Situational Awareness

When people find out what I do for a living, I usually get one of two responses. Firstly, someone will always tell me a story of how their friend/relative had an operation and the anaesthetist’s bill was so high, yadda yadda etc etc. The second response is usually, “so are you there the whole time while the patient is asleep?”

This represents an indictment on our discipline. Not that we are bad doctors (for the most part) but that we are bad at letting people know what it is that we do. Some folks don’t even think that we are doctors. (we are, by the way. I have 10years training). The analogy I use to illustrate what it is we do, is to think of the anaesthesiologist as an airline pilot. We get very busy at the beginning and the end of a case, don’t do too much in the middle, but if something goes pear-shaped, you’d better hope you have a good one.

To be honest, 99.9% of the time, nothing happens. The patient goes to sleep uneventfully, and wakes up comfortably, and in-between we maintain a state of alertness, which I term “situational awareness” (also borrowed from the aviation industry). I never leave theatre while my patient is under anaesthetic. I don’t necessarily always look at the monitors, but I know that I can detect the slightest change in parameters. A study done in specialist anaesthesiologists demonstrated that we can detect, using our ears, a 3 beat/minute change in heart rate without looking at the monitor. I pay attention to what the surgeon is doing (making sure he isn’t trying to operate my patient to death!), monitor perfusion of the extremities by periodically laying a hand on a limb, and even, occasionally have a peek at the Sudoku.

Yes, anaesthesiologists do sometimes do mundane things like reading or Sudoku in theatre. The point is, that we don’t let these interfere with our situational awareness. The good anaesthesiologist is the super calm chap sitting quietly in the corner with half an eye on the goings on in theatre at all times. The best anaesthetists I know, are those who can do this. Then, if anything does go wrong, they move. Quickly. With purpose, and calmly. The anaesthesiologist should be the last person in theatre who panics. I have seen registrars (trainees)who panic when things go wrong. They are then in trouble, because if they lose the plot, they aren’t thinking, and then someone is going to have a poor outcome.

So the response to the first comment people make is, in fact the same as the response to the second one. The reason we are expensive (and I know some guys billing takes the piss) is because you are paying for that level of skill and training. You should hope your anaesthesiologist never needs to use the full level of their skills.