I am a medical doctor (Consultant Anaesthetist) with 18 years experience in the NHS. I currently specialise in providing anaesthesia for Hepato-pancreato-biliary (liver, pancreas and bile duct) procedures and Liver transplantation. I also have a specialist interest in perioperative transoesophageal echocardiography. In my current post, I am part of a cohesive team of highly skilled multidisciplinary clinicians, forming the largest liver transplant unit in Europe. Hepato-pancreato-biliary anaesthesia comprises 30 per cent of the work that I undertake. The remaining 70 per cent is split across many different specialties. My other anaesthetic interests are anaesthesia for Vascular, Renal, General, Urological, ENT and Emergency surgery, amongst many.
Anaesthetists form the largest specialty group of doctors in NHS hospitals. As an Anaesthetist, I am extensively educated in human physiology (how the human body works in health and disease), pharmacology (how drugs work), anatomy and physics. We have to know about everything from cellular respiration, to how our drugs work, to all of the internal workings of the human body to the workings of medical machinery. We are trained in the use of some of the most sophisticated monitoring equipment in medicine today. Many modern surgical techniques would not be possible without the anaesthetic knowledge, drugs, techniques and the equipment that anaesthetists use today.
Much of what we study as anaesthetists is a key component of the scientific basis of medicine. As an anaesthetist, we have to thoroughly understand the physiology of all the organ systems of the body (the heart, lungs, nervous system, endocrine system to name a few), in greater depth than most. We also have to understand how all medicines that people take work and affect the human body. This puts me in a unique position to treat people.
Throughout our training, we are extensively trained in:
- 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.
Anaesthetists must retain a breadth of general medical knowledge, as we have to manage and optimise people’s current medical problems to get them safely through surgery. This is achieved by tailoring every anaesthetic to each individual, their illnesses and the surgery that they are about to undergo. Anaesthetists are the largest body of hospital doctors and are amongst the most skilled doctors in the hospital. Anaesthesia is a very safety-oriented specialty; we’ve led the way in reducing patient harm by looking at human factors, using simulation training and developing reporting systems to analyse “near misses”.
Preoperative optimisation prior to surgery
You may feel that you have little or no control over what’s going to happen to you during and after an operation. While there are certain aspects that you cannot control, there are many things that you can do to improve your outcome and lower the risks of surgery.
Having surgery is a very important moment in your life and it is quite normal to feel anxious about it, especially if the surgery is major. Your general level of fitness has a huge impact on your outcome following surgery. The fitter you are, the less likely you are to suffer serious complications from your surgery. Fitter patients also recover more quickly from surgery. Your heart and lungs have to work harder after an operation to help the body to heal. If you are already fit and active, they will be used to this. It would be helpful if you can try and increase your activity levels while you are waiting for your operation. What you do now can have a really big impact on your recovery.
Diet and weight management
Your body needs to repair itself after surgery – eating a healthy diet before and after your surgery, to provide your body with the right fuel to heal, can be really helpful. Many cancer patients have lost weight prior to surgery. Malnutrition is a modifiable risk factor for surgery. Malnutrition can:
- Decreased immune function
- Delayed wound healing
- Organ dysfunction
- Prolonged hospital stay
- Greater risk of readmission following discharge
- Greater risk of complications
If you are overweight, losing weight can help reduce complications following surgery. In addition it can help to:
- lower your blood pressure
- improve your blood sugar control
- help improve your mobility before and after surgery
- reduce your risk of blood clots after surgery
- reduce your risk of wound infections after surgery
- allow you to exercise more easily before surgery, in order to get fitter.
Pre-existing medical conditions
How well controlled your chronic health conditions are, majorly influence outcome follow surgery. It is the job of the anaesthetist to assess your fitness for surgery and how well controlled your medical conditions are prior to surgery. It is also part of our job to minimise the effect of any medical conditions during and after the surgery itself (e.g. controlling your blood sugar within a specific range during and after surgery if you are diabetic, maintaining your blood pressure and heart rate during surgery if you have heart disease and minimizing the body’s stress response to surgery afterwards.
- Provide a thorough Pre Assessment service prior to your operation.
- Help improve your fitness prior to surgery
- Help improve your nutritional status and weight management before surgery
- Help optimise your pre-existing medical conditions to give you the best chance for your pending operation.
I enjoy the aspect of my job that allows me to look after one patient at a time and it is this ability to offer a premium level of care why I became an anaesthetist in the first place. Already having a deep understanding of the interconnected nature of the human body and how medications act on the body, is also part of the reason behind developing an interest in Functional Medicine.