1) An anesthesiologist plays a critical role in surgery beyond just putting the patient to sleep - they must continuously monitor the patient's vital signs and be prepared to respond if complications arise. 2) It takes extensive education and clinical training to become a physician anesthesiologist. Using them provides patients the highest level of care and safety during their procedure. 3) Research shows that having a physician anesthesiologist present reduces the risk of death from surgical complications.

1. You’re being wheeled into surgery. The Centers for Disease Control says that
some 53 million other Americans will make a similar trip this year. As you roll
down the hallway you might be thinking your life is now in the hands of God and
your surgeon. You’d be wrong. There is a second set of (mortal) hands just as
important as your surgeon’s and they belong to your anesthesiologist.
Dr. Geoffery Wolf, a physician anesthesiologist and chair of the anesthesiology
department at the Indian River Medical Center, says that every surgery is far
more of a team effort than many folks realize. Besides, while the man or woman
with the scalpel may get the bulk of the credit for a successful surgery, it’s
probably your anesthesiologist who will have kept you alive during the procedure.
The anesthesiologist’s job, according to Wolf, is much more than just
administering the drugs that put you to sleep and wake you up when surgery is
over. He or she must also provide continuous assessments and updates to the
rest of the surgical team, including the surgeon, on your body’s vital life signs and
functions including your heart rate, blood pressure, body temperature and
breathing rate while simultaneously controlling your pain. He or she must also be
able to instantly intercede with breathing tubes, mechanical ventilators or
resuscitation drugs should anything goes wrong. It takes about 12 years of
schooling and between 12,000 to 16,000 hours of clinical training to become a
physician anesthesiologist so since January 11 to 17 was National Physician
Anesthesiologist Week, VB32963 sat down to ask Wolf some questions.
Q: I understand that IRMC uses only physician anesthesiologists in its operating rooms
while some hospitals choose to use nurse anesthetists. What, in your opinion, are the benefits
of using physician anesthesiologists?
A: Well, to begin with, physician anesthesiologists have a lot more education and
training than nurse anesthetists do. That isn’t to belittle nurse anesthetists. They
work very well in a lot of places but we have used a different practice here for
years with only physician anesthesiologists and that means that everyone who

2. goes to sleep here has a physician with them from the start of an operation to the
finish…which is rare. You don’t see that very often…but the public and the
media, they don’t realize that patients have a choice. Patients can ask, “who’s
going to be taking care of me when I’m asleep? Is it going to be a nurse or a
doctor?” We encourage patients to go ahead and ask those questions. They
have a choice.
Q: Are there any other benefits to having a physician anesthesiologist in the OR?
A: There is a wealth of information that the physician anesthesiologist can give
the patient to make their experience safer and better. When you share your
medical history with your anesthesiologist (he or she) is going to go ahead and
tailor your anesthetic plan to your individual needs. If you have had a bad
experience before, for example, you may have certain options that are available
to you. There are lots of different ways to put someone to sleep. There’s not just
one way to do it. Just as much as your surgeon is going to do a medical history
and a physical to come up with a plan on how to do your surgery, your
anesthesiologist is going to go ahead and craft a plan to optimize for your
condition. If you have a respiratory problem, you may benefit from lung
medications that will help improve your breathing prior to surgery. If you have a
cough or are wheezing or your blood pressure is a little bit high – these are things
that we as anesthesiologists will help to modify a little bit if we need to. We work
in conjunction with your primary care doctor to change a few things if we need to.
When you’re there in the operating room your anesthesiologist is your doctor.
Your family doctor is not there with you.
Q: Does Vero Beach’s senior population present any specific difficulties when it comes to
administering anesthesia?
A: Sure. Our geriatric population here presents a different set of challenges than
a lower age group. We treat those patients, often times, with different kinds of

3. anesthetics and often with different quantities of anesthetics. People in this age
group have more problems with blood pressure and respiratory problems. So,
sometimes a regional anesthetic is better for these patients because it can
minimize some of the side effects or hazards associated with general
anesthetics. With general anesthesia the big thing to worry about in this age
group is “post-operative cognitive dysfunction” which is basically delirium or
confusion after surgery. It can last for a day or it can last for weeks. Often times
just a little anesthetic for someone over the age of 75 can make them very
confused. By doing a regional anesthetic like a spinal or an epidural it gives
them, essentially, nothing that is going to make them sleepy or confused and the
brain, therefore, really doesn’t see the effects of a general anesthetic at all and is
clearer after surgery.
Q: So, would you say that regional anesthesia is now more popular than general anesthesia?
A: I think if you were really going to narrow it down, the most frequent type of
anesthesia is still general anesthesia. However, general anesthetics have
become shorter acting in the past 10 to 15 years and they cause fewer side
effects. We are always trying to promote lowering risk, lowering complications
and improving safety. It’s our top priority at the American Society of
Anesthesiologists. We preach it all the time.
Q: I read a term I didn’t really understand connected to anesthesiology and Webster’s wasn’t
much help: the term was ‘titrate.” Can you explain?
A: It’s “adjusting.” So, in the past 10 or 15 years, we would give something (a
drug) that would last two hours no matter what. Now we are able to give drugs
that last a minute or two. So, if I want to, I can go ahead and shut things on and
off like a light switch. If I want you to be in this position asleep for 15 minutes, I
can give you exactly this amount of drug that is going to wear off in 20 minutes. I
couldn’t do that 20 years ago.

4. Q: I know the American Society of Anesthesiologists’ (ASA) slogan or motto is “when
seconds count, physician anesthesiologists save lives” so I dug around and found out that in the
past 25 years anesthesia-related deaths with physician anesthesiologists have plummeted from
two in every10, 000 surgeries to fewer than five in every one million surgeries. Is that what the
slogan means?
A: Very good. You’ve done your research. I’m impressed. That’s exactly right.
For a healthy person the quote is about five in a million or about one in 200,000
so that’s pretty small. There is a greater risk of dying in a motor vehicle accident
than dying in anesthesia.
To further bolster Wolf and the ASA’s claims on the value of physician
anesthesiologists in the operating room, the Agency of Healthcare Research and
Quality, a federal agency for researching health care quality, cost, outcomes and
patient safety, reports that “the presence of a physician anesthesiologist
prevented 6.9 excess deaths per 1,000 cases in which an anesthesia or surgical
complication occurred.”
In other words, in today’s world of hyper-powerful intravenous drugs and
barbiturates such as propofol, sodium thiopental and methohexital and inhaled
anesthetics including sevoflurane and isoflurane, it appears that having a
physician anesthesiologist watching over you during surgery actually is a pretty
good idea.