Career in Anaesthesia

INTRODUCTION

• Do you want an exciting and rewarding career? Do you enjoy working as part of a team?

• Are you able to work well under pressure?

• Do you want to be part of the single largest hospital speciality?

If your answer is yes, then read on and discover the benefits of a career in anaesthesia.

How much do you know about anaesthesia? Unless you have spent time with anaesthetists, it is unlikely that you are aware of the scope of this speciality. Since the mid-nineteenth century anaesthesia has developed to revolutionise the way in which surgery is practised. Every surgical advance has been mirrored by accompanying advances in anaesthesia.

WHERE CAN YOU FIND AN ANAESTHETIST?

The obvious place to look is the operating theatre but the perioperative care of patients by anaesthetists does not begin or end there. You will also find anaesthetists on wards and in clinics where they have a key role in the preparation of patients for surgery and the instigation of postoperative management. The anaesthetist also takes the lead in acute and chronic pain services, provides obstetric analgesia and anaesthesia and has a pivotal role in the provision of intensive care medicine, resuscitation and management of trauma. 
Anaesthetists play a big role in teaching and are instructors on courses such as ATLS, ALS and APLS, and are increasingly involved in simulator training.

ANAESTHESIA IS A SUPRA-SPECIALITY

One of the best things about a career in anaesthesia is the fact that there really is something for everyone. These sub-specialities not only follow surgical ones (e.g. paediatrics, obstetrics, cardiac surgery, neurosurgery) but many have evolved in their own right. Anaesthetists are a multi-talented group and they have many skills which can be applied in different areas.

ANAESTHESIA AND PERIOPERATIVE MEDICINE

Anaesthetists act as peri-operative physicians for surgical patients. This role starts with the pre-operative assessment which usually takes place on the ward. The anaesthetist must decide if the patient is fit for anaesthesia and surgery. Some patients require further investigation and treatment to get them into optimum condition before major operations, and anaesthetists are best placed to initiate this process. The pre-operative assessment enables the anaesthetist to establish a rapport with the patient which helps to relieve anxiety and is a good time to discuss post-operative pain relief. Safety is a watchword in anaesthesia and this means that, before anaesthesia is induced, the anaesthetist must check that the equipment is working properly and then prepare all the drugs that may be necessary. Once the patient reaches theatre, the anaesthetist tailors the anaesthetic to each patient’s needs. 

After anaesthesia is induced, the anaesthetist becomes the guardian of the patient. The control of the patient’s airway, breathing and circulation are of particular importance. Close attention is paid to the patient’s condition during surgery and the 
anaesthetist responds quickly if any problems arise. At the end of the procedure, the anaesthetist is responsible for ensuring full recovery from anaesthesia in a safe environment for the patient as well as establishing good pain relief.

Not all patients need to have a general anaesthetic for their operation and anaesthetists are skilled at providing regional anaesthesia, where only specified parts of the patient are anaesthetised. This may be important for patients who are considered high risk for general anaesthesia or who make a specific request. These techniques can also be used to provide postoperative analgesia and may be used alongside general anaesthesia. The anaesthetist plays a key role in the team caring for the patient in the perioperative period and this involves working closely with surgical and nursing staff.

INTENSIVE CARE MEDICINE

Most intensive care doctors (93%) have an anaesthetic background. This is because intensive care developed around the long term artificial support of the respiratory system. Anaesthetists have a detailed knowledge of respiratory and other physiology, as well as pharmacology and monitoring techniques. This knowledge was put to good use as intensive care developed and methods of supporting other systems evolved. Today, there are many avenues through which intensive care medicine can be approached but medical and anaesthetic skills are essential. Anaesthesia is the only speciality where experience in intensive care is an essential part of basic training. As a trainee in anaesthesia, you will develop skills in the management of profoundly ill patients in intensive care as part of the curriculum from the first year of training, and throughout the training programme.

RESUSCITATION AND TRAUMA MANAGEMENT

Anaesthetists are core members of major trauma teams and much oftheir on-call commitment involves initial resuscitation of trauma victims in A & E followed by safe transfer to theatre before starting anaesthesia and peri-operative care. In addition, anaesthetists are involved in the transfer of critically ill patients over long distances by land and air, very often being the only medical personnel present during the transfer.

