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The Anesthesiologist assistantsâ?? Role in the Management of Patients Undergoing General Anesthesia
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Medical and Hearing (Volume 28 S1) / March 2024

Research Article Pages:6-17
10.5935/0946-5448.2024.S1.02

The Anesthesiologist assistantsâ?? Role in the Management of Patients Undergoing General Anesthesia

Authors: Jasim Khalaf*, Afraa Ibrahim, Hayder Abbas Alkayssi

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Abstract

Background: The present study designed as a descriptive one, was carried on 57 anaesthesiologist assistants and 18 anesthesiologists at operating rooms in four hospitals in Al Anbar govern including Al- Ramadi Teaching Hospital, Al-Ramadi Teaching Hospital for Maternity and Children, Al-Razi Hospital and Al -Safwa Hospital. Aim: This study was to determine the role of anesthesiologist assistant for the care of patients undergoing general anesthesia. Methods: Data were collected using an anesthesiologist assistant’s role opinion. Results: The result of this study revealed that the majority of the anesthesia assistants and anesthesiologists from all hospitals agreed about the role to be delegated to the anesthesiologist assistant’s during the preoperative phase, the preinduction of anesthesia toward equipment and patient, the induction and maintenance of anesthesia, and during the emergency period. The majority the anesthesia assistants and anesthesiologists agreed about anesthesia courses containing knowledge and skills to be included in any educational program during the basic study, post basic and on the job and the majority reported that, it should be given by specialists from the medical and nursing staff, two years after Diploma of Technical Medical Institute of Anesthesia plus training in the anesthetic field were and reported by more than any other qualifications from both anesthesia assistants and anesthesiologists. The anesthesiologist assistant should work interdependently and must work under the direction and supervision of anesthesiologist. Conclusions: It is concluded that the anesthesiologists and operating room assistants agreed about the role of an anesthesiologist assistant’s during the perioperative phases of general anesthesia. Recommendation: The study recommended different strategies to enhance an anesthesiologist assistant’s knowledge and practice related to general anesthesia in the operating room.

Keywords: Anesthesia; Anesthesiologist; Anesthesiologist Assistantâ??s.

Introduction

Meeting the goals of a reformed healthcare system requires the expertise of professionals, especially those with specialized knowledge and skills. In the instructed health care system, Anesthesiologist assistant’s prepared for anesthesia is considered to be unique and valuable providers [1]. The concept of anesthesiologist assistant’s is the healthcare professionals who specialize in administering anesthesia to patients before, during, and after medical procedures or surgeries. Their primary role is to ensure patient safety and comfort by managing pain, maintaining vital functions, and monitoring the patient’s condition throughout the procedure. In North America and the United Kingdom, respectively, when anesthesiologist assistants who had completed courses and implies a level of knowledge and skill in anesthesia system which is acquired during the courses of basic anesthesia education [2].The specific roles and responsibilities of anesthesiologist assistant’s may vary slightly between different world and Arab countries, depending on the local healthcare system and regulatory frameworks. However, the overall objective remains the same: to ensure the safe and effective administration of anesthesia and the wellbeing of patients during surgical procedures [3]. A study conducted in Iraq aimed to determine and understand the quality of life among anaesthesiologist assistants who were coping with COVID-19 and non-COVID-19 intensive care units. The study enrolled 1,100 anaesthesiologist assistants working at the time of the COVID-19 outbreak in treatment centers in different regions of Iraq. The results showed that the mean SF-36 score was 65.2, with a lower mean score of the mental component summary than the physical component summary [4]. He [5] added study conducted in Iraq aimed to explain that anesthesiology assistant’s work collaboratively with physician anesthesiologists to provide the highest level of patient care in clinical settings. However, this study is not specific to Iraq and anesthesia provider also include Anesthesia Technician in Iraq does not provide specific information about the role [6]. A job description fact sheet from the University of Colorado Denver explains that anesthesiology assistants are qualified by academic and clinical education to provide anesthetic care under the direction of a qualified physician anesthesiologist [7].

Material and Methods

Research Design:

A descriptive research design was utilized in this study that was portrayed under four main designs as follows:

1. Technical Design

2. Operational Design

3. Administrative Design

4. Statistical Design

Technical Design: The technical design of the study includes setting, target population and tool for data collection.

