Central Line
Episode Number: 156
Episode Title: Inside the Monitor – The Road to and from the
Perioperative Experience
Recorded: February 2025
(SOUNDBITE OF MUSIC)
VOICE OVER:
Welcome to ASA’s Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
DR. ZACH DEUTCH:
Hello, everybody, and welcome back to the Central Line Podcast. I'm
your host for today's edition, Dr. Zach Deutch. I'm joined today by Drs. Mohammad
Rafique and Igor Tkachenko, who are guest editors of the April issue of The
Monitor. This is going to be on the subject of the perioperative experience,
the road both to and from. So an all encompassing experience and an all
encompassing topic which most of us are deeply involved in. I'm really excited
to have both of these gentlemen with me today. Welcome to you both.
DR. MUHAMMAD RAFIQUE:
Thank you.
DR. IGOR TKACHENKO:
Thank you.
DR. DEUTCH:
Dr. Rafique. You've been here before, and we're well known to each
other as members of the editorial board. But, Dr. Tkachenko, this is your first
time with us, so I'd like to hear from both of you. But starting with you, give
us a little background about yourself and what you're currently involved in
professionally.
DR. RAFIQUE:
So I'm Doctor Mohammad Rafique. I'm a professor of anesthesiology and
perioperative medicine at Loyola University School of Medicine in Maywood,
Illinois. I specialize in pediatric anesthesia with a focus on delivering compassionate,
high-quality care to our youngest patients. Beyond the operating room, I am
deeply passionate about teaching, mentorship, and the use of simulation to
advance the education and skills of future anesthesiologists.
DR. DEUTCH:
Can you introduce yourself to our listeners? Yes.
DR. TKACHENKO:
Thank you. Hello again. Yes, this is my first time here at podcast,
and thank you so much for inviting me. I am an attending anesthesiologist and
an associate professor at the Department of Anesthesiology at Loyola University
Medical Center here in Maywood, Illinois. I'm also part of our pediatric
anesthesiology section, and pediatric anesthesia is my primary area of
expertise. Um, and also I am focused on medical education, specifically medical
simulation. Yes. And together with Dr. Rafiq, we are part of our anesthesia,
um, simulation curriculum.
DR. DEUTCH:
Very good. Thank you both. And we're going to get right into this
topic. First to go forward, we're going to go back. We're a very technological
society right now. Or at least we like to think of ourselves that way. And
certainly we are in comparison to the past. So I'm going to ask you gentlemen,
and I'm going to ask you, Dr. Rafique specifically, talk to us about the
evolution of anesthesia and how we got to where we are and where we started.
Um, you know, thinking back even to the days of the American Civil War with
ether or alcohol or simply biting on a bullet to get things done?
DR. RAFIQUE:
Yes. Um, before anesthesia surgery was really a harrowing experience.
And as you mentioned, that either alcohol or biting on the bullet or opium were
used sometimes, but they were not enough relief. Surgery was performed on awake
patients. They endured excruciating pain as surgeons operated and often racing
against time to complete life saving procedures. The psychological trauma of
surgery left many preferring death over the operating table. The breakthrough
to this misery came in 1846, when Dr. William Morton demonstrated ether
anesthesia during a surgery in Boston. For the first time, a patient went under
a pain free operation. This was a revolution. Ether allowed for longer, more
precise procedures, transforming surgery into a viable and humane option. Soon
after, chloroform gained popularity, though it carried greater risks.
The 20th century brought rapid advancements. Early anesthesia machines
improved delivery, while endotracheal intubation in the 1920s secured airways
and enhanced surgery. The 1940s introduced muscle relaxants like curare,
enabling lighter anesthesia with better surgical conditions. Halothane induced,
introduced in the 1950s, became the first modern inhaled anesthetic, offering
greater control and safety. The later half of the century focused on monitoring
and specialization. Devices like pulse oximeters and capnographs provided real
time physiological feedback, reducing complications. Regional anesthesia
techniques such as epidural and spinal blocks became refined, and
subspecialties like pediatric, cardiac or obstetric anesthesia emerged.
