‘I trusted the team at MGH’: How anesthesiologists contribute to patient care

When Joan Wilson discovered last year she would be undergoing her first surgery, she was, understandably, a little nervous.

Joan was scheduled to receive knee replacement surgery at Michael Garron Hospital (MGH), which is her community hospital. The procedure would help address her osteoarthritis.

Joan was months away from retirement and had plans to use her newfound free time to lead a more active lifestyle, so it was especially important to her that the surgery go well.

“The pain I was experiencing had worsened over the years. It was limiting my life professionally and physically," Joan says.

"I knew I needed to proceed with the surgery and I trusted the team at MGH."

Joan assumed her care would be primarily provided by orthopaedic surgeons at MGH, including her surgeon, Dr. Justues Chang.

However, she quickly learned that an interdisciplinary team would be supporting her from assessment to surgery to recovery.

This team included surgeons, nurses, pain nurse practitioners, physiotherapists, anesthesiologists and anesthesia assistants. Anesthesiologists and anesthesia assistants, in particular, were involved in every step of her knee replacement journey.

Role of anesthesiologists in hospital

At MGH, there is a team of 23 anesthesiologists who provide care for patients.

Anesthesiologists are doctors, just like primary care providers and surgeons. They evaluate, monitor and supervise patient care before, during and after surgery.

When a patient is in surgery, an anesthesiologist evaluates their overall health, administers anesthesia, and monitors the effects of anaesthesia and surgery on the patient’s vital functions.

In addition, they run an acute pain service to follow patients after surgery, manage pain control for those in labour and provide sedation for patients having endoscopies. They may also be involved in airway management for critically ill patients outside of the operating room.

This means anesthesiologists work in many areas at MGH, including the Intensive Care Unit (ICU), Surgery, the Family Birthing Centre and other departments.

Before most procedures, an anesthesiologist meets with the patient to conduct a pre-operative assessment. This helps ensure they know everything about the patient’s health and relevant family history, which helps the procedure go as safely as possible.

“At the pre-operative assessment, an anesthesiologist will meet with the patient and ask questions to help decide which anesthetic technique to use,” says Dr. Juliana Tibbet, Anesthesiologist at MGH who was involved in Joan’s care.

The anesthesiologist determines the type of anesthesia to use by considering the patient's needs and the nature of the procedure. They may choose from general, regional or local anesthesia to create a plan that ensures a positive patient experience.

“During this time, patients can also ask us questions. This helps reduce any stress or anxiety they may be feeling,” adds Dr. Tibbet.

After her pre-operative assessment, Joan says she felt calm and prepared for her knee replacement surgery.

“I appreciated that an anesthesiologist met with me beforehand and explained each step of the process. They even let me know how I could manage any pain after the procedure,” Joan says.

The anesthesiologist also provides the patient with any preventive pain pills and anti-nausea medications to take before their surgery.

“It’s important to ensure we have an effective pain control plan with minimal side effects. This allows for enhanced recovery after surgery,” Dr. Tibbet says.

How anesthesiologists support patient care

“When the day of the surgery arrived, I was greeted by Dr. Tibbet,” Joan says. “She made sure I was comfortable before the procedure and treated me with kindness and compassion.”

Dr. Tibbet performed a nerve block as well as a spinal anesthetic, which are both typically performed in knee replacement surgeries. Nerve blocks help control pain after surgery and minimize the need for opioids, while the spinal anesthetic numbs the lower half of the body for several hours to block pain during surgery.

 “During surgery, anesthesiologists remain in the procedure room to monitor the patient’s vitals and comfort level,” Dr. Tibbet says.

“For procedures like a knee replacement, when a spinal anesthetic is in place, patients may be awake or sedated rather than being fully asleep. To monitor their comfort level, I engage in light conversation to see how they’re feeling and can adjust the sedation if needed,” she adds.

After the knee replacement surgery is complete, the patient is transported to a recovery room where they are monitored before going home.

Patients undergoing this type of procedure now do not necessarily require overnight admission. In Joan’s case, her procedure occurred towards the end of the day, so she was admitted overnight.

Because this was her first procedure, Joan says she didn’t mind staying the night at MGH and felt more comfortable knowing she could quickly receive assistance if she had any concerns.

Before being discharged from the hospital the next morning, a member of the Anesthesiology and Pain Medicine team met Joan to review a pain management plan. Here, Joan once again received information about what to expect in her recovery and how she could most effectively manage any pain or discomfort.

Joan says she left MGH with a smile on her face. She was excited to be able to start her the next chapter in her life.

 “It has been several months since surgery and I’m so pleased with my mobility and recovery!” Joan says. “Thank you to the teams at MGH for showing me compassion and for the great care I received.”