What defines a reasonable anesthesiologist?

Defining a Reasonable Anesthesiologist

A reasonable anesthesiologist is defined as an appropriately trained and suitably experienced medical professional who maintains continuous presence with the patient during anesthesia or sedation, adheres to established monitoring standards, and employs both technical and non-technical skills to ensure patient safety throughout the perioperative period. 1

Core Characteristics of a Reasonable Anesthesiologist

Professional Qualifications and Presence

• Must be appropriately trained and suitably experienced in anesthesia practice
• Maintains continuous presence with the patient throughout anesthesia or sedation
• Remains with the patient until WHO sign-out is completed and care is handed over to appropriately trained staff 1
• Properly supervises trainees when required, sometimes providing direct supervision 1

Technical Standards and Monitoring

• Implements minimum monitoring standards appropriate to the type of anesthesia:

  • For general anesthesia: ECG, SpO2, NIBP, capnography, and age-adjusted MAC monitoring 1
  • For regional anesthesia: ECG, NIBP, and SpO2 1
  • For procedural sedation: ECG, SpO2, NIBP, and capnography when verbal response is lost 1

• Uses quantitative neuromuscular monitoring whenever neuromuscular blocking drugs are administered 1

• Employs processed EEG monitoring when using TIVA with neuromuscular blockade 1

• Monitors blood glucose regularly in appropriate patients 1

Ergonomic Considerations

• Adjusts operating tables and equipment to appropriate heights for optimal patient care 1
• Positions equipment properly for procedures like central venous cannulation 1
• Makes accommodations for personal limitations (pregnancy, disability) to ensure optimal patient care 1

Consent and Communication

• Provides appropriate information to patients about anesthesia procedures 1
• Documents discussions and agreement to specific modes of anesthesia 1
• Tailors information to what each particular patient wants to know 1
• Respects valid advance decisions 1

Patient-Centered Approach

• Demonstrates confidence, empathy, humanity, personal connection, forthrightness, respect, and thoroughness 1
• Addresses common patient concerns about anesthesia (e.g., not waking up, dying during operation, awareness during surgery) 1
• Provides reassurance directly rather than delegating this responsibility 1
• Explains procedures in simple terms without jargon or emotive language 1

Professional Judgment and Ethical Considerations

• Makes reasonable efforts to judge what would be particularly significant risks for specific patients 1
• Provides honest answers to patient questions 1
• Respects patient autonomy while balancing beneficence and non-maleficence 2
• May refuse to treat a patient if they don't feel capable of providing proper care consistent with the patient's wishes, provided no additional harm results and reasonable attempts are made to find an alternative anesthesiologist 1

Pitfalls to Avoid

1. Inadequate monitoring: Failing to implement appropriate monitoring for the specific anesthetic technique being used 1
2. Poor documentation: Not documenting discussions with patients or agreements to specific anesthetic interventions 1
3. Insufficient presence: Leaving patients unattended during anesthesia or sedation 1
4. Communication failures: Using medical jargon or failing to address patient-specific concerns 1
5. Ergonomic errors: Not adjusting equipment properly, leading to suboptimal working conditions 1

The reasonable anesthesiologist recognizes that while monitoring and technology are important, they do not prevent all adverse incidents. Human error is inevitable, but proper monitoring reduces risks by detecting consequences of errors and providing early warning of patient deterioration 1. By combining technical expertise with effective communication and patient-centered care, the reasonable anesthesiologist works to maximize patient safety and quality outcomes throughout the perioperative period.