Although chloroform and ether were used since the time of Lord Lister, 150 years back, the speciality of anaesthesia has taken a long time to develop. Advances in anaesthetic agents, muscle relaxants, anaesthetic gadgets, ventilators and monitors have rapidly converted anaesthesia into a sophisticated speciality. Today the anaesthetist (syn: anaesthesiologist) is the most important member of any surgical team.
The primary role of the anaesthesiologist is as follows:
1. Pre operative check up.
2. Sedation and relaxation of the patients during the operation so that both patients and surgeon can be comfortable.
3. Airway control, and to monitor essential parameters in unconscious patients to keep them in safe limits.
4. Take care of post operative pain.
Some would also include:
5. Critical and intensive care.
6. Venous access of the larger veins.
7. Management of intractable pain.

The speciality has developed vertically and horizontally. Horizontally to include regional blocks and spinal anaesthesia. And vertically into sub specialities like neuro anaesthesia, cardio anaesthesia and paediatric anaesthesia.
The practice of anaesthesia varies from person to person and institution to institution. Many institution and hospitals engage anaesthetists on a full time basis. Some even provide them with living quarters. This is a 9 - 5 job. The pay packet includes a lump sum, with Provident Fund and Gratuity, but tax deductable at source. Some give lump sum with a percentage per case. This is preferred by lady doctors, who also have to run a home and family.
Some anaesthetists like to free lance and like to work with several surgeons, nursing homes and hospitals. They come when called, give anaesthesia and are paid pro-rata. Some carry their own bag which includes all their necessities including monitors and even syringes. Others depend for supplies on the Nursing Home. They only lend their skills. It is rare for them to see the patients before surgery and only an exceptional one phones to find out about post operative pain. Some anaesthetists are called largely as stand byes, for example, in eye operation. Here they administer sedation and monitor the patient.

Structuring their professional charges has remained a contentious issue between the surgeons, hospitals and anaesthetists. A conscientious anaesthetist who goes through the investigation of the patients, is gentle with his hands, gets venous and spinal punctures easily, gives a smooth anaesthesia and discusses the post operative management in terms of fluid therapy and pain with the surgeons deserves a higher fee. The maverick anaesthetist who only gives his skill and keeps asking for supplies and monitors from the Nursing Home, and walks away as soon as the patient is wheeled out of the theatre, is different. Some even keep the patient light so that they can go away easily. This type is a theatre hopper who hops from place to place and is always looking at his watch, so that he can cover more and more operations during the day.

All said and done it must be remembered that the anaesthetist is a specialist and deserves a fair share of his fee. It must have a lower limit even if it does not have a higher limit. In large corporate hospitals anaesthesists are paid 33% of the surgeon's fee, but in private nursing home practice most of them regard 20-25% of the surgeons fee as adequate. If the surgeon chooses to do a free operation, the anaesthetist must get a minimal respectable fee because he is not a part of the charity. It is a pity that most anaesthetists like to spend their time in operation theatres because it is more paying. Not many like to get involved with Intensive care, Critical care, Hyper alimentation and Research because it is not lucrative enough.

Some anaesthetists are now moving into a new speciality: that is pain management. They give anodynes, analgesics, epidural medication and even acupunture to relieve pain. There is tremendous scope for expansion and include paramedical specialities like acupressure, acupuncture, vibration therapy etc. Also good scope for research.
One looks forward to see the speciality of Anaesthesia bloom further and occupy a pristine place among other disciplines.

P Madhok
Ex Hon. Paediatric Surgeon,
Bai Jerbai Wadia Hospital for Children, Parel.
Hon Surgeon, Arogyanidhi Hospital, Juhu and
BARC Hospital, Deonar, Mumbai.