Today, anesthesia is safer and more precise than ever. Short acting
drugs like propofol and sevoflurane minimize side effects and speed recovery,
while ultrasound guided regional anesthesia allows for targeted pain management.
ERA protocols optimize perioperative care and advanced monitoring tools like
anesthesia depth monitors ensure patient safety and effective unconsciousness.
The future seems even brighter with innovations like AI driven anesthesia and
personalized care.
From its humble beginnings with ether to today's sophisticated
practice, anesthesia has transformed surgery from a perilous ordeal into a
safe, routine and lifesaving procedure. And I have to say here, the whole host
of invasive cosmetic procedures are only possible because of the advances in
safety and efficacy of anesthesia medications and techniques. This remarkable
journey reflects the power of innovation and enduring commitment to patient
care. In a nutshell, it is journey from agony to assurance.
DR. DEUTCH:
Mohammad, that's an excellent capsule summary, and I'm thinking we
should almost condense it for social media posting and information by the ASA
in general. So I appreciate that. And we'll move from that into our modern era.
And Dr. Tkachenko, this will be addressed to you. Let's talk about what is our
contemporary role in the OR. What are we doing now and how has that evolved, also
looking back a little bit?
DR. TKACHENKO:
Thank you. Um, we all agree that the role of anesthesiologists and the
operating room has always been pivotal. Uh, and that evolved along with the
advancements in surgical technology and patient care. Today, anesthesiologists
play a crucial role in highly complex procedures. We are utilizing techniques
such as cardiac bypass, circulatory arrest, single lung ventilation, assisting
with robotic assisted surgeries. As medical advancements have progressed, the
idea of patients being quote unquote too sick for surgery has largely disappeared.
We nowadays manage patients with significant comorbidities, and a good example
of that is performing spinal fusion on a patient with single ventricle physiology.
Additionally, we utilize a variety of airway management devices invasive,
monitoring technique, intraoperative transesophageal echocardiography, all of
that to enhance patient safety. The development of modern anaesthetic
medications with a safety profile has allowed us faster and more reliable
post-operative recovery, reinforcing the indispensable role of
anesthesiologists in today's surgical care. From the moment the patient enters
the operating room, I'll just manage anesthesia induction, airway control,
hemodynamic stability. Throughout the surgery, we continuously monitor vital
signs, adjust anesthetic depth, manage fluid balance, intervene in real time to
address any complications. The expertise extends beyond anesthesia
administration, of course, encompassing pain management, ventilation strategy,
and intraoperative hemodynamic optimization. And also by maintaining constant
communication with the surgical team and other OR staff, the anesthesiologist,
we help to create a controlled environment where complex procedures can be
performed safely and efficiently.
DR. DEUTCH:
Okay, also an excellent summary and I appreciate that. So we know that
especially these days, it seems like almost anywhere can be an anesthetizing
location. It's not just your standard OR, but it can be cardiology,
interventional radiology, the emergency room, the ICU, you name it. So, Dr.
Rafique, I'm going to ask you about operating rooms that aren't in the
hospital, but in the ambulatory setting. These are obviously designed to
minimize costs, maximize patient satisfaction by keeping them out of the hospital,
getting them in, getting them out, but still getting them appropriate care,
which is high quality. Talk to us generally about your views and impressions of
surgery center care, ambulatory care, and the implications that it has for the
overall picture of perioperative care in this country.
DR. RAFIQUE:
Yes. Very good question. Ambulatory surgery centers, or ASCs as we
call them, have really revolutionized surgical care by offering efficient, cost
effective, and patient focused outpatient procedures. Today's ASCs handle about
35 to 40% of all surgeries annually in the US. And procedures at ASC cost
almost 40 to 60% less than in the main hospitals. So they save money to the
patients and the hospitals, as well as they free hospital resources for more
complex cases. According to a report, the ASCs save about more than 4 billion
to Medicare annually. At the core of ASC success are anesthesiologists who not
only ensure patient safety, but also play a pivotal role as leaders in surgical
efficiency, innovation and quality improvement. So the costs can be cut but
quality is maintained or even enhanced. Beyond clinical care, anesthesiologists
are instrumental in developing and implementing protocols that enhance patient
outcomes and streamline workflows. They lead initiatives such as ERAS,
multimodal pain management, and opioid sparing techniques, all of which improve
efficacy and reduce complications. Their expertise and resource optimization
and OR scheduling help maximize case volumes while maintaining patient safety.
