“Anesthesiology is so much more than just putting people to sleep,” says Stanley H. Rosenbaum, MD, director of Yale Medicine Perioperative & Adult Anesthesiology. It also includes traditional intraoperative care, as well as such subspecialties as chronic pain management and critical care.
Yale Medicine takes a unique approach to critical care anesthesiology due to the breadth and depth of experience that anesthesiologists take into the intensive care unit.
What kinds of patients do critical care anesthesiologists treat?
Critical care anesthesiologists care for patients who have had recent major surgery or who suffer from the effects of severe infections or trauma. “I would describe them as all the varied types of surgical and postoperative patients,” says Dr. Rosenbaum.
At Yale Medicine such patients may be admitted into these intensive care units (ICUs):
Cardiac Surgical ICU: Provides care for postoperative cardiac surgical patients (for example, patients who have undergone valve surgery or coronary bypass surgery).
General Surgical ICU: Provides care for postoperative general surgical patients (for example, patients with severe trauma, and patients who have undergone major chest, abdominal or orthopedic surgery).
How does critical care anesthesiology work?
“Anesthesiologists may work in intensive care units as intensivists, which are critical care doctors,” Dr. Rosenbaum says, adding that they manage treatment and coordinate with other specialists to deliver the full range of care.
A patient can expect to have the critical care anesthesiologist and the full ICU team (usually consisting of an advanced training fellow and several residents) round daily—often combined with visits by the patient’s surgical team.
After the initial morning visits, the critical care anesthesiologist will continue to check on the patient multiple times throughout the day, with continuing care by the team of critical care doctors in the ICU through the night.
“There is almost always a physician within 100 feet,” Dr. Rosenbaum says. Many patients tend to be discharged from the ICU after a few days, but some may stay for as long as several months.
What standard care protocols do critical care anesthesiologists follow?
Patients admitted to the ICU will typically have an intravenous (I.V.) line with saline solution connected to them so that they stay hydrated. Patients are also fitted with devices that continuously monitor such standard vital signs as:
- Electrical activity of the heart (electrocardiogram monitoring)
- Blood oxygen saturation (pulse oximeter monitoring)
- Blood pressure
- Respiratory rate
- Heart rate
The critical care anesthesiologist, in combination with the ICU nurse, follows these readings closely. The patients in the ICU usually have complex problems requiring various medications administered via the I.V.
For example, a patient with an infection will be given antibiotics, a patient with kidney problems may be connected to a dialysis machine, and a patient with lung problems may have breathing supported by a ventilator.
What major decisions can a patient expect to make when admitted to the ICU?
Before surgeries that require an anesthetic, the patient undergoes a diagnostic assessment to determine his or her ability to survive the stress of the surgery and anesthesia. There is also a discussion of the surgical and anesthetic plans. In the ICU, the patient (and often the family) may expect a conversation on end-of-life questions if the physician determines that:
- The patient is critically ill and dying or close to death.
- It is likely that the patient may have to be resuscitated.
- The patient can live, but only aided by machines and with great suffering.
If the patient is unable to make those decisions, a proxy (usually a family member) may act as a substitute. “It’s a very difficult conversation,” Dr. Rosenbaum says. While this conversation is usually initiated by someone from the ICU team, it is almost always a combined discussion with the patient’s surgeons and possibly other physicians participating.
How do critical care anesthesiologists work with doctors across disciplines?
Critical care anesthesiologists supervise, coordinate, and manage the patient’s care with the ICU team and work closely with the surgeons and other specialty consultants as needed.
Critical care anesthesiologists often serve as mediators between surgeons and other physicians, making sure that the entire team is working together effectively and for the same purpose, Dr. Rosenbaum says. The medical team—including the critical care physician, surgeons, consultants and nurses—typically have a daily conference on the patient’s condition.
How is Yale Medicine’s approach to critical care anesthesiology unique?
Yale Medicine’s approach to critical care anesthesiology is unique in the breadth and depth of experience that anesthesiologists take into the ICU. Yale Medicine Anesthesiology is a national leader in academics as well as clinical anesthesiology and resident education. This year, we will deliver approximately 52,000 anesthetics in more than 80 clinical locations where we ensure our patients receive state-of-the-art care.