Setting: The study was carried out in the operating rooms of the following hospitals:

• Al- Ramadi Teaching Hospital

• Al-Ramadi Teaching Hospital for Maternity and Children

• Al-Razi Hospital

• Al -Safwa Hospital

Target Population: The study population was divided into two groups:

Group (A): Consisted of all available anesthetic physicians working in the operating rooms in the abovementioned settings. These were 18 anesthesiologists distributed as following:

• 5 from Al Ramadi Teaching Hospital

• 5 from Ramadi Teaching Hospital for Maternity and Children

• 4 from Al-Razi Hospital

• 4 from Al -Safwa Hospital

Group (B): Consisted of all available anesthesiologists’ assistants working in the operating rooms of the abovementioned settings. They were 57 anesthesiologists’ assistants distributed as following:

• 23 from Al Ramadi Teaching Hospital

• 11 from Ramadi Teaching Hospital for Maternity and Children

• 12 from Al-Razi Hospital

• 11 from Al -Safwa Hospital

Inclusion Criteria: (for both anesthesiologists and anesthesiologists’ assistants):

• Male and female

• Had at least three years’ experience in operating room.

Study Tool: It is a structured interview sheet developed by Heather Douglass (2018) based on review of literature and international standards of anesthesiologists’ assistants and modified by the researcher to determine anesthesiologist’s and anesthesiologists’ assistants opinion about the role of anesthesiologists’ assistants in the care of patients undergoing general anesthesia. This tool includes following parts.

Part (1): It includes items related to socio demographic characteristics such as age, workplace, qualifications, positions, years of experience and previous attendance of training program related to general anesthesia.

Part (2): Includes items related to the role of anesthesiologists’ assistants for patient undergoing general anesthesia during preoperative, intraoperative and postoperative phases.

Preoperative Phase: It includes items related to anesthesiologist assistant role during the preoperative phase.

Intraoperative Phase: It items related to anesthesiologist assistant role during Intraoperative phase.

Postoperative Phase: It includes items related to anesthesiologist assistant role during postoperative phase.

Scoring System: For anesthesiologist assistant and physicians’ impact, a checked answer was scored “one” for (Yes) and the unchecked (No) answer was scored “zero”. The scores of the items were summed up and the total divided by the number of the items, the score was converted into a percent score.

Operational Design: It includes preparatory phase, content validity, pilot study and fieldwork.

Preparatory Phase: It includes reviewing of literature, previous studies and theoretical knowledge of various aspects of the problem using books, articles, and Internet, periodicals magazines in order to develop the tools.

Content Validity: It was ascertained by 5 expertises from anesthetic physicians having at least 3 years of experience in operating rooms and accordingly modifications were done.

Pilot Study: A pilot study was carried out over a period of 4 days. It was applied on 10% of the study sample (two anesthesiologists and five anesthesiologist assistant) to test the feasibility of the study and clarity of the questions and the necessary modifications were done.

Fieldwork: Data were collected within 6-month period starting from the beginning of August 2022 till the end of February 2023. The researcher interviewed all anesthesiologist assistant and physicians in operating rooms in individual base, during three shifts, morning, afternoon and evening for three days per week. Two to three anesthesiologist assistants and physicians were interviewed per day, by the researcher who first introduced his self and explain the objective of the study. The sheets were distributed to anesthesiologist assistant and physicians and the researcher asked them to complete the sheets. Each interview lasted for 20-25 minutes depending on the interviewee’s responses.

Administrative Design: An official permission to conduct the study was obtained from the Directors of the mentored study sample after explanation of the purpose of the study. Anesthesiologists and anesthesiologist assistants consent for participation were obtained after explanation of the objectives of the study.

Results

(PART I)

Table 1 shows the distribution of anesthesia assistants and physicians in all hospitals according to their socio demographic characteristics