Anesthesiologists also take the lead in staff training, crisis management, and
quality assurance. By conducting simulation based training and emergency
preparedness drills, they ensure surgical teams can respond swiftly to
complications. Their role in infection control, sedation policies and
standardization anesthesia techniques further enhances ASC. Safety and
reliability. In addition, anesthesiologists influence ASC policy, accreditation
and compliance with regulatory standards. Their leadership in benchmarking performance
metrics and driving continuous quality improvement ensures ASCs maintain the
highest standards of care while remaining financially sustainable. In a sense,
I have to say, the ACSs exemplify modern, efficient surgical care, and
anesthesiologists, as leaders in the center for perioperative medicine are
their driving force. Through clinical expertise and visionary leadership, they
ensure ASC continues to set the standard for excellence in outpatient surgery.
DR. DEUTCH:
Okay, so I like what you have to say, but I'm going to bring up a
small point that I'd like to hear both of you comment on. And I'm going to ask
you, Muhammad, to comment first, which all of us have encountered. And I'll
just put it this way. It's like this in in quotes. I can't believe they want to
do blank at the surgery center. Now you take it from there.
DR. RAFIQUE:
Oh, very good comment and question. Yes. Surgery centers, although
they are very safe places to get surgery done, but they have their limitations.
One of the biggest things is that the resources are limited there and the help
is limited there. And at the end of the day, everybody goes home, which means
that they shut the doors and go home. So there is nobody to take care of
patients if a patient needs to stay there for longer or maybe overnight. So
like patients who have certain comorbidities probably are not the candidates
for surgery, like I would say, patients with very high BMI. In our surgery
center here, we have a kind of cutoff of between 45 and 50. If somebody is that
high, we probably prefer them to be in the main hospital. Somebody who has
really bad comorbidities like cardiac issues or arrhythmias, or sometimes if
somebody could need postoperative ventilation for several hours. Those are the
kind of patients who may be going and undergoing a smaller procedure, probably
are not the best suited for the ASCs because of their own safety.
DR. DEUTCH:
Okay, Dr. Tkachenko, I'm going to ask you to to give your commentary
on that. And I'm also going to ask you to specifically relate to us. What was
the most ridiculous thing that you've seen proposed, and did it happen or not
happen?
DR. TKACHENKO:
That's a great question, and I agree with you and Dr. Rafique on the division
of the ambulatory surgery center nowadays, that surgeons are trying to do
things that are more complex and require higher level of anaesthetic care.
Traditionally or historically, so to speak, surgery centers evolved as
institutions that provide care to healthier patients for straightforward
procedures. But with advancements, again getting back to technology and
pharmacology, we can provide safer care for patients who are sicker with more
comorbidities for more complex surgical procedures. Classic example of that, as
you mentioned, is patients with higher BMI. And I'm afraid to say that that
we're pushing the envelope further and further, and we need more evidence-based
support for our practice in that aspect of anesthetic care. But overall, we
know that we provide very safe care to all, all the patients with significant
comorbidities and utilizing techniques like regional anesthesia avoiding
systemic opioids. We make their care a lot safer and reliably can discharge
them home on the same day.
As to the most ridiculous thing that I've ever heard or seen in the
ambulatory surgery center, it's difficult to come up with a specific example.
But sometimes, you know, when we do our preoperative assessment, just looking
through the patient's chart, many of us are a little bit puzzled with the
choice of ambulatory surgery center as the place to perform certain procedures,
and we bring that to the surgical teams, discuss that with them. And we most of
the time agreed on what we need to do, what is the safest way to provide care
to those patients.
