This profession, which is vital to everyone's life, is now desperately lacking

streak

2024-06-03 17:01Posted in Anhui Life Field Creator

January 2024,

The sudden death of Zhu Xiang, a 46-year-old anesthesiologist, caused an uproar.

In recent years, sudden death of anesthesiologists has been frequent.

Let the public pay attention to the anesthesiologist profession.

According to official statistics, there are 100,000 anesthesiologists in China.

The actual demand could reach 300,000 people,

The entire industry is facing an extreme shortage of manpower,

And the training of an anesthesiologist takes at least 10 years.

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Jiang Zhengyu is an attending physician in the Department of Anesthesiology at Shanghai Changhai Hospital and a popular science blogger with 100,000 followers

From painless deliveries, major surgical procedures,

To daily painless gastrointestinal endoscopy, etc.,

Under modern medicine, almost everyone has to deal with anesthesiologists.

But anesthesiologists are often misunderstood:

"Our job is so much more than just a 'shot.'"

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A conversation with Jiang Zhengyu

In March, 31-year-old front-line anesthesiologist Jiang Zhengyu,

Published a new book "Take a deep breath, start anesthesia",

He tried to take the case of surgery that he had personally experienced,

To educate the public about the profession of anesthesiologist:

"We're feeling more pressure than ever before.

Today, the mortality rate of anesthesia has dropped to less than one in a million.

We joke that the risk of sudden death for anesthesiologists,

The risk of death is even higher than that of patients undergoing anesthetic surgery. ”

Editor: Zhang Ruijia

Editor-in-charge: Chen Ziwen

There will be some misconceptions about anesthesiology and anesthesiologists among the public. For example, people think that anesthesia is a very easy job, and the anesthesiologist gives me an injection, and I fall asleep and enter a stable state, but this is not the case.

From awakening to anesthesia, your consciousness gradually disappears, your self-regulation ability is weakened, and you need to be provided with life support from the outside world, and our anesthesiologists are to ensure that the patient is safe and comfortable no matter what surgical step you are in. The anesthesiologist will monitor the entire procedure until the patient's signs are smoothly returned to the room.

When I took the college entrance examination, I aspired to study medicine, why did I choose anesthesia? At that time, the concept of anesthesia was that it was over with one injection, and I always felt that the work of anesthesia was easy until I entered school and started studying.

We learned more than any other medical student, in addition to the regular courses of clinical medicine, we also had to take anesthesiology-related courses, I remember that the whole school was on winter vacation, only we stayed and continued to take classes, and I felt the pain of this major for the first time.

Unlike surgeons, who have one or two surgery days a week, anesthesiologists operate every day and face high-intensity and tense surgeries every day.

My daily routine is generally like this: get up at 6:30 in the morning, arrive at the operating department at 7:30 to prepare, start the formal operation at 8 o'clock, and the teacher will change you out for dinner at noon, which is only 20 minutes, and continue to return to the operating room in the afternoon; We perform an average of 3 to 4 surgeries a day, and depending on the time of operation, we leave work at 8 or 9 o'clock in the evening, and 5 or 6 o'clock in the morning. In addition to this, there are business learning and research debriefings. I basically went home and took a shower and went to sleep, day after day.

The most memorable month was the internship rotation to pancreatic surgery anesthesia. Pancreatic surgery is a relatively large operation in general surgery, because the position of the pancreas is very deep, the blood vessels are abundant, and blood pressure fluctuations often occur during the operation.

Maybe one second I was dealing with its blood pressure, the next second it had a heart rate problem, and then the surgery had a heavy hemorrhage and needed to quickly replenish blood volume to maintain the stability of vital signs, and also to calculate how much intravenous fluid to give it considering how long the operation had been going on. For the entire three or four hours of surgery, I was in a state of high nervous tension. One day I was so depressed that I told my teacher in despair that I really couldn't do it anymore.

Over time, our anesthetized colleague's body is in a sub-healthy state, even a state of stress, if his physical condition is not very good, there will be some emergency heart problems, or even sudden death.

According to official statistics, there are currently 100,000 anesthesiologists in mainland China, but the actual demand is about 300,000, so anesthesiologists are in an extremely short supply, which also leads to the problem of overwork and high sudden death rate of anesthesiologists.

The training cycle of an anesthesiologist is long, from a student to working independently, which can take up to 10 years. Therefore, we will face a shortage of anesthesiologists for a long time in the future, and it cannot be solved immediately in one or two years.

In particular, everyone's requirements for comfortable medical care have increased, and in the past, everyone may have endured gastrointestinal endoscopy, but now they basically have to do painless, which has also led to an increase in anesthesia workload, and now painless gastrointestinal endoscopy accounts for almost 1/3 of the workload of anesthesiology.

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Inform the patient's family of the risks of anesthesia before surgery

We generally divide anesthesia into 3 types:

The first is intravenous anesthesia, such as painless family planning, painless gastrointestinal endoscopy, etc., which are exposed to daily life, and you will be given an injection, and the anesthetic will enter from the blood vessels, and you will fall asleep.

The second is general anesthesia, for example, the patient has to experience a relatively large surgical trauma, we intubate him, use a full set of anesthetic drugs, he is unconscious during the whole operation, and respiratory arrest, blood pressure may also fluctuate violently, and he will slowly wake up after the operation, so this type of anesthesia requires more detailed and comprehensive monitoring by doctors.