The skills and experience of anaesthetists makes them eminently suitable to offer medical cover at sporting events eg. motor racing. Here anaesthetists can get a chance to meet and work with others from a wide variety of backgrounds.

OBSTETRICS

Analgesia 
Medical management of high risk patients 
Lead in obstetric HDU care

About 60% of women giving birth are likely to come into contact with an anaesthetist in some capacity. Anaesthetists see patients in antenatal assessment clinics where methods of pain relief, anticipated anaesthetic problems or special analgesic requirements can be discussed. 
Anaesthetists provide analgesia for labour, often in the form of epidurals, as well as anaesthesia for surgical procedures. Mortality and morbidity statistics clearly demonstrate that the presence of anaesthetic support on the delivery suite has been accompanied by a reduction in perinatal disasters. 
In addition, obstetric anaesthetists play a leading role in the development of obstetric high dependency units.

PAIN MANAGEMENT

Acute 

A working party in 1990 revealed that postoperative pain was being very poorly dealt with. This led to the establishment of acute pain teams, headed by anaesthetists. With adequate resources, anaesthetists have the skills to provide excellent quality postoperative analgesia, using epidural and other techniques. Increased awareness of what we have to offer has led to the application of these techniques to other acute pain situations such as trauma.

Chronic

Chronic pain conditions affect a large number of people and there is a great demand for pain management services. Anaesthetists are ideally suited to this relatively new and evolving specialty. Most anaesthetists with an interest in chronic pain have outpatient consultation sessions and theatre treatment sessions. They are experts in invasive treatment techniques like nerve blocks, injection procedures and, in some centres, implantation of pain relieving devices. In addition, anaesthetists play a central role in multidisciplinary pain management programmes.

TRAINING

The training programme in Ireland is Training is regulated by the College of Anaesthetists RCSI.

The programme has a minimum duration of 7 years. During the initial 4 years, the training will be highly structured and rather prescriptive to enable the SHO to gain basic knowledge and skills, and to ensure that SpRs 1 / 2 are exposed to a broad range of anaesthetic practice within the major sub-specialties

At least 2 years will be spent as an SHO, including 3 months training in Intensive Care Medicine. An initial assessment of competency occurs after 3 – 6 months to allow working without direct clinical supervision. To enter the SpR grade the SHO must have passed 10 workplace assessments, demonstrated acceptable attitudes and behaviour, passed the Primary FRCA or equivalent and obtained the SHO Training Certificate.

The SpR training consists of 5 years. Year 1 and 2 can only be completed in Ireland or the UK and the trainee must have passed the required workplace assessments, the Final FRCA or equivalent and been issued with the SpR 1 / 2 Training Certificate in order to progress to year 3.

The final 3 years are more flexible to accommodate special interests which will prepare the trainee for the consultant post. Satisfactory completion of training culminates in the award of a Certificate of Completion of Specialist Training (CCST) which is recognised across Europe.

USEFUL CONTACTS

The College of Anaesthetists RSCI 
Merrion Square, Dublin 2, Ireland 
Website: http://www.coairl.org/

Anaesthetists in Training in Ireland 
PO Box 6526, Dublin 4. 
Website: http://www.anaesthetics.org/

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) 
21 Portland Place, London W1B 1PY. 
Tel: 020 7631 1650. 
Fax: 020 7631 4352. 
Email: infoaagbi.org 
Website: http://www.aagbi.org/

Group of Anaesthetists in Training (GAT) 
The Association of Anaesthetists of Great Britain and Ireland, 
21 Portland Place, London W1B 1PY. 
Email: gataagbi.org

Royal College of Anaesthetists 
48–49 Russell Square, London WC1B 4JY. 
Tel: 020 7813 1900. 
Fax: 020 7813 1876. 
Website: http://www.rcoa.ac.uk/

Note: This text has been reproduced in part from the Association of Anaesthetists of Great Britain and Ireland publication entitled ’Your career in Anaesthesia’, 2nd Edition 
2004

USEFUL LINKS

Interested in a Career in Anaesthesia? 
This document, compiled by the Anaesthetists in Training, gives useful information regarding a career in the specialites of Anaesthesia, Intensive Care and Pain Medicine

Anaesthesia in Australia and New Zealand