DR. DEUTCH:
Well, I was looking for the cheap laugh to get the story of the
patient who was on ECMO, but they wanted to bring him over to do a cataract.
But you guys did not oblige me, so we'll just move on. But I think…
DR. RAFIQUE:
I have an example of very close to that. Uh, once I was reviewing the
charts and patient was scheduled to be at ask for a shoulder surgery, which is
very common there. The patient had heart transplant and had a liver transplant,
two transplants, and was quite inactive. And they wanted to bring him to
surgery center and do the surgery and send him home. I was like, no, this is
somebody who needs to be in the bigger hospital where all the specialties are
around. If there is a need for a cardiologist to come by, or if there is a need
for a cardiac anesthesiologist to come by and take care of him during the
procedure, or give consultation and during the procedure, that is the place for
him. So somebody like that? I don't think so.
DR. DEUTCH:
Well, hats off to you for being the first and last line of defense
there, although I do actually have to give some kudos to whoever the transplant
surgeons were, because if this guy is in a position where the biggest thing
that's bothering him is his shoulder, they must have done something right. So I
guess in a certain way, there's a silver lining to this.
DR. RAFIQUE:
That is true.
DR. DEUTCH:
So we'll move on. I think we covered that. And I thank you guys for
your input there. Um, we'll talk a little bit Alpha and Omega here--pediatric
and geriatric. These patient populations have unique challenges as we all know.
Dr. Tkachenko, I'm going to ask you to discuss the challenges that come with
these differing ends of our lifespan in terms of anesthetic and perioperative
management. And you know, how they differ from each other and how they differ
from adults in the middle.
DR. TKACHENKO:
That is a very important question. As part of a pediatric
anesthesiology section, we provide care to pediatric patients and adult
patients and very often geriatric patients. Pediatric and geriatric anesthesia
presents very distinct perioperative challenges. Those require very tailored
approach to ensure their safety and optimal outcomes. Pediatric patients are
very often otherwise healthy, and we do many of those procedures in ambulatory
surgery center, leading to a fast-paced condensed surgical schedule. However,
psychological preparation is very crucial not only for the child but also for
the family. Building trust with the patients and their families and alleviating
their anxieties and fears is a very essential part of pediatric anesthesia
care. I would say this is the art of pediatric anesthesia, so to speak. In
contrast, geriatric patients typically have complex medical histories, and that
necessitates very thorough chart reviews, extensive medical optimization,
coordination with consulting services. Geriatric patients may be accompanied by
extended family member or at times they may face surgery alone. This shifts our
focus towards quality of life, shared decision making, and balancing surgical
benefits with overall well-being of our geriatric patients. While both
populations require very specialized care, the emotional and medical
consideration for each are very different and that shape anesthesiologist role
in the very unique way.
DR. DEUTCH:
Well, I don't like to hijack these sessions as the host, I like to let
the guest speak, but I'm going to give a slight monologue since we're on the
subject of pediatric and geriatric. On the subject of pediatric, I just want to
say you guys mentioned earlier single ventricle patient for complex spine
surgery. And I just wanted to say I'm really glad people like you are doing
that, because I sure as heck don't want to do it. And I'm glad we've got some
pediatric experts that can really do some serious stuff. So that was what did I
want to say about pediatric. Um, as far as geriatric goes, one of the things
that I find puzzling is treating patients at extreme of age in the sense that
they're there at the end of their natural lifespan, regardless of any
comorbidities, medical or surgical. For example, I mean, you get to be like, I
don't know what our life expectancy currently is in this country, but I think
we'd all agree when you're 90 plus, you could die of natural causes in your
sleep at any time, and that would be an appropriate biological event. So for
example, last night we treated a patient who was 97 years old for a hip
fracture, and the patient did quite well, as they often do in this situation.
And I found myself thinking the whole thing seems a bit absurd because the
patient could literally die in their sleep tonight, unrelated to anything that
had been done in the perioperative setting. And then, of course, we all know
what would happen. The patient would be coded and all these interventions would
happen. And I found it just very, very troubling. And I also it also made me
think, and we'll get to this in another question, that we really haven't
figured out how to approach end of life in this country. So that's my monologue
from the beginning and the end. And if you guys have anything you want to add
to that, I'd be happy to hear it as well.