The third type is neuraxial anesthesia, also known as hemibody anesthesia, such as lower limb and joint surgery and painless delivery. We do a puncture on the back of the pregnant woman, and a catheter is placed and some anesthetic medication is continuously pumped in order to relieve the pain during labor.

Painless childbirth is not a new technology, we have been doing it since the 90s, but why has it only recently started to be promoted? On the one hand, the team of anesthesiologists is growing as a whole, and on the other hand, everyone has higher requirements for comfortable medical care.

Despite this, the rate of painless delivery is still relatively low, with only about 30% in public hospitals. Many people say that they can't get on the list, but in fact, it is also because of the shortage of anesthesiologists, so they can only give priority to the anesthesia of surgical operations, and then do painless delivery with the remaining strength.

Unlike many people think, anesthesiologists can make decisions just like surgeons. For example, there was a patient with a huge abdominal tumor that weighed up to 60 pounds. On the operating table, although the more tumors are removed, the longer the patient's survival is also an affirmation of the surgeon's skills, but for the anesthesiologist, this represents the higher the risk of the patient. Can the patient's body tolerate such a large amount of resection? Can the bleeding from surgery be controlled? Our primary concern is whether the patient will be able to wake up smoothly when they return to the ward.

Therefore, the operation was stopped after a bleeding session, because the amount of blood was really insufficient, and I could not guarantee that the patient would survive the operation in the face of bleeding in the back, so I insisted on telling the surgeon to stop the larger resection.

In many cases, the anesthesiologist is the gatekeeper, and we have to make sure that the patient gets out of the operating room alive, and this premise is met, and all surgical treatments are effective.

We are more like the conductors in the operating room than the surgeons who focus on surgery, and if the surgeon has a problem with the surgery, we call it "the surgeon poked us in the basket again" (laughs), and that's when we rush forward. We are like brothers in the trenches, standing on top of each other.

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Stills from the medical-themed documentary "The World".

Of course, the anesthesiologist also has the risk to take, and a major anesthetic mistake during the operation is called "intraoperative knowledge", and I also describe a case that I personally experienced that may be "intraoperative knowledge".

At that time, when I was on the stage with my superior, I saw that the patient's EEG data continued to rise, even exceeding our threshold, according to the teaching in the book, this patient may be in the stage of awakening, and it was in the middle of the operation, I panicked, should I deepen the anesthesia? But his signs were steady.

At that time, my superior was present and the patient's heart rate and blood pressure were normal, and there was no intraoperative knowledge. What do you think of a single piece of data for a vital sign? This requires a lot of clinical experience.

The now recognized origin of modern anesthesiology is ether anesthesia, which was publicly demonstrated at the Massachusetts General Hospital in the United States in 1846.

Before that, surgery was a very painful process, and the West would use methods such as drinking alcohol and sticks to make the patient faint, and some simple surgical procedures would be done, but it was very dangerous, the patient faced severe pain, unstable vital signs, and there could be heavy bleeding, and the infection was not controlled.

In 1846, patients were allowed to go to sleep and undergo surgery, and we also have records in China of Hua Tuo's use of Ma Boiling Powder, and patients fell asleep after drinking Chinese medicine.

In the last 100 years, our medicines have also advanced a lot. Nowadays, we will use three important drugs in anesthesia:

One is a sedative, which makes you fall asleep; One is analgesics, so you don't have pain; One is called muscle relaxant, which keeps you from moving and meets the needs of surgery.

During surgery, drugs are constantly being administered and stimuli are constantly changing, and we need to put the patient in a smooth anesthesia phase in general. Sometimes the anesthesia is a little shallower, sometimes it is a little deeper, and these are all dynamically adjusted by us.

There was once a case in the United States where its sedatives and analgesics did not work, but muscle relaxants worked, so the patient could not move or make a sound during the whole process, but could feel the pain.

Until now, the mortality rate of our anesthesia has been reduced to less than one in a million, and the safety has been fully guaranteed. So in recent years, the focus of our discipline has been on improving patient comfort.

So we joke that the risk of death is lower for patients undergoing anesthesia surgery than for sudden death by anesthesiologists.

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Jiang Zhengyu and colleagues in the Department of Anesthesiology

There are a total of 130 anesthesiologists in our hospital, and there are 13 anesthesiologists working in the workplace, and the anesthesiology department of each hospital is the department with the largest number of doctors in this hospital, and it is the hub of the hospital, which not only has to deal with the needs of internal medicine, surgery, and auxiliary examinations, but also has the largest workload.

In fact, I feel quite stressed about the future development of anesthesia. Because medical care is becoming more and more comfortable, we are the central discipline of comfortable medical care, and what everyone is most afraid of when they go to the hospital is whether this operation will be painful and uncomfortable?

But I think this is also the meaning of our work, the work of the past few decades has done a good job of patient safety, and in the future, I hope that everyone will come to the hospital to see a doctor, there is no discomfort, and I will be discharged when I am well, which is the state that all of our medical workers hope to achieve.

Writing this book not only wants the public to know about anesthesiologists, but also has a selfish desire to hope that more medical students can understand anesthesia and then join the anesthesia profession. My colleague joked that you have to "pit" many medical students in this book, but I think the development of a profession or discipline needs people, and the more people join, the better and better our industry can develop. In order to solve the problem of shortage of anesthesiologists, comfortable medical care can develop better.

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Personal opinion, for reference only