Anesthesia Without Fear: What a Patient Needs to Know Before Surgery

How does an anesthesiologist’s professional training develop?

An anesthesiologist’s training begins at medical university. At the university the doctor receives basic theoretical knowledge and a fundamental understanding of how the body works. The next stage is internship (residency). It is there that theoretical knowledge begins to merge with practice.

In theory, one can know pharmacokinetics, pharmacodynamics, and the side effects of drugs, but in real practice questions arise that force you to view anesthetics from a practical perspective — taking into account their mechanisms of action and the patient’s specific condition. Independent clinical practice is a different level of responsibility. An anesthesiologist continues to learn every day by analyzing personal experience and new clinical situations.

What additional skills should a good anesthesiologist have?

The university provides the foundation, but a large portion of an anesthesiologist’s practical skills are formed during residency and independent work. It is very important to be able, in a short time, to establish rapport with the patient and build trust so the patient understands they are in reliable hands.

Communication does not end once the operation is over. After awakening, the patient needs clear and calm explanations about what is happening: the surgery is finished, the anesthesia is wearing off, now certain simple commands must be followed and preparations made for transfer to the ward. These skills are largely developed through hands‑on experience.

Does an anesthesiologist really just sit and do nothing during surgery?

From the outside it may appear that the anesthesiologist is not constantly engaged in active tasks during surgery. But the essence of their work lies in constant readiness to respond to changes in the patient’s condition. During anesthesia the physician continuously monitors the readings on the monitors, the sounds of alarms, the functioning of equipment, and the overall situation in the operating room. Therefore, even at moments when it seems externally that the doctor is doing nothing, they remain involved in the process and ready to react quickly.

How many operations can an anesthesiologist perform during a single working day?

During one operating day there may be a single operation lasting about six hours, or several shorter procedures — four to five operations of about an hour each. It is incorrect to evaluate an anesthesiologist’s workload solely by the number of operations. The duration and complexity of each procedure are what matter.

Does an anesthesiologist get tired while working?

Like any physician, an anesthesiologist can become tired. However, the significant burden during work is associated not only with physical fatigue but also with constant cognitive strain. Many processes occur simultaneously during an operation that must be controlled and assessed. The anesthesiologist is continually analyzing information, monitoring the patient’s condition, and must be ready to make quick decisions if the situation changes.

Is it acceptable to be careless about the choice of anesthesia and the place where the operation is performed?

Anesthesia should be treated with the same responsibility as the surgical intervention itself. A person without medical education is not obliged to know all the specifics of anesthesiology, equipment, or drugs. Nevertheless, the patient has the right to ask questions and receive information about how their safety will be organized during the operation.

Before a procedure it is perfectly reasonable to ask the anesthesiologist what equipment is used, how the patient’s condition is monitored, and which parameters are tracked. The patient should understand whom they are entrusting their health to and what conditions for providing anesthesia are in place at the particular medical facility.

How does the anesthesiologist’s consultation take place?

Before a planned operation, the patient always has a consultation with the anesthesiologist. The main goal is to assess the patient’s condition, collect necessary information, and plan the future anesthesia. The anesthesiologist takes a detailed medical history, asking questions such as:

• whether the patient has had previous surgeries and anesthesia;
• whether there are chronic illnesses;
• whether there was any reaction to anesthesia;
• whether there are allergies;
• whether there have been injuries or other conditions that might be relevant to anesthesia;
• whether the patient is taking any medications.

The patient is also informed about how long the operation and the anesthesia are expected to last.

Does the anesthesiologist perform a physical examination during the consultation?

The anesthesiology consultation includes taking the medical history, a physical examination, and an assessment of the patient’s condition. In particular, the following are carried out:

• measurement of blood pressure;
• auscultation — listening with a stethoscope;
• assessment of the airway;
• determination of the patient’s anthropometric characteristics (e.g., height, weight, body proportions).

All this information is necessary for the anesthesiologist to evaluate the patient’s condition and plan anesthesia tailored to their individual features.

Should the anesthesiologist be informed about all medications the patient is taking?

For safe preparation for anesthesia, it is important to know as much as possible about the individual. Therefore the patient must inform the doctor about all medications they take regularly or intermittently. These may include antidepressants, cardiovascular, endocrine, and neurological drugs, anticoagulants, etc. Drugs used during anesthesia can interact with those the patient is taking, which may cause adverse effects.

For patients taking certain medications, anesthesia is selected individually. Some drugs need to be temporarily stopped before surgery, while others should be continued.

Can the operation be postponed after the anesthesiology consultation?

The operation is postponed if administering anesthesia could be dangerous for the patient. Possible reasons for postponement include:

• an acute respiratory viral or other infectious disease in the active stage;
• exacerbation of a chronic illness;
• high blood glucose levels;
• uncontrolled arterial hypertension; etc.

Because this concerns elective, non‑urgent surgery, the procedure is delayed until the patient’s condition improves. The patient may be advised to consult the appropriate specialist, undergo additional examinations, and optimize their health before the operation.

How do surgeons react if the anesthesiologist believes the operation should be postponed?

The decision to postpone an elective operation is always discussed with the surgeon. Trust and mutual understanding within the team are important, with patient safety being the priority. If the preoperative assessment reveals a truly decompensated condition, the elective procedure is postponed until the patient’s condition is stabilized.

How is preparation for anesthesia organized for patients coming from other countries?

Working with patients from abroad requires thorough medical preparation and well‑planned logistics. The patient needs to plan the trip so there is enough time for consultations, the surgery, the postoperative period, rehabilitation, and necessary follow‑up visits, including suture removal if required.