DR. RAFIQUE:
Yes. Uh, very rightly said, you're spot on in this situation that a
lot of our seniors present for care. And sometimes there are surgeries which
really look absurd, that these surgeons want to perform surgeries on these
patients who are never going to walk or they're never going to ambulate, but
because there is a fracture, we need to fix it kind of surgeons are out there.
DR. DEUTCH:
Dr. Tkachenko, any thoughts?
DR. TKACHENKO:
Yes. I think this is a very important part of our discussions with the
patients and their families, because we very often put life expectancy as the
first priority and quality of life a little bit aside. And the families look at
us for suggestions for our expert advice. They look at their primary care
physicians, and very often it's a very difficult decision. Many of us face that
during our lifetime, you know, with our older relatives at some point. But
sometimes I feel to make a good decision, you really need to know medicine. You
almost need like to have a degree in healthcare, because knowing about
complications and seeing complications is very different. When we mention
during discussions about surgical consent, anesthesia consent, we mentioned
those complications. But very often the patients and family members don't
really have great idea about how difficult their post-operative period might
be.
DR. DEUTCH:
Yes. Well said. And I've often thought that having worked, as many of
us have to get appointments for myself, my kids, my wife, friends, by knowing
people, by having the cell phone numbers of proceduralists, how difficult it
must be to navigate the system as, quote, an outsider. So I think that's a very
good point and could be the topic of a whole, I mean, probably a whole issue of
the ASA Monitor and multiple podcasts as well. But since we've kind of touched
on one of my pet topics, which is the inherent absurdity of much of American
medicine, I would like to look abroad and I'd like to hear from both of you.
But, Mohammed, I'd like to hear from you first. Talk about the role of
anesthesiologists, perioperatively and otherwise in countries outside the US.
DR. RAFIQUE:
Thank you very much. A very good question. Uh, any operative care in
and the role of anesthesiologists varies significantly across the world and is
shaped by the differences in healthcare infrastructure, workflow, distribution,
training, and resource availability. While anesthesiologists play a central
role in ensuring patient safety and optimizing clinical outcomes, the scope of
their responsibilities differs based on the region's healthcare system and
economic status.
For example, in high income countries, anesthesiologists are deeply
integrated into all phases of perioperative care, including preoperative risk
assessment, intraoperative management, postoperative pain control, controlled
and critical care. They often lead initiatives for patient improvement and care
improvement like multimodal analgesia, ERAS, and other perioperative medicine
programs. They work collaboratively with surgeons and other specialists to
optimize patient outcomes. Advanced health care systems allow for
subspecialization in areas such as regional anesthesia, cardiac anesthesia, or
pediatric anesthesia, and further expand their role. Anesthesiologists in these
settings are actively involved in quality improvement, patient safety, and
healthcare policy development.
In low and middle income countries. Access to anesthesiologists is
often limited, leading to significant disparities in perioperative care. Many
regions rely on non-physician anesthesia providers, such as anesthesia nurses
or other non-physician extenders to deliver anesthesia services due to
workforce shortages. Perioperative care is frequently constrained by limited
resources, outdated equipment, and a higher burden of untreated comorbidities,
making anesthesia riskier. Anesthesiologists in these settings often take on
broader responsibilities including critical care, trauma management, and
training of non-physician providers to expand access to safe anesthesia care.
Global health organizations have focused on these disparities by
training programs and capacity building initiatives. Cultural and systemic
factors also influence perioperative care. In some countries, preoperative
optimization is limited due to delayed healthcare access. A lot of times,
anesthesiologist is the first doctor these patients see in their lifetime when
they come for an urgent and emergent surgery leading to higher perioperative co-morbidities
and mortality. Post-operative pain management also varies significantly. In
high income countries, they are devising different techniques such as opioid
sparing or regional anesthesia or other initiatives. But in low and middle
income countries, a lot of times no pain medicine is available and pain totally
goes untreated. Despite these differences, the role of anesthesiologists as
advocates for patient safety and surgical outcomes remains universal. Efforts
to strengthen perioperative care globally continue through training programs,
telemedicine initiatives, and international collaboration aimed at reducing
anesthesia related disparities and improving surgical safety worldwide.
