Intended for healthcare professionals


Operations: spinal versus general anaesthetics— a patient's view

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1606

A Kiss for the Anaesthetist is More Appropriate

Your Anaesthesiologist has used his expertise to keep you comfortable
and free from pain during a considerably difficult operation. Even though
he has visited you just once he has nevertheless correctly assessed you as
suitable for being allowed to be awake during the procedure.

He is YOUR anaesthesiologist, and not the surgeon's!No way would he
have agreed to (or should have agreed to)a spinal anaesthetic if he had
considered you an unsuitable candidate for it.He obviously considered it
safer for you to have a spinal anaesthetic, keeping in mind your request
and the surgeon's willingness to have you awake in spite of the
complicated surgery.

The "ether screen" was originally intended to not only keep the ether
fumes away from the operating team, but more importantly to separate the
sterile field (where your operation is performed)from the rest of the
operating table. If it was not there, your speech, or sneeze, or cough
could spray infected material into the sterile field,resulting in possible
post-operative problems like wound infection. Ofcourse you could have worn
a surgical mask, but you could have been more claustrophobic than with the

Anaesthetists are usually well aware of the reflection on the
light,and this could have been deliberately ignored if the anaesthetist
was sure (by your attitude in the OR) that you are unlikely to faint at
the sight of your blood or open wound. You may be interested to know that
many a hefty anb brave man has needed to be resuscitated after seeing his
own blood during blood donation.You may also be interested to know that
often the anaesthetist will turn his viewing mirror towards the patient so
that he/she can watch the surgery without having to remove the ether

The "poor surgeon" should have requested the anaesthesiologist to
visit you in consultation; this would have allowed you to discuss all
aspects of your anaesthetic wellin advance,including the possibility of
you watching the surgery ( which ofcourse your surgeon may object to-they
may not like non-medical persons watching them mess about inside your

The public/ consumer does not usually know about the heroes unseen in
the OR. This has been so for many decades in the past. One of the reasons
has been because the surgeon does not wish to share the credit for the
successful operation with any one else and project himself as the great
man; however this attitude of a century ago has been outdated and one
rarely meets it in mordern times. However one occasionally sees remnants
of this attitude, note:"my anaesthetist"!

The anaesthesiologist has also not particularly projected himself as
one of the most vital members of the operating team,nor has he given
adequate publicity to his profession in the past.A supreme example of this
was seen on the occasion of the party given by Prime Minister Indira
Gandhi to thank the team which operated on her young children-Rajiv and
Sanjay- (who had had their tonsils removed). the surgeon who provided the
PM's office with the guest list made sure the anaesthetist's name was not
on it/or conveniently forgot to include it!

Therefore madam, do give credit where credit is due.Your anaesthetist
is a more worthy recipient of your post-operative kiss.

Competing interests: No competing interests

28 December 2000
Sarojini Devanandan
Head of Dept. of anaesthesia
Ambur, S.India