Physician Anesthesiologist or NORA Subspecialty?
Physician anesthesiologists evaluate, monitor, and supervise patient care before, during, and after surgery. They deliver anesthesia, lead the Anesthesia Care Team and ensure optimal patient safety. Typically, physician anesthesiologists have 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training. They have the necessary knowledge to understand and treat the entire human body.
New trends in nonoperating room anesthesia (NORA) continues to increase in popularity and scope. National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail.
In order for anesthesia specialists and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite.
Physician anesthesiologists are usually in charge of providing the following types of anesthesia care:
- General Anesthesia – Provided through an anesthesia mask or IV. It is used for major operations.
- Monitored Anesthesia or IV Sedation – Results in various levels of consciousness ranging from minimal (drowsy but able to talk) to deep (won’t remember the procedure). Often used for minimally invasive procedures. IV sedation is sometimes combined with local or regional anesthesia.
- Regional Anesthesia – Pain medication to numb a large part of the body, given through an injection or through a catheter. You will be awake but unable to feel the area that is numbed. Often is used during childbirth and for surgeries of the arm, leg or abdomen.
- Local Anesthetic – This is an injection that numbs a small area of the body where the procedure is being performed. Often used for procedures such as removing a mole, stitching a deep cut or setting a broken bone.
Certification in one of the following subspecialties requires additional training and assessment as specified by the American Board of Anesthesiology:
- Adult Cardiac Anesthesiology – Has expertise in the imaging, diagnosis, physiology, pharmacology and management of adults with advanced cardiac disease. Their practice includes medical and periprocedural care for patients with disease of the heart and great blood vessels, including diagnostic, surgical, minimally invasive and transcutaneous procedures that may require cardiopulmonary bypass or other mechanical circulatory assistance.
- Critical Care Medicine – Diagnoses and treats patients with critical illnesses or injuries, particularly trauma victims and patients with multiple organ dysfunction who require care over a period of hours, days or weeks. These physicians also coordinate patient care among the primary physician, critical care staff and other specialists and their primary base of operation is the intensive care unit (ICU) of a hospital.
- Hospice and Palliative Medicine – Provides care to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing the physical, psychological, social and spiritual needs of both patient and family.
- Neurocritical Care – The medical specialty of Neurocritical Care is devoted to the comprehensive multi-system care of the critically ill patient with neurological diseases and conditions.
- Pain Medicine – Diagnoses and treats patients experiencing problems with acute or chronic pain, or pain related to cancer, in both hospital and outpatient settings and coordinates care needs with other specialists.
- Pediatric Anesthesiology – Provides anesthesia for neonates, infants, children and adolescents undergoing surgical, diagnostic or therapeutic procedures as well as appropriate pre- and post-operative care, advanced life support, and acute pain management.
- Sleep Medicine – Has expertise in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, or that are affected by disturbances in the wake-sleep cycle. This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory.
While NORA is a rapidly growing field of anesthesia, as new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room. However, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings.
Role of the Physician Anesthesiologist. www.asahq.org
National Trends in Nonoperating Room Anesthesia: Procedures, Facilities, and Patient Characteristics. pubmed.ncbi.nlm.nih.gov
Anesthesiology Subspecialties. www.abms.org