DR. DEUTCH:
And Muhammad, I remember from our previous discussions that you had
trained in Pakistan and worked there maybe for a few years before coming to
this country. Do you have experience working or via medical missions or
anything else in any other countries besides those two.
DR. RAFIQUE:
I did work a little bit in Middle East and Saudi Arabia, and I have
done mission trips to Pakistan. And what I saw, I would say in Saudi Arabia,
although it is a rich country in a sense of economic status, but it lacks
trained professionals. The only way for them to get trained professionals is
from foreign. They hire doctors from the West like US or Europe. They hire a
lot of doctors from other Middle Eastern countries or Asian countries where
education is there. But because of economic constraints, people want to go
abroad. So you will see in Saudi Arabia, a lot of physicians who trained in
different parts of the world, and they come there for work. Uh, one of the
biggest problems I noticed there that there is a lot of times there is a lack
of cohesion between different parts of the care for a patient. Sometimes the
team building is challenging because of language barriers, and other cultural
barriers sometimes make it difficult, and in the end it is usually the patient
who is suffering. And while doing mission trips in Pakistan, I saw a lot of
misery. We regularly used to go to Pakistan for pediatric cardiac surgeries,
and you would go there for a 6 or 7 day period, and wherever you are, you look
outside and there is like a thousand people gathered and they all want their
kid to be seen and operated in the seventh day. At least that is their hope.
And that always broke my heart that this is something which all these people
deserve. But for known and unknown reasons, they cannot get that care. And they
have their hopes that this team who came from a different country will take
care of their loved one.
DR. DEUTCH:
Yes. And I think that point, especially for someone like myself that
grew up with the very, you know, I would, I would say privileged background in
the sense that I never had to worry about these type of things in terms of, you
know, shelter, food, education, having a family that cared. So I always take
these moments to say, no matter what faith you are, what whatever belief system
you have, count yourself lucky for the things that you have that are so
important. So absolutely. I'm reminding myself of that, listening to what
you've said.
DR. RAFIQUE:
Um, absolutely. We are very privileged and very lucky to be living in
this society, in this country where everything is definitely available and
accessible one way or the other.
DR. DEUTCH:
Now, Dr. Tkachenko, I'd like to hear from you as well. And I'm going
to guess from your last name that you have some experience in Ukraine or that
part of the world, and I'd like to hear about your experiences abroad and in
this country and your thoughts about, you know, international medicine from a
pragmatic and personal experience perspective.
DR. TKACHENKO:
Yes. Thank thank you so much. Indeed, I did my medical school and
started my medical career in Ukraine, and I've been working here in the United
States for almost 30 years. I constantly remind myself how lucky we are,
providing cutting edge healthcare to our patients, and being able to meet all
the challenges that we face nowadays with patients being sick and complex
surgical procedures. I always think when we bring the arterial blood gas
machine to the operating room and check blood gases on the spot, I always think
about when I started my medical career in one of the pediatric intensive care
units, we got that large arterial blood gas machine that was donated by one of
the German hospitals, and we were calibrating that every morning, and in a
couple of months we ran out of, um, supplies for that. So we were not able to
check blood gases any longer. Luckily, we had another shipment of supplies, but
it was such a tremendous improvement of our ability to provide care to sick
children. And every time I step in the operating room and provide care to our
patients, I feel how lucky we are.
DR. DEUTCH:
And this is why I'm grateful to be in medicine, as well as to meet
people with different backgrounds so that I can get more of a window on the
world than I've gotten just from from my life and my travels so far, which have
been compared to others, somewhat limited. Um, out of curiosity, have you done
any mission work or any type of work outside of this country since that time,
30 years ago, when you transitioned to living here and working here?