Items RTH RTHMC RH SH Total
Anesthesia assistants Physicians Anesthesi assistants Physicians Anesthesia assistants (n= 12) Physicians Anesthesia assistants (n=11) Physicians Anesthesia assistants (n=57) Physicians
(n= 23) (n= 5) (n=11) (n= 5) (n= 4) (n= 4) (n= 18)
  No % No % No % No % No % No % No % No % No % N o %
Age                                        
>20 1 4.3 0 0 0 0 0 0 0 0 0 0 2 18.2 0 0 3 5.3 0 0
20<30 4 17 2 40 5 46 0 0 1 8.3 0 0 7 63.6 0 0 17 29.8 2 11
30<40 12 52 0 0 4 36 1 20 11 92 3 75 2 18.2 0 0 29 50.9 4 22
40+ 6 26 3 60 2 19 4 80 0 0 1 25 0 0 4 100 8 14 12 67
Sex                                        
Male 1 4.3 5 100 1 9.1 5 100 4 33 2 50 0 0 4 100 6 10.5 16 89
Female                                        
22 96 0 0 10 91 0 0 8 67 2 50 11 100 0 0 51 89.5 2 11
Qualifications                                        
Doctorateof anesthesia                                        
0 0 1 20 0 0 0 0 0 0 0 0 0 0 1 25 0 0 2 11
Master ofanesthesia                                        
0 0 4 80 0 0 5 100 0 0 4 100 0 0 3 75 0 0 16 89
Diplomaof Technical MedicalInstituteof Anesthesia                                        
21 91 0 0 8 73 0 0 9 75 0 0 7 63.6 0 0 45 78.9 0 0
Diplomaof TechnicalInstituteof   Nursing 2 8.7 0 0 0 0 0 0 3 25 0 0 2 18.2 0 0 7 13.2 0 0
BSC of Nursing 0 0 0 0 3 27 0 0 0 0 0 0 2 18.2 0 0 5 8.8 0 0
Position:                                        
Head nurse 3 13 0 0 1 9.1 0 0 1 8.3 0 0 1 9.1 0 0 6 10.1 0 0
 Technicalanesthesia                                        
2 8.7 0 0 0 0 0 0 3 25 0 0 2 18.2 0 0 7 12.3 0 0
 Doctorateof anesthesia                                        
0 0 5 100 0 0 5 100 0 0 4 100 0 0 4 100 0 0 18 100
 AnesthesiaAssistants                                        
18 78 0 0 10 91 0 0 8 67 0 0 8 72.7 0 0 44 77.2 0 0
Years ofexperience                                        
 3<5 1 4.3 2 40 4 36 1 20 2 17 1 25 4 36.4 0 0 11 19.3 4 22
5<10 4 17 0 0 2 18 1 20 0 0 2 50 4 36..4 0 0 10 17.5 3 16,7
10<15 2 8.7 0 0 0 0 0 0 4 33 0 0 2 18,2 0 0 8 14 0 0
15+ 16 70 3 60 5 45 3 60 6 50 1 25 1 9 4 100 28 49,2 11 64
 Previous attendance of training programs related to general anesthesia                                        
2 8.7 5 100 3 27 5 100 1 8.3 4 100 0 0 4 100 6 10.5 18 100

Table 1. Distribution of operating room anesthesia assistants and anesthesiologists' in all hospitals according to their socio demographic characteristics.

Regarding to age, slightly more than half of the total studied anesthesia assistants (50.9%) were in the age group 30-<40, while 66.7% of all physicians had 40 years or more. As regards sex, the majority of total anesthesia assistants were females in all settings (89.5 %). In addition this table shows that, majority of the physicians (88.9%) were males.

Concerning qualification, 78.9% of total studied anesthesia assistants had Diploma of Technical Medical Institute of Anesthesia, while the majority of total studied physicians (88.9%) had master degree in anesthesia. In relation to position, more than three quarters of total studied anesthesia assistants from all hospitals were operating room anesthesia assistants (77.2%), while all studied physicians are doctors.

Considering the years of experience, only 49.2% of total studied anesthesia assistants had experience 15 years or more, while 14.0% of total anesthesia assistants had experience from 10 -< 15 years, and more than three fifths (61.1%) of the total studied physicians had experience 15 years or more.

The results also revealed that only minorities of anesthesia assistants, working in Al-Ramadi Teaching Hospital (8.7%), Al- Ramadi Teaching Hospital for Maternity and Children (27.3%), Al-Razi Hospital (8.3%) had previous training programs related to general anesthesia, while none of the anesthesia assistants working in Al Safwa Hospital had any training. On the other hand, all of the studied physicians in all settings had previous training in general anesthesia as illustrated by Table 1.

(PART II)

Table 2 and Figure 1 show anesthesia assistants’ and physicians’ opinions regarding the anesthesiologist assistant role during preoperative phase

tinnitus-anesthesiologist-assistant

Figure 1: Anesthesia assistant’s and physician’s opinions regarding the anesthesiologist assistant role (the day before surgery)).

The results revealed that less than two thirds of total studied anesthesia assistants’ and physicians, agreed about all items related to the role of anesthesiologist assistant during the preoperative phase. The table shows that less than two thirds of total studied anesthesia assistants’, and more than three quarters of total studied physicians agreed about most items related to the role of anesthesiologist assistant as regards assessing and recording physical condition of the patients, except for item related to weight was reported by less than half the anesthesia assistants in Al-Razi Hospital (41.4%), and (45. 5%) in Al- Safwa Hospital. In addition to height was reported by 41.7% in Al-Razi Hospital, also habits (narcotics alcohol, cigarettes), allergies, intake of medications, previous disease history and previous anesthesia (type & any reactions) were agreed by 40.0% of physicians in Ramadi Teaching Hospital. As for assessment and recording of psychological condition of the patient less than three quarters (72.2%) of total physicians and (73.7%) of total anesthesia assistants’ agreed about this item.

