Spotlight on: Our anaesthetists

Anaesthetists may also care for you in labour or delivery, in the Emergency Department, the resuscitation area and when you are critically ill.

They are specialist doctors responsible for providing anaesthesia and pain management to patients across the Trust, before, during and after operations and surgical procedures.

Dr Manasi Bhagwat, Consultant Anaesthetist, and Dr Rachel Morris, Chief of Service for Anaesthesia, give an insight into their work.

“Our responsibility with a patient starts with pre-operative assessment that can either be in a consultant anaesthetist clinic, or we will see them on the day of the procedure,” said Rachel.

“We ask relevant questions, including their general health, what medicines they take, or whether they’ve had any operations before. We explain what we are going to do from an anaesthetic point of view and encourage a patient to ask questions.

“Of course, when patients leave the pre-operative assessment and in advance of surgery, it’s very important that they understand the risks of anaesthesia and the procedure ahead.

“Depending on the procedure, there are different ways of providing anaesthesia that don’t necessarily mean the patient is asleep. For some procedures and in some circumstances regional anaesthesia may be beneficial – this is where a local anaesthetic is injected around nerves to numb a specific part of the body. We discuss with the patient which would be better and which they would prefer. It’s shared decision-making though, of course, patient safety is the priority and this frames how we guide them.

Tailoring anaesthetics for our patients

“People’s perception might be that we give the same anaesthetic to everybody, but in fact we carefully tailor anaesthetics for our patients. The range of patients we see varies hugely, from the quite old and frail to potentially a six foot four, second row rugby player. So, tailoring our anaesthetic to each individual is crucial and looks at many factors.”

“It’s helpful to patients to give information early so that they can digest what it is being discussed with them and what they need to do”, said Manasi. “That is particularly important for day surgery. Patients need to know in advance that their procedure is appropriate as a day procedure, with the benefit of going home the same day – which patients much prefer.

“When it’s a major operation and there’s a lot of information for the patient to consider, they need to actually have time to be able to digest what’s been discussed and then they can come back with different questions at different times. It’s a perfectly normal response. When we are patients, we focus on some details and need more time to think about others.

“People don’t always know a lot about us. Most patients won’t remember you, which is part of the job – in a typical week I may look after 20 patients.

“We quickly build a relationship of trust with the patient when we first see them, even if only in a few minutes. It’s important that the patient feels comfortable enough and confident enough for their procedure and that we’re totally focused on looking after them during that time and carefully helping them recover from the anaesthetic.

“I think this is one of the biggest responsibilities you could have as a doctor and we take it extremely seriously.”

The importance of team work

Rachel said: “Providing a safe service for our patients is very satisfying – busy, challenging, but satisfying. It’s important that we work in a safe, comfortable and friendly environment and team working is part of this. Everybody has their own individual skills and is a crucial part of the team.

“Within a team you will have an anaesthetist, surgeons, an operating department practitioner, a theatre support worker and the theatre nurses.

“As anaesthetists, we all have the same generic skills. However, we all specialise in different areas, similar to surgeons. For example, you can have a vascular anaesthetist or a specific regional anaesthetist. Many surgical specialties, head and neck cancer, thoracic surgery or colorectal, for example, require anaesthetists with particular skills.

“I like doing a busy list seeing several patients and also the more complex cases. Manasi and I both provide anaesthesia for HIPEC procedures – hyperthermic intraperitoneal chemotherapy. We are one of only a very small number of hospitals able to deliver this therapy.”

Hyperthermic intraperitoneal chemotherapy

HIPEC is a procedure carried out following the completion of complex surgery to remove all visible cancer in the abdomen and pelvis. After the initial procedure has been completed, a 40-42°C solution is washed through the patient, in an attempt to kill off any cancer cells that are not visible to the surgeons. Patients must meet very strict criteria to be eligible – they need to be assessed fit enough to undergo this extensive surgery.

“It’s very difficult, but very rewarding,” said Manasi. “A patient can be anxious at the start, but then at the end of it you see them a few days later and they’re going home.

“It’s a privilege to be part of a medical profession where the progress and development of technology now is absolutely mind-blowing. It’s also a privilege to look after patients and play our part in keeping them safe day in and day out.”

• The HIPEC equipment was purchased thanks to a grant from the N&N Hospitals Charity and donations from Norfolk businesses, insurance specialist Alan Boswell and charity supporter David Geiss.