The specialty of Anaesthesia is sometimes indicated as a ‘’Divine Specialty’’. This is because in Genesis during creation’ God gave the first anaesthetic and I quote ‘And the Lord God caused a deep sleep to fall upon Adam, and he slept and took one of his ribs and closed up the space with flesh thereof; The rib which the Lord God had taken from man, made he the woman and brought her unto the man’’ (Genesis 2:21-22).
This story illustrates the close link between surgery and anaesthesia from the creation story, a story that is sometimes lost in meaning, a story of kindness, humility, understanding and empathy.
Modern day anaesthesia is said to have started on Friday 16th October 1846, when a Boston dentist William Thomas Green Morton (1819–1868) successfully demonstrated publicly the anaesthetic properties of ether (diethyl ether). This took place in the Bullfinch operating theatre of the Massachusetts General Hospital, USA, in front of an invited audience. Before these patients were made insensible using alcohol like whisky or patients were held tightly down as surgery was done. Anaesthesia has evolved remarkably into a very scientific specialty over the last 150 or so years.
Anaesthesia is therefore a term meaning the entire loss or partial loss of sensation or feeling of part of the body or a general state of insensibility or unconsciousness applied for medical purposes especially to a patient having a surgery or procedure. Anaesthesia is a way to controlling sensation including pain during a surgery or procedure by using various medications including those that primarily induce anaesthesia called anaesthetics. The anaesthetic procedure may involve the control the patient’s breathing, blood pressure, blood flow, and heart rate and rhythm. Anaesthesia may be used to make one sleepy or forgetful, unconscious, block pain and paralyse the muscles for surgery.
Besides general anaesthesia, other forms of anaesthesia may provide only light sedation or use injections to numb only a small area (local anaesthesia) or a larger region (regional anaesthesia) of your body.
The Physician Anaesthetist is said to be a physician trained in anaesthesia and perioperative medicine, which is management of patients before, during and after surgery. Pre-surgery clinics, also called ‘preoperative clinics’ have helped to prepare patients for surgery, reduced cancellation of cases, modified patient drug therapy, discovered diseases the patient may have and counselled patients when patients were confused or distressed because of scheduled surgery
Unfortunately, there is inadequate knowledge of the scope of the specialty, as well as the pivotal role anaesthetists play in the healthcare delivery system by the public, healthcare professionals and policy makers.
The field of anaesthesia has changed over the years and the function of the physician anaesthetist is not just to put people to sleep for surgery. With the extensive scientific knowledge that is imbibed during their long years of training physician anaesthetists are equipped to deliver excellent management of perioperative patients, the critically ill requiring Intensive Care and offer pain management services.
After qualifying as medical doctors and having undergone the two-year internship, physician anaesthetists undergo several years of training in the field of anaesthesia: Three years (3) to become a Specialist and five (5) years to become Senior Specialist. A further 1-2 years are required after being a senior specialist to sub-specialise and become an expert in one of the branches of anaesthesia (obstetric anaesthesia, neuro-anaesthesia, paediatric anaesthesia, cardio-thoracic anaesthesia, regional anaesthesia and interventional pain management among others)
This extensive training of the physician anaesthetist gives the anaesthetist an extensive knowledge of the workings of the body, the diseases that affect the body, the drugs that are used to treat these conditions and to safely give anaesthesia for adults, children, pregnant women, patients with severe co-morbid conditions and for specialised surgeries. A few pictures below show how physician anaesthetists help surgeons to perform very difficult and previously unheard of surgeries in the country. The pictures below show how anaesthesia has allowed heart surgery (upper left), liver surgery (upper right) and surgery for patients who do not want to be transfused (Jehovah’s Witnesses-lower left).
The lower right picture shows Dr P. degraft-Johnson a Senior Specialist in Anaesthetist trained in pain medicine performing a pain procedure in a patient with a complex regional pain syndrome. Advances in x-ray technology and other imaging technology like ultrasound – which allow pictures of the inside of the body to be taken and viewed easily, have made anaesthetists pacesetters in the management of patients with severe pain when other management modalities have failed. Pain clinics are now run weekly in the Korle-bu Teaching Hospital and the Komfo Anokye Teaching Hospitals. With the training of more pain specialists, more pain clinics are expected to be opened in other areas of the country.
The current Covid-19 pandemic has revealed a huge gap in the ability of most hospitals to manage seriously ill patients. The management of severely ill patients who need their chest, heart, kidneys and other organ support require physician anaesthetists (sometimes called intensivists). Treatment of severely ill Covid-19 patients were spearheaded by physician anaesthetists in in the treatment centres. These interventions reduced the number of patients who would have died from the pandemic. These specialists also helped to develop treatment guidelines for severely ill Covid-19 patients and patients with other severe illness who need admission to intensive care units. Policy makers have to accelerate the training of these physician anaesthetists and intensive care specialists to cover the numerous intensive care units that are being rapidly established around the country.
The increase in the intensivists should be associated with a proportionate increase in the number of critical care nurses whose work will complement the work of these specialists. The specialists should also be involved with the setting up and implementation of guidelines of the intensive care units in the country.
Physician Anaesthetists are also involved with teaching and training of medical students to be doctors, in the teaching hospitals and universities throughout the country. Teaching of cardiopulmonary resuscitation (CPR) is a basic tenet of anaesthesia training. Members of the fraternity have been training nurses, anaesthesia technicians and the general public how to bring back to life people who collapse anywhere in our cities, towns and villages.
As of February 2020, there were 32 Senior Specialist/Consultants, 59 specialist anaesthetists and over 40 diplomates in the specialty. This is a remarkable improvement if these numbers are compared to what they were a few years ago. The current residents in training are over 60 in number and these are all potential pacesetters in the specialty.
The career opportunities are upbeat and with the current training programmes from the Ghana College of Physicians and Surgeons, and the West African College of Surgeons, more doctors are being encouraged into the specialty. The Modular Diploma in Anaesthesia as well as the envisaged Modular Membership programmes signify the importance we attach to providing high quality professionals needed to improve the delivery of anaesthesia services in all the regional and district hospitals in the country.
The Physician Anaesthetist has a major role to play in the management of patients outside the theatre. This role is expected to increase as more physician anaesthetists are trained in the various subspecialties of the profession. The Covid-19 pandemic has showcased the importance of physician anaesthetists in the provision of a high quality and holistic healthcare especially in the management of the severely ill. Anaesthesia should more correctly be considered as peri-operative medicine and the possibilities of carving out a niche in the field are endless.
On this important day ‘16th October 2020 –World Anaesthesia Day’, we commend all physician anaesthetists for the great work they are doing and urge them to continue to improve the standards of anaesthesia in Ghana even more.
By Prof Ernest Aniteye,
University of Ghana Medical School & Korle-Bu Teaching Hospital,
Ghana Anaesthesia Society.
Dr Robert Djagbletey
Interventional Pain and Regional Anaesthesia Specialist,
University of Ghana Medical School &Korle-Bu Teaching Hospital