Going in for surgery can be scary. The thought of general anesthesia can be something that keeps people from getting a much needed procedure.
Anesthesiologists are the person in the room that will provide continuing assessment of a patients care.
Anesthesia is considered very safe, but while the idea of "going under" may worry you, the risks of anesthesia are pretty low.
Jared Chase, DO, Anesthesiologist and a member of the medical staff at Temecula Valley Hospital, is here to discuss the vital role an anesthesiologist plays before, during and after surgery.
The Role of the Anesthesiologist
Featured Speaker:
Learn more about Jared Chase, DO
Jared Chase, DO
Jared Chase, DO is an Anesthesiologist and a member of the medical staff at Temecula Valley Hospital.Learn more about Jared Chase, DO
Transcription:
The Role of the Anesthesiologist
Melanie Cole (Host): When preparing for surgery, many patients think of the physician anesthesiologist as the person behind the mask who puts them to sleep and wakes them when it’s over. They may not realize the comprehensive medical care the physician anesthesiologists provide between those two points and beyond. My guest today is Dr. Jared Chase. He is an anesthesiologist and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Chase. Tell us: what is an anesthesiologist? What all encompasses what you do?
Dr. Jared Chase (Guest): Thank you, Melanie. I appreciate the opportunity to reach out to some listeners. Physician anesthesiologists, like you had mentioned, obviously it is a little more complex than just simply putting someone to sleep and waking them up. The training is four years of medical school along with four years of residency training. Essentially, I look at each individual patient as our job is similar to, you could say, an airline pilot in that we kind of sit in our cockpits and we’re monitoring all of the different physiologic parameters of each patient during the surgery. Basically, the medications that we use to allow the surgeon to operate kind of knock out all of the symptoms that typically keep that patient alive. Therefore, we are there monitoring all of those things and helping in managing all of those various physiologic processes in order to safely get them through that procedure that they’re having.
Melanie: It’s not only during surgery, though. You meet with patients beforehand and afterwards. Speak about the other roles that you have.
Dr. Chase: Exactly. That’s a very good point. The anesthesiologist today is more of a peri-operative position which basically includes, like you mentioned, the preoperative assessment. We meet with the patient beforehand, typically just right before surgery although there are also a lot of places that have pre-operative assessment clinics where an anesthesiologist may visit you a couple of weeks before. That’s where it’s extremely important for us to get a good understanding of the patient’s overall medical history as the medical history can affect a lot of different things during surgery. That’s the pre-operative assessment – usually just a few minutes. We ask some questions to get a good idea of where their baseline cardiac function might be, respiratory function might be. Then, from there, we obviously continue that care in the operating room. Then, even afterwards, like you mentioned, we continue to monitor the patient in the recovery room which is the PACU – the post anesthesia care unit – ensuring that their pain is controlled, nausea, any other side effects that might happen during surgery or after or due to the anesthesia. For some surgeries we may follow them for a few days while they’re still in the hospital.
Melanie: You’re also a physician and you’ve described all of your training. What else as far as chemistry, biology – because that’s where that I see that it’s such a complicated field that you’re in. It’s an amazing thing that you're able to do is to monitor all those things.
Dr. Chase: Exactly. In the operating room, I would say the key things that we are doing, the medications that we give that induce anesthesia also knock out your breathing; they kind of knock out your blood pressure a little bit to a degree; they knock out your body’s ability to regulate its own temperature. We monitor temperature. We’re monitoring your heart function. We’re monitoring your breathing--how much oxygen we’re delivering, how much carbon dioxide they’re expiring. We’re basically in charge of all of those parameters. We’re basically trying to maintain the physiologic balance which anesthesia actually causes an imbalance. We’re maintaining it by tweaking little things – giving a little medicine here to raise your blood pressure or tweaking the respiratory rate to change the amount of carbon dioxide that is being expelled and just trying to maintain that homeostasis throughout surgery.
Melanie: Why do people need to have an empty stomach prior to surgery, Dr. Chase?
Dr. Chase:That’s a very common question. It’s a very good question. They key there is that when we administer the medications to the patient that renders them unconscious - which is going to sleep – it also relaxes your lower sphincter in the esophagus. If there were food in there, that food could easily come up and the patient could then aspirate, which means that the food could go into their trachea and into their lungs which could cause a really devastating pneumonia or a bad chemical pneumonitis which is a kind of scarring or burning of the lungs which, obviously, would not be a good thing. That’s why fasting before surgery is always very crucial and can be a case to cancel a case, if it’s an elective case. Obviously, in emergency cases, we go to the O.R. and there are things that we do to try to prevent that aspiration as best as we can. But, that’s the reason for it.
Melanie: People, they hear the word general anesthesia they get concerned but for things such as a colonoscopy you guys call it “twilight”. Explain the differences between some of the different types of sedation that you use.
