What knowledge, skills, and qualities can psychiatrists bring to anesthesiology?

Psychiatrists' Contributions to Anesthesiology

Psychiatrists bring critical expertise in cognitive assessment, mental health evaluation, and psychopharmacology that directly addresses perioperative neurocognitive disorders—the most common complications in older surgical patients—while also contributing to communication skills, crisis management, and the emerging field of anesthetic drugs as antidepressants. 1, 2

Core Knowledge Domains

Perioperative Brain Health and Cognitive Assessment

• Psychiatrists possess specialized training in cognitive assessment and screening for preoperative cognitive impairment, which is essential since delirium and postoperative neurocognitive disorder are the most common perioperative complications in patients over 65 years, yet anesthesiologists often fail to routinely screen for these conditions 1

• Mental health evaluation skills enable identification of patients at risk for postoperative delirium and cognitive dysfunction, including assessment of baseline cognitive function, depression, anxiety, and other psychiatric conditions that increase perioperative risk 1

• Expertise in non-pharmacologic interventions for delirium prevention is particularly valuable, as simple strategies can reduce delirium incidence by up to 40% 1

Psychopharmacology and Drug Interactions

• Deep understanding of psychotropic medications, their side effects, and potential interactions with anesthetic agents is crucial as increasing numbers of psychiatric patients undergo surgery 3

• Knowledge of how psychiatric medications affect cognition, mental physiology, and perioperative outcomes helps optimize anesthetic planning and avoid adverse drug interactions 3

• Emerging expertise in anesthetic drugs as antidepressants, particularly ketamine, nitrous oxide, propofol, and isoflurane, positions psychiatrists at the forefront of repurposing general anesthetics for neuropsychiatric treatment 2

Essential Clinical Skills

Communication and Patient Interaction

• Advanced communication skills with patients and families, particularly in delivering difficult news, managing expectations, and addressing anxiety about cognitive outcomes—areas where most older adults express significant concern 1

• Expertise in communicating with agitated, confused, or combative patients, which is valuable in pre-anesthesia sedation scenarios where physical restraint might otherwise be required 1

• Training in simulation-based communication with patients and relatives has been shown to improve quality of communication and patient/family satisfaction in critical care settings 1

Crisis Management and Non-Technical Skills

• Understanding of cognitive biases that affect clinical decision-making, including anchoring bias, availability bias, and premature closure bias—errors that are more often associated with defects in reasoning than lack of knowledge 1

• Experience managing high-stress situations and maintaining situational awareness, which translates to improved crisis resource management in the perioperative setting 1

• Skills in team coordination and leadership during psychiatric emergencies that parallel the demands of anesthesia crisis management 1

Critical Personal Qualities

Psychological Resilience and Emotional Intelligence

• Capacity to manage patients' psychological distress, anxiety, and fear—emotions that can significantly impact preoperative preparation, compliance with oxygen administration, and overall perioperative outcomes 1

• Understanding of the psychological impact of medical complications, such as the embarrassment, frustration, anxiety, and social isolation that can follow adverse events, enabling provision of appropriate counseling and support 4

• Ability to provide holistic assessment beyond physiologic parameters, including psychosocial conditions that contribute to surgical vulnerability 1

Collaborative Practice Orientation

• Experience working in multidisciplinary teams to address complex patient needs, which aligns with the anesthesiologist's role in coordinating perioperative care across specialties 1

• Comfort with shared decision-making approaches that engage patients as active participants in their care, particularly important for high-risk surgical candidates 1

Specialized Applications

Electroconvulsive Therapy (ECT)

• Comprehensive understanding of ECT indications, procedures, and treatment devices, which is essential for safe anesthesia management during modified ECT 1, 5

• Knowledge of cognitive assessment requirements before, during, and after ECT, including memory assessment at treatment termination and 3-6 months post-treatment 1

• Expertise in managing psychiatric medications during ECT, knowing which agents interfere with treatment and require discontinuation 1

Perioperative Mental Health Integration

• Ability to conduct mental health evaluations as part of comprehensive preoperative assessment, identifying conditions like chronic pain, opioid dependence, drug and alcohol use, and potential for postoperative cognitive decline 1

• Skills in providing supportive care and "surgery coaching" to prepare high-risk patients psychologically for their surgical experience 1

• Capacity to reset patient and family expectations about postoperative recovery in collaboration with surgical teams, reducing unrealistic assumptions about return to normal quality of life 1

Common Pitfalls and Caveats

• Psychiatrists entering anesthesiology collaboration must understand that their primary specialty training alone does not qualify them to administer anesthesia—specific anesthesia training and competency assessment are required 1, 6

• The traditional boundary between psychiatry and anesthesiology is eroding, creating opportunities for collaboration but also requiring clear delineation of roles and responsibilities 2

• While psychiatrists bring valuable cognitive assessment skills, implementation within fee-for-service systems can be challenging, requiring convincing hospital administration that healthier patients reduce costs through complication avoidance 1

• Personality traits that predict good performance in anesthesiology (lower neuroticism, higher extraversion, higher conscientiousness) should be considered when selecting psychiatrists for collaborative perioperative roles 7