In a series focusing on medical specialisms, Dr John Gothard talks about being an anaesthetist.
'Occasionally one complex surgical procedure will take all day'
The term anaesthesia is derived from the Greek (an-aisthesis) meaning 'without feeling'.
Most major and many minor operations in the UK are carried out under general anaesthesia where patients are completely unconscious, pain free and unaware of events.
WHAT IS YOUR JOB?
I am a consultant anaesthetist at the Royal Brompton Hospital, in London.
I anaesthetise patients for heart and lung surgery.
We are a specialist hospital so most of the procedures are major ones, which need to be carried out with an anaesthetised (asleep) patient. It is my role to anaesthetise and look after patients during their surgery.
We use either a combination of intravenous drugs or gaseous agents to ensure that the patient does not wake-up during the operation.
WHAT IS THE MOST COMMON CONDITION?
My work is mainly concerned with children having surgery to correct congenital heart disease.
The children range in age from a neonate (new-born) to a sixteen year-old and can have a variety of problems such as hole-in-the heart and abnormalities of heart valves or major blood vessels.
WHAT IS THE MOST COMMON PROCEDURE?
This is to anaesthetise children for heart surgery. At the most I will undertake take one or two cases a day.
Occasionally one complex surgical procedure will take all day.
WHAT IS THE HARDEST THING ABOUT YOUR JOB?
Aside from the logistics of working in the modern NHS the hardest thing can be the stress of operating on small babies.
There is a small, but significant mortality associated with this type of surgery, which puts pressure on the medical team, particularly the surgeon. The general public often have unrealistic expectations of 100% success in these situations.
On the other hand even complex procedures become relatively straight forward for a well-trained team and as the babies have serious heart defects they often would not survive without surgical intervention.
WHAT IS YOUR MOST SATISFYING CASE?
You may meet some patients several times as they grow up and perhaps require further surgery.
Knowing that parents are happy to continue to entrust you with the care of their child can be very satisfying.
A young child is anaesthetised prior to surgery
I looked after one patient recently who I had first anaesthetised as a newborn baby 14 years previously.
I think it is reassuring for the patient and parents when there is this type of continuity of care.
WHY DID YOU CHOOSE THIS SPECIALTY?
Initially I wanted to be a GP.
I did various junior hospital jobs and then did a rotation in anaesthesia.
I realised then that anaesthesia was a very interesting speciality which combines the use of practical clinical skills and the ability to utilise one's knowledge of physiology and pharmacology.
Career prospects in anaesthesia were also very good at the time and I had good chance of getting to the top in the speciality.
IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?
I think if I had my career again I would choose anaesthesia, on the other hand there are other things I would have liked to have tried as well, perhaps even surgery!
HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?
Anaesthetists are doing more and more within the hospital environment.
Apart from providing anaesthesia services in the operating theatre anaesthetists are involved in resuscitation, intensive care, pain relief services and medical management.
We are also involved in transporting seriously ill patients by ambulance, air ambulance and helicopter.
CV - Dr John Gothard
1971: Qualified: St Mary's Hospital, London
1979:Appointed Consultant Anaesthetist, Royal Brompton Hospital
2000: Examiner: Royal College of Anaesthetists
2001:Chairman: Association of Cardiothoracic Anaesthetists (UK)