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 when he was admitted to NIMS for a minor ankle problem. Raghavendra Rao slipped into coma and finally death after he was administered anaesthesia for a simple surgical procedure. Though Raghavendra Rao is an extremely rare case study for doctors, the incident has nevertheless raised several issues including the expertise of our anaesthetists and how well 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 patient in what has become the first known case of surgery without pain (an, without; aesthesia, sensation), city doctors emphasise the importance of quality training for anaesthetists and updation of knowledge and skills at regular intervals. In memory of Morton’s assistance 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 most important persons in any surgical team. Often the role of an anaesthetist becomes more important than that of a surgeon. It is no wonder then that after Raghavendra Rao’s sad episode, many patients are insisting on well-qualified and well-trained anaesthetists to be 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 during recovery 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 pain after surgery”.
Dr Somasekhar however argues that with modern equipment and anaesthetic drugs, especially the regional anaesthetic techniques, have cut down complications associated with anaesthesia.
The State, for that matter the country, has an acute shortage of well-trained and well-qualified anaesthetists. The shortage is such acute that an anaesthetist has to often run across hospitals to administer anaesthesia to surgical patients. This leaves a little time for the anaesthetist to tend more time to any of his patients. Lack of proper monitoring of patients post surgery often leads to severe complications associated with 
anaesthesia.
As Dr Ratnam Naidu, consultant anaesthetist of Apollo Hospitals, says an anaesthetist has a “significant role in defining the patient care” in terms of pre-operative assessment peri-operative and post-operative management.
The role of an anaesthetist is not restricted to operating rooms any more. “His services are important in emergency rooms to cath labs. Anaesthetists play significant role in pain management in cancer wards and in Obstetrics wards too,” he clarifies.
But what becomes important for an anaesthetist is “better understanding of patho-physiology of disease process, fluid and blood transfusion therapy”, as Dr Ratnam says. He, however, does not want to attribute anaesthesia complications to doctors. “Unsuccessful outcomes do occur, not due to negligence, but due to expected risk of anaesthesia 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 is the 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 and brain. “It’s a double edged sword, to be used very cautiously by an anaesthetist,” cautions Dr Aftab.

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Anaesthesia complications
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Serious complications associated with anaesthesia are generally rare, though often they may lead to even death. Doctors classify complications as normal, rare and extremely rare. It is the extremely rare complications that create major trouble to patients as well 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


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Types of anaesthesia
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Anaesthesia is generally of three types. A qualified anaesthetist decides which type of  anaesthesia should be administered to the patient concerned. A lot of thought and consultation with physician and surgeon goes before the anaesthesia is administered. The physician certifies whether a patient is fit for surgery. He also writes a note of caution 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 needs external breathing support. It is used in major surgeries.
2. Regional anaesthesia: A large part of the body is made senseless in regional anaesthesia.
3. Local anaesthesia: Only a smaller area is covered under local anaesthesia. Broadly speaking, local and regional anaesthesia do not cause any major complications.