Dr. Chase: Sure. We call that a “twilight” or we would call that also a “MAC anesthetic”. MAC – which stands for monitored anesthesia care. Basically, the main difference there is that the patient is still going to be – we’re bringing them to the point where they’re still breathing on their own. They’re still able to maintain a lot of their normal respiratory physiology. So, they’re breathing on their own and we’re just supplementing some extra oxygen for them but their ability to remember and recall events is inhibited. They’re basically sleeping and comfortable. They’re still kind of breathing on their own and, if we need to, we can lighten it up quickly and they’ll respond to us if we need to ask them a question. That kind of thing. That’s actually a pretty fine art being able to do a good MAC case or a sedation twilight case like that. General anesthesia, like I mentioned is a deeper anesthetic where we are now controlling their breathing for them via an endotrachea tube and a ventilator.
Melanie: Why do you think people are so concerned about general anesthesia?
Dr. Chase: It all relates back to patient safety and really anesthesia is the practice of medicine that has invented--or at least really propagated--the idea of patient safety. Back in the 40’s and 50’s anesthesia was not as safe as it is today. There were probably around 70 cases of mortality out of 100,000 cases which doesn’t seem like a lot but that is a lot. Now, with the idea of monitoring that we use that came around in the 70’s and the 80’s which is mostly pulse oximetry and capnography, which monitors their CO2. General anesthesia has completely changed the ball game and is now, for relatively healthy patients, the mortality rate for general anesthesia is 0.4 out of 100,000 which is really, really excellent. Just because of that notion of the 40’s and 50’s when it wasn’t as safe – the monitoring techniques that were available, the technology wasn’t there yet. Now, since the 70’s and 80’s, it has completely changed and general anesthesia today is a very safe way to have surgery. Again, the key is each individual condition or medical history that each patient has, those bring separate risks and separate challenges to the anesthesiologist. General anesthesia in a healthy patient is very safe.
Melanie: In just the last few minutes, Dr. Chase, what should people considering a surgical procedure think about when seeking care?
Dr. Chase: What they should think about is, obviously, they have a lot to worry about. They are maybe they’re concerned about the procedure or if it’s going to go okay but they should realize that the anesthesiologist taking care of them is very well trained. They should know that they’re going to be in really good hands of somebody who has done extensive training in rendering patients unconscious and comfortable. If they have any questions, they should definitely feel very comfortable asking the anesthesiologist. That anesthesiologist is the person in the room during the case that really is going to be monitoring everything and making sure that the surgery can be performed as safely as possible.
Melanie:Why should they come to Temecula Valley Hospital for their care?
Dr. Chase Temecula Valley Hospital is a newer hospital here in this area and the physicians here are eager to provide excellent care. They require all of the physicians to be board certified in their specialties and it shows in the care and expertise that we bring here.
Melanie: That’s great information and so important for listeners to hear, Dr. Chase. Thank you so much for being with us today. You’re listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can go to TemeculaValleyHospital.Com. That’s TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
The Role of the Anesthesiologist
Melanie Cole (Host): When preparing for surgery, many patients think of the physician anesthesiologist as the person behind the mask who puts them to sleep and wakes them when it’s over. They may not realize the comprehensive medical care the physician anesthesiologists provide between those two points and beyond. My guest today is Dr. Jared Chase. He is an anesthesiologist and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Chase. Tell us: what is an anesthesiologist? What all encompasses what you do?
Dr. Jared Chase (Guest): Thank you, Melanie. I appreciate the opportunity to reach out to some listeners. Physician anesthesiologists, like you had mentioned, obviously it is a little more complex than just simply putting someone to sleep and waking them up. The training is four years of medical school along with four years of residency training. Essentially, I look at each individual patient as our job is similar to, you could say, an airline pilot in that we kind of sit in our cockpits and we’re monitoring all of the different physiologic parameters of each patient during the surgery. Basically, the medications that we use to allow the surgeon to operate kind of knock out all of the symptoms that typically keep that patient alive. Therefore, we are there monitoring all of those things and helping in managing all of those various physiologic processes in order to safely get them through that procedure that they’re having.
Melanie: It’s not only during surgery, though. You meet with patients beforehand and afterwards. Speak about the other roles that you have.
Dr. Chase: Exactly. That’s a very good point. The anesthesiologist today is more of a peri-operative position which basically includes, like you mentioned, the preoperative assessment. We meet with the patient beforehand, typically just right before surgery although there are also a lot of places that have pre-operative assessment clinics where an anesthesiologist may visit you a couple of weeks before. That’s where it’s extremely important for us to get a good understanding of the patient’s overall medical history as the medical history can affect a lot of different things during surgery. That’s the pre-operative assessment – usually just a few minutes. We ask some questions to get a good idea of where their baseline cardiac function might be, respiratory function might be. Then, from there, we obviously continue that care in the operating room. Then, even afterwards, like you mentioned, we continue to monitor the patient in the recovery room which is the PACU – the post anesthesia care unit – ensuring that their pain is controlled, nausea, any other side effects that might happen during surgery or after or due to the anesthesia. For some surgeries we may follow them for a few days while they’re still in the hospital.
