Anaesthetist

An Anaesthetist is responsible for delivering safe and effective anaesthesia care throughout the preoperative, intraoperative, and postoperative phases. Their work begins with assessing the patient’s medical history, comorbidities, laboratory findings, airway anatomy, and medication use to determine the safest anaesthesia plan. They provide general, regional, local, or sedation anaesthesia based on surgical requirements and patient stability. During surgery, the Anaesthetist continuously monitors vital signs—including ECG, blood pressure, oxygen saturation, capnography, and ventilation parameters—to maintain hemodynamic stability. They manage fluid therapy, blood transfusions, and emergency interventions when needed. Postoperatively, they ensure smooth recovery, manage pain, detect complications such as respiratory distress or hypotension, and provide critical care support. Outside the OT, Anaesthetists also assist in ICU management, emergency intubations, trauma resuscitation, labour analgesia, and procedures like endoscopy or cardioversion. Their role is vital for patient safety and surgical success.

Assessment begins with a thorough pre-anaesthetic check-up (PAC), including history taking, physical examination, airway evaluation, and review of laboratory and imaging investigations. The Anaesthetist evaluates cardiovascular, respiratory, renal, neurological, and endocrine systems to identify risk factors that may affect anaesthesia. Tools such as the ASA Physical Status Classification help stratify risk levels. Airway assessment uses parameters like Mallampati grading, neck mobility, and jaw protrusion to predict intubation difficulty. The Anaesthetist reviews medications, allergies, bleeding risks, and previous anaesthesia reactions to prevent complications. They also optimize uncontrolled comorbidities such as hypertension, diabetes, COPD, or anaemia prior to surgery. Patient counselling regarding fasting instructions, anaesthesia type, risks, and postoperative expectations forms an essential part of suitability assessment. This preoperative evaluation ensures safety, minimizes complications, and enables smooth perioperative planning.

Intraoperative complication management requires rapid decision-making, continuous monitoring, and knowledge of advanced airway and resuscitation techniques. The Anaesthetist anticipates risks through preoperative assessment and prepares emergency drugs such as vasopressors, bronchodilators, analgesics, and resuscitation agents. When complications arise—such as hypotension, arrhythmias, bronchospasm, laryngospasm, malignant hyperthermia, or difficult ventilation—they initiate immediate corrective measures while maintaining communication with the surgical team. Airway management skills, including endotracheal intubation, supraglottic device placement, and emergency cricothyrotomy, are critical. The Anaesthetist adjusts ventilation settings, oxygen concentration, and anaesthetic depth to stabilize the patient. All events are documented promptly, followed by postoperative monitoring and review. Their expertise ensures surgical safety even during unexpected emergencies.

Patient safety is ensured through continuous, protocol-based monitoring using ECG, non-invasive or invasive blood pressure, pulse oximetry, end-tidal CO₂, temperature, and urine output. Anaesthetists maintain appropriate anaesthetic depth to prevent awareness while avoiding excessive sedation that may depress vital functions. They adhere to WHO surgical safety checklists, confirm patient identity, allergies, fasting status, and consent before induction. Equipment such as ventilators, suction devices, defibrillators, and anaesthesia machines are checked thoroughly before each case. Strict aseptic techniques are followed during invasive line insertions. During surgery, early detection of deviations in oxygenation, perfusion, or ventilation helps prevent complications. After the procedure, the Anaesthetist monitors recovery, airway reflexes, postoperative pain, and overall hemodynamic stability in the recovery room. Their vigilance ensures high-quality perioperative care.

Postoperative care includes monitoring airway stability, consciousness, breathing, circulation, and pain levels in the PACU (Post Anaesthesia Care Unit). Anaesthetists administer multimodal analgesia using opioids, NSAIDs, nerve blocks, PCA (patient-controlled analgesia), or epidural infusions depending on the surgery. They manage nausea, vomiting, shivering, respiratory depression, and delayed awakening. For regional anaesthesia cases, monitoring of limb movement, sensation, and block regression is essential. The Anaesthetist coordinates with surgical and nursing teams for fluid management, oxygen therapy, and early mobilization strategies. They also educate patients about pain control methods and signs of complications. Proper postoperative care ensures smooth recovery, reduces complications, and improves patient satisfaction.

An Anaesthetist must complete MBBS followed by a postgraduate specialization such as MD Anaesthesia, DA (Diploma in Anaesthesia), or DNB Anaesthesiology, which provides intensive training in airway management, pharmacology, ventilator support, and perioperative care. Many specialists further pursue fellowships in cardiac anaesthesia, neuro-anaesthesia, paediatric anaesthesia, critical care, or pain medicine to gain advanced skills. Registration with the National Medical Commission (NMC) or relevant state council is mandatory. These qualifications ensure that the Anaesthetist can manage high-risk patients, complex surgeries, and emergency scenarios with clinical precision.

Core postgraduate degrees (MD/DA/DNB) are essential, but many hospitals prefer candidates with advanced training such as Fellowship in Critical Care (IDCCM/FNB), Fellowship in Cardiac Anaesthesia, Diploma in Pain Management, Ultrasound-guided Regional Anaesthesia Training, or Difficult Airway Management Courses. Certifications like ACLS, BLS, Ventilator Management, and Advanced Trauma Life Support enhance proficiency in emergency handling, ICU support, and perioperative safety. These courses expand career opportunities and prepare the Anaesthetist for specialized surgical centers.

Anaesthetists in India typically earn ₹1.2 lakh to ₹2.5 lakh per month as fresh postgraduates, while experienced consultants earn ₹3 lakh to ₹6 lakh per month, depending on hospital level, city, workload, and specialty area. Senior anaesthetists in cardiac surgery, neurosurgery, and critical care may earn ₹8–12 lakh per month or more, especially in high-volume corporate hospitals. Freelance OT anaesthetists and pain specialists frequently earn additional income from case-based services.

Yes, demand is consistently high due to increased surgical volumes, ICU expansion, emergency services, and the growth of super-speciality hospitals. Anaesthetists are required in general surgery OTs, cardiac centers, neurosurgery units, trauma care, obstetric OTs, endoscopy suites, IVF centers, cath labs, and critical care units. Government hospitals, private hospitals, day-care surgical centers, and standalone surgical units regularly recruit Anaesthetists, particularly in tier-2 and tier-3 cities where shortages are more significant.

While postgraduate training is mandatory, advanced certifications such as Difficult Airway Certification, Ultrasound-guided Nerve Block Training, Pediatric Anaesthesia Fellowship, Cardiac Anaesthesia Fellowship, Pain Management Certification, and Critical Care Fellowships significantly enhance capabilities. These credentials improve clinical confidence, broaden procedure handling capacity, and increase eligibility for senior roles in tertiary care hospitals.