia is generally of three types. A qualified anaesthetist decides which type ofanaesthesia should be administered to the patient concerned. A lot of thought andconsultation with physician and surgeon goes before the anaesthesia is administered. Thephysician certifies whether a patient is fit for surgery. He also writes a note ofcaution if the patient has existing health complications like heart and kidney problems. The age of the patient is also important. 1. General anaesthesia: In general anaesthesia the patient becomes unconscious and needsexternal breathing support. It is used in major surgeries. 2. Regional anaesthesia: A large part of the body is made senseless in regionalanaesthesia. 3. Local anaesthesia: Only a smaller area is covered under local anaesthesia. Broadlyspeaking, local and regional anaesthesia do not cause any major complications.