DR. TKACHENKO:
No, unfortunately, I didn't have an opportunity to do that. But many
of my coworkers here at Loyola and at my previous job at the University of
Chicago did that. And I clearly early how helpful and enlightening that
experience was for them. We had one of our CRNAs who went on a mission trip a
couple of years ago, and she presented at our grand round her experience in, I
believe it was in Colombia. It was very exciting for all of us to see how we
bring advances in patient care to the countries that have limited access to
patient care.
DR. DEUTCH:
Yes, agreed. I've seen staff members, whether they be physicians or
nurses, come back from trips and do AV presentations, and it's just so great
because you can really get a sense like this is what their sterile processing
looks like. This is what the recovery room looks like. This is the equipment
you have to work with. And that just really drives the point home. So those are
always excellent educational and not just educational, but delivering
perspective experiences that are good for everybody.
Um, okay, gentlemen, we're coming to the end here. And I'm going to I
want to hear from both of you, having worked together to edit this issue of the
Monitor and obviously thought deeply about this topic. Talk to our listeners
and potential readers of that issue. What do you feel are the most important
takeaways? What are the bullet points they really need? What things do you feel
most passionate about? And Muhammad, I'm going to start with you.
DR. RAFIQUE:
So I would say the pursuit of excellence and innovation has been key
to the progress which has been made in the perioperative care in the last two
centuries, and the same desire to excel and the same desire to innovate will
take us to the next step, whatever it is for tomorrow. So until and unless we
continue to believe in excellence and keep innovating, we will keep progressing
and surgery and anesthesia will become even more safer and, uh, a better
experience for the patient, um, in the coming days.
DR. DEUTCH:
And Dr. Tkachenko, your thoughts? Yes.
DR. TKACHENKO:
To me, it's very important. And I feel for all of us to embrace the
role of being not just intraoperative physicians, but being more involved in
perioperative care. Um, anesthesia extends far beyond intraoperative
management. It is a very comprehensive, patient centered approach that begins
well before the first dose of anaesthetic is administered. And effective
perioperative care starts with a thorough preparation assessment, very thorough
review of patient's medical history, developing of very individual strategies
to optimize their conditions. As anesthesiologists, we evaluate risk factors in
their cardiovascular disease, pulmonary conditions, genetic metabolic
disorders. We create very tailored perioperative plan and this may include
managing their hypertension, optimizing glycemic control many, many other
things. And that detailed evaluation and interdisciplinary approach
interdisciplinary collaboration, as anesthesiologist, we ensure that patients
enter the operating room in the best possible condition. You know, we very
often have that discussion with surgical teams or conversations, so to speak,
about what we can do to better optimize patients and ultimately improving
surgical outcomes and minimizing intraoperative risks are the most important
goal of perioperative management. I think this is a very important part of our
practice, and this is the big aspiration for me and for all of us.
DR. DEUTCH:
Agreed. It all comes down to risk benefit. The biggest simplification
you could ever make, because the patient is at the center and everything else
should be secondary to that.
DR. RAFIQUE:
Absolutely.
(SOUNDBITE OF MUSIC)
DR. DEUTCH:
It's been great speaking with both of you. Thank you for joining us on
this edition of Central Line Podcast. You gentlemen are obviously learned and passionate
and articulate, and I look forward to reading the April edition of the ASA Monitor.
For our listeners out there, you can always go to asamonitor.org for
more information on this topic or other topics that might be of interest to
you. We look forward to seeing you next time on the Centerline podcast. Take
care.
DR. RAFIQUE:
Thank you very much. Zach.
DR. TKACHENKO:
Thank you. Thank you so much.
VOICE OVER:
Create and Improve Systems for Perioperative Care with CPMed Perioperative
Medicine Highlights 2025. Delve into ten sessions from anesthesiology 2024 that
address managing concurrent diseases, aging patients, and perioperative
clinics. Visit asahq.org/cpmed to learn more.
Subscribe to Central
Line today wherever you get your podcasts or visit asa.org/podcasts for more.