Melanie: You’re also a physician and you’ve described all of your training. What else as far as chemistry, biology – because that’s where that I see that it’s such a complicated field that you’re in. It’s an amazing thing that you're able to do is to monitor all those things.
Dr. Chase: Exactly. In the operating room, I would say the key things that we are doing, the medications that we give that induce anesthesia also knock out your breathing; they kind of knock out your blood pressure a little bit to a degree; they knock out your body’s ability to regulate its own temperature. We monitor temperature. We’re monitoring your heart function. We’re monitoring your breathing--how much oxygen we’re delivering, how much carbon dioxide they’re expiring. We’re basically in charge of all of those parameters. We’re basically trying to maintain the physiologic balance which anesthesia actually causes an imbalance. We’re maintaining it by tweaking little things – giving a little medicine here to raise your blood pressure or tweaking the respiratory rate to change the amount of carbon dioxide that is being expelled and just trying to maintain that homeostasis throughout surgery.
Melanie: Why do people need to have an empty stomach prior to surgery, Dr. Chase?
Dr. Chase:That’s a very common question. It’s a very good question. They key there is that when we administer the medications to the patient that renders them unconscious - which is going to sleep – it also relaxes your lower sphincter in the esophagus. If there were food in there, that food could easily come up and the patient could then aspirate, which means that the food could go into their trachea and into their lungs which could cause a really devastating pneumonia or a bad chemical pneumonitis which is a kind of scarring or burning of the lungs which, obviously, would not be a good thing. That’s why fasting before surgery is always very crucial and can be a case to cancel a case, if it’s an elective case. Obviously, in emergency cases, we go to the O.R. and there are things that we do to try to prevent that aspiration as best as we can. But, that’s the reason for it.
Melanie: People, they hear the word general anesthesia they get concerned but for things such as a colonoscopy you guys call it “twilight”. Explain the differences between some of the different types of sedation that you use.
Dr. Chase: Sure. We call that a “twilight” or we would call that also a “MAC anesthetic”. MAC – which stands for monitored anesthesia care. Basically, the main difference there is that the patient is still going to be – we’re bringing them to the point where they’re still breathing on their own. They’re still able to maintain a lot of their normal respiratory physiology. So, they’re breathing on their own and we’re just supplementing some extra oxygen for them but their ability to remember and recall events is inhibited. They’re basically sleeping and comfortable. They’re still kind of breathing on their own and, if we need to, we can lighten it up quickly and they’ll respond to us if we need to ask them a question. That kind of thing. That’s actually a pretty fine art being able to do a good MAC case or a sedation twilight case like that. General anesthesia, like I mentioned is a deeper anesthetic where we are now controlling their breathing for them via an endotrachea tube and a ventilator.
Melanie: Why do you think people are so concerned about general anesthesia?
Dr. Chase: It all relates back to patient safety and really anesthesia is the practice of medicine that has invented--or at least really propagated--the idea of patient safety. Back in the 40’s and 50’s anesthesia was not as safe as it is today. There were probably around 70 cases of mortality out of 100,000 cases which doesn’t seem like a lot but that is a lot. Now, with the idea of monitoring that we use that came around in the 70’s and the 80’s which is mostly pulse oximetry and capnography, which monitors their CO2. General anesthesia has completely changed the ball game and is now, for relatively healthy patients, the mortality rate for general anesthesia is 0.4 out of 100,000 which is really, really excellent. Just because of that notion of the 40’s and 50’s when it wasn’t as safe – the monitoring techniques that were available, the technology wasn’t there yet. Now, since the 70’s and 80’s, it has completely changed and general anesthesia today is a very safe way to have surgery. Again, the key is each individual condition or medical history that each patient has, those bring separate risks and separate challenges to the anesthesiologist. General anesthesia in a healthy patient is very safe.
Melanie: In just the last few minutes, Dr. Chase, what should people considering a surgical procedure think about when seeking care?
Dr. Chase: What they should think about is, obviously, they have a lot to worry about. They are maybe they’re concerned about the procedure or if it’s going to go okay but they should realize that the anesthesiologist taking care of them is very well trained. They should know that they’re going to be in really good hands of somebody who has done extensive training in rendering patients unconscious and comfortable. If they have any questions, they should definitely feel very comfortable asking the anesthesiologist. That anesthesiologist is the person in the room during the case that really is going to be monitoring everything and making sure that the surgery can be performed as safely as possible.
Melanie:Why should they come to Temecula Valley Hospital for their care?
Dr. Chase Temecula Valley Hospital is a newer hospital here in this area and the physicians here are eager to provide excellent care. They require all of the physicians to be board certified in their specialties and it shows in the care and expertise that we bring here.
Melanie: That’s great information and so important for listeners to hear, Dr. Chase. Thank you so much for being with us today. You’re listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can go to TemeculaValleyHospital.Com. That’s TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.