Dearth of anaesthetists: A matter to ponder upon, says Dr Mirza Ali Azhar

By Azizullah Sharif

A normal body has 1 litre of oxygen, 250 ml of which is consumed per minute so the total reserve of oxygen is only three minutes. It means if a person did not get oxygen for three minutes, he/she might expire

‘It is mandatory upon anaesthetists to remain present until patients regain consciousness’



IRONICALLY, there are only around 1,250 anaesthetists in Pakistan as against its actual requirement of 20,000 and as such the existing huge gap was being filled by unqualified anaesthesists.

This was stated by prominent anesthetist Dr Mirza Ali Azhar during an interview with the Medical News.

Elaborating on the subject of anaesthesia and its importance, Dr Ali Azhar, who is also secretary general of Pakistan Medical Association (PMA-Central), admitted that there is a dearth of anaesthetists across the country.

“On the one hand, the number of anaesthetists being trained in the country is much less than its requirement and, on the other hand, some of the anaesthetists had gone abroad either due to security reasons or financial aspects or for a better quality of life. 

Asked if all hospitals of Karachi (both public and private) are equipped with anaesthesia machines and monitors, he said that though about 80 per cent of the city’s hospitals are equipped with anaesthesia machines, some of them did not have Intensive Care Units (ICU) or proper recovery rooms. About the hospitals which are not equipped with anaesthesia machines and monitors, he said in such hospitals, anaesthetists carry their portable anaesthesia machines which are, of course, not up to the mark.

To a question, he said that surgeons won’t gear up for surgeries as long as they get green signal from the anaesthetist concerned.

To another query whether it is obligatory upon anaesthetists to remain at the health facilities as long as the patients to whom they administer anaesthesia gain consciousness after their surgeries, he replied in the `affirmative’, saying “it is, definitely, mandatory under the anaesthesia protocols. However, in the case of open heart surgeries and other surgeries requiring longer duration, heavy dose of anaesthesiais given, though not in one go, and hence such patients are normally visited by anaesthetists the next morning.

Talking about balanced technique of general anaesthesia (GA), DrMirza Ali said thatit includes making a patient unconscious, pain free and relaxation of body muscles.

LAUGHING GAS: About the nitrous oxide (N2O), he said that it is also commonly known as `laughing gas’ due to euphoric effects of inhaling it and as such itis used in surgery and dentistry for its anaestheticand analgesic effects.

“In fact, anaesthesia is a way to control pain during a surgery or procedure by using medicine called anesthetics. It can help control your breathing,blood pressure, blood flow, and heart rate and rhythm,” he said, adding anesthesia may be used to make you unconscious for your surgery, block pain and make sleepy or forgetful. Other medicines may be used along with anaesthesia, such as ones to help you relax or to reverse the effects of anaesthesia and as pre-medication, medicines are given to relieve anxiety and stress.

Types of anesthesia:

Local anesthesia numbs a small part of the body for minor procedures. For example, you may get a shot of medicine directly into the surgical area to block pain. You may stay awake during the procedure.
Regional anesthesia blocks pain to a larger part of your body. You may also get medicine to help you relax or sleep. Types of regional anesthesia include:
Peripheral nerve blocks. This is a shot of anesthetic to block pain around a specific nerve or group of nerves. Blocks are often used for procedures on the hands, arms, feet, legs, or face.
Epidural & spinal anesthesia. This is a shot of anesthetic near the spinal cord and the nerves that connect to it. It blocks pain from an entire region of the body, such as the belly, hips, or legs.
General anesthesia (GA) affects your brain and the rest of your body. You may get some anesthetics through a vein (intravenously, or IV), and you may breathe in some anesthetics. With general anesthesia, you're unconscious and you don't feel pain during the surgery.

While administering anaesthesia, Dr Mirza Ali explained, the anaesthetist has to maintain airway - the passage through which air enters and leaves the body-, pulse and vital organs has to be maintained. In this regard, he informed that a normal body has 1 (one) litre of oxygen, 250 ml of which is consumed per minute so the total reserve of oxygen is only three minutes and it means that if a person did not get oxygen for three minutes, he/she might expire.

What do Anaesthetists do?



Anaesthetists form the largest single hospital medical specialty and their skills are used in all aspects of patient care. Whilst the perioperative anaesthetic care of the surgical patient is the core of specialty work (and this includes all types of surgery from simple body surface surgery in adults to the most complex surgery in patients of all ages, including the premature (newborn) many anaesthetists have a much wider scope of practice which may include:

The preoperative preparation of surgical patients
The resuscitation and stabilisation of patients in the Emergency Department
Pain relief in labour and obstetric anaesthesia
Intensive care medicine
Transport of acutely ill and injured patients
Pre-hospital emergency care
Pain medicine including
The relief of post-operative pain
Acute pain medicine and the management of acute teams
Chronic and cancer pain management
The provision of sedation and anaesthesia for patients undergoing various procedures outside the operating theatre. Examples of this include different endoscopic procedures, interventional radiology and dental surgery.
What happens while you're under anesthesia and when you recover?

When the procedure is complete, you will stop getting the medicine. How quickly the anesthesia wears off depends on the anesthetics and other medicines used and on your response to the medicines.

After surgery, patients are taken to the recovery room. A nurse checks their vital signs and any bandages and ask about how much pain they have and if they are in pain, they should not hesitate to say so.

Some effects of anesthesia may last for many hours after surgery.

You may have some numbness or less feeling in part of your body if you had local or regional anesthesia.
Your muscle control and coordination may be affected.
You may have nausea and vomiting. Most of the time, this can be treated and doesn't last long.
You may feel cold and may shiver when you first wake up.
For minor surgeries, you may go home the same day. If surgery is more complicated, you may have to move to a hospital room to continue your recovery.

Divulging into details of the risks and complications of anesthesia, Dr Mirza Ali said major side effects and other problems of anesthesia are not common, especially in people who are in good health.

However, all anesthesia has some risk. For instance, after general anesthesia heart problems, pneumonia, sore throat, orvomiting might occur.

Besides, with high doses of local anesthesia, the anesthetic can go into the rest of the body and affect the patient’s brain or heart.

After spinal anesthesia some people get headaches.
Your risk depends on the type of anesthesia you get, your age, your health, and how you respond to the medicines used. Some health problems, such as heart or lung disease, increase your chances of problems from anesthesia. Taking certain medicines, smoking, drinking alcohol, and using illegal drugs can also increase your chance of problems, he warned.

What happens while you're under anesthesia and when you recover?

Before and during surgery, an anesthesia specialist will take charge of your comfort and safety. He or she will give you the anesthesia and closely monitor you. This means he or she will check your blood pressure, breathing, heart rate, and other vital body functions throughout the surgery. During surgery, the anesthesia specialist also will continue to give anesthesia to keep you free of pain.