If the patient has already consulted with a plastic surgeon and the operation is scheduled months later, they may be given in advance a list of required laboratory and instrumental tests. Whenever possible, these tests are done in the country where the patient lives and the results are sent to the doctors. This allows the patient’s condition to be assessed ahead of time.

Online consultations with an anesthesiologist are also held for patients who are abroad. During such a consultation the medical history is taken, comorbidities and medications are clarified, and other anesthesia‑relevant details are discussed. If needed, required laboratory and instrumental tests can be performed at the VIRTUS clinic.

Can a patient choose whether the anesthesiologist is male or female?

Sometimes patients have such preferences, and they are accommodated when possible. These preferences may be related to religious beliefs or to working with children, who may sometimes feel more comfortable with female physicians. The composition of the operating team is adjusted according to the patient’s wishes.

Is it really true that the shorter the anesthesia, the better for the patient?

Anesthesia safety is not determined solely by its duration. The main goal is to maintain the patient in the safest possible condition throughout the surgical procedure. Anesthesia is a controlled state that enables the operation. Its quality depends on the drugs used, the patient’s overall condition, and how appropriately the anesthetic strategy is chosen.

However, the duration of surgery can indeed increase certain risks. For example, during procedures lasting seven to eight hours, the risk of thrombotic complications rises. The anesthesiologist’s task is to ensure the patient’s safety and comfort and to implement measures to prevent potential complications.

How is patient safety ensured during a prolonged operation?

During surgery, measures are taken to prevent possible complications. Thromboprophylaxis is performed using special limb‑compression devices. Special warming blankets and fluid warmers are used to prevent the patient from becoming hypothermic during a long stay in the operating room.

What fears do patients have before anesthesia?

If a person encounters anesthesia for the first time, they may feel fear and anxiety. This is a completely normal reaction, especially if they have no prior experience with general anesthesia. A common fear is losing control over the situation and one’s own body. The patient understands that during anesthesia they will not be able to control what is happening themselves. However, control does not disappear — it is transferred from the patient to the anesthesiologist. During the operation, it is the anesthesiologist who continuously monitors the patient’s condition and vital signs.

It’s similar to flying in an airplane: when a person boards a plane, they do not control the mechanisms, the pilot, or the air traffic controllers, but they understand that there is a system and people who are working. Therefore they accept the flight calmly and move from point A to point B. The same applies to anesthesia. There is a system in place that works for the patient and ensures their safety.

How can a doctor calm a patient before surgery?

One of the most effective ways to reduce anxiety before anesthesia is an open and constructive conversation with the physician before the operation. When a patient has the opportunity to ask all their questions and receive clear answers, the unknown becomes smaller, and with it the fear decreases.

Various psychological techniques can also be used during preparation for anesthesia to help redirect the patient’s attention. For example, if it becomes clear during the consultation that the patient sometimes drinks alcohol, the anesthesiologist may describe the initial sensations from an intravenous anesthetic as something similar to the feeling after a glass of wine. Such an association helps the patient form a calm expectation of what they will feel.

Scented masks are used for preoxygenation. The patient may be offered pleasant aromas — chocolate or wild berries — which makes the procedure feel less frightening.

Sometimes even a detailed consultation and answers to all questions are not enough to fully overcome intense fear. In such cases, pharmacological modulation of the emotional state may be used. Medications that help reduce the anxiety component are administered for this purpose.

Is it normal if a patient is not afraid of anesthesia at all?

The absence of fear is also a perfectly normal reaction. A calm attitude toward anesthesia is often associated with prior positive experience. If a person has previously undergone anesthesia without negative experiences, a subsequent operation may provoke significantly less anxiety.

Do patients really sometimes dream during anesthesia?

Dreams during anesthesia are possible, but patients usually do not remember them, especially when it concerns a deep phase of sleep. If awakening is smooth, the patient may sometimes wake up and report that they dreamed about something.

Is there a separate anesthesia protocol for plastic surgeries?

There is no single protocol, because each patient requires an individualized clinical approach. In plastic surgery, simultaneous procedures are often performed, when several operations are combined in one session — for example, abdominoplasty with mammoplasty, or mammoplasty with blepharoplasty. This increases the duration of the operation and therefore requires corresponding anesthesia planning. The anesthesiologist’s task is to adapt the anesthesia management to the specific surgical procedure and the patient’s overall condition.

What does the expression «to change hands» mean in anesthesiology?

«To change hands» is a common practice when a certain action does not succeed on the first attempt and the physician asks a colleague for help. This is a completely normal situation that occurs not only among anesthesiologists but also among other doctors and medical staff.

Sometimes a colleague can approach the same situation from a different angle and immediately see something the first doctor missed. For example, when working with a patient the anesthesiologist is positioned at the head, and certain details may remain outside their view. A colleague coming from another position may notice that it is enough to slightly change the position or make a small rotation of the head — literally by a few centimeters — and the required maneuver becomes possible.

This does not mean one doctor is bad and another is better. A second opinion or a different approach sometimes helps accomplish what the patient needs more quickly. That is coordinated teamwork.

How does anesthesiology in films differ from the work of an anesthesiologist in real life?

Films most often show anesthesiology at moments of acute and dramatic situations: emergency operations, critical states, resuscitation measures, and the struggle to save a patient’s life.

In real life, the scope of work for an anesthesiologist–resuscitation specialist (anesthesiologist‑intensivist) is much broader. One of the key directions of their work is to do everything necessary to prevent critical situations from arising.

This is especially evident in elective surgery. Unlike urgent cases, where situations often develop suddenly, a planned operation allows time to assess the patient’s condition in advance, identify risk factors, perform the necessary examinations, and prepare the anesthesia. If the anesthesiologist’s work appears calm and even boring from the outside, that can be the best compliment to their work.