Table 2 considering providing psychological support and assurance also reveals that the item related to answer or look for the answers of any question was agreed to be assumed by the anesthesiologist assistant by 78.9% of the studied anesthesia assistants’ and 66.7% of the studied physicians. Check the chart for the presence of investigations, informed consent, special medication, obtain anesthesia consent and instruct the patient about NOP, and stop smoking were agreed to be assumed by the anesthesiologist assistant by ( 87.7% and more) of total studied anesthesia assistants’ and physician. Concerning removal of jewelry, hair pins, nail polish and make up, they were agreed to be assumed by the anesthesiologist assistant by most of the anesthesia assistants’ and by all studied physicians except for prosthesis as report by 83.3%. The only statistical significant difference between anesthesia assistants’ and physicians’ opinions was found regarding to the assessment of patient weight at p ≤ 0.05., as illustrated by Table 2 and Figure1.

Items RTH RTHMC RH SH Total FEp
Anesthesia assistants (n= 23) Physicians Anesthesia assistants (n=11) Physicians Anesthesia assistants (n= 12) Physicians Anesthesia assistants (n=11) Physicians Anesthesia assistants (n=57) Physicians
(n= 5) (n= 5) (n= 4) (n= 4) (n= 18)
No % No % No % No % No % NO % No % No % No % No %
1- Assess the physical condition of the patients and records it on anesthesia chart                                          
Age 18 78 3 60,0 11 100,0 5 100 11 92 4 100 8 73 4 100 48 84 16 88,9 1
Height 19 83 4 80 11 100 4 80 5 42 4 100 6 55 4 100 41 72 16 89 0,200
Weight   16 70 4 80 11 100 5 100 5 41 4 100 5 45,5 4 100 37 65 17 94 0.016*
Skin Condition 16 70 4 80 11 100 5 100 9 75 4 100 8 73 4 100 44 77 17 94 0.165
Mobility 18 78 3 60 11 100 5 100 9 75 3 75 8 73 4 100 46 81 15 83 1
Habits (narcotics, alcohol, cigarettes) 19 83 2 40 11 100 5 100 11 92 4 100 8 73 3 75 49 86 14 78 0.466
Allergies 20 87 2 40 11 100 5 100 11 92 3 75 8 73 4 100 50 88 14 78 0.444
Intake of medications 17 74 2 40 10 90.9 5 100 11 92 4 100 7 64 3 75 45 79 14 78 1
Previous disease history 19 83 2 40 11 100 5 100 9 75 4 100 6 55 3 75 45 79 14 78 1
Previous anesthesia (type and any reactions 20 87 2 40 11 100 5 100 9 75 4 100 7 63 3 75 47 83 14 78 0.731
Pulse rate 21 91 3 60,0 11 100 5 100 10 83 4 100 9 81 3 75 51 90 15 83 0.441
Blood pressure 21 91 3 60,0 11 100 5 100 11 91,7 4 100 9 81 3 75 52 91,2 15 83 0,389
Respiratory rate and rhythm 20 87 3 60,0 11 100 5 100 10 83 3 75 7 64 3 75 48 84 14 78 0,499
Airway potency 19 83 4 80 10 90.9 5 100 9 75 3 75 6 55 3 75 44 77 14 78 1
Level of consciousness 18 78 3 60,0 11 100 5 100 8 67 3 75 6 55 3 75 43 75 14 78 1
(2) Assess the psychological   condition of the patients and record it on anesthesia chart (fear, irritability and insomnia) 18 78 4 80 11 100 4 80 6 50 3 75 7 64 2 50 42 74 13 72 0.754
(3) Provide psychological   support and assurance                                          
Explain what is the meant by general anesthesia 20 87 3 60 11 100 4 80 10 83.3 3 75 6 54.5 3 75 47 82.5 13 72.2 X2
=0.895    p=0.344
Answer or look for the answers of any question 20 87 2 40 11 100 5 100 8 66.7 3 75 6 54.5 2 50 45 78.9 12 66.7 X2
=1.131    p=0.288
(4) Check for the presence of the following patients chart                    
                   
 Investigations 20 87 4 80 11 100 5 100 11 91.7 4 100 9 81.8 3 75 51 89.5 16 88.9 1
                   
Informed consent 21 87 4 80 11 100 5 100 11 91.7 4 100 9 81.8 4 100 52 91,2 17 94.4 1
Special medication 20 87 3 60 11 100 5 100 12 100 4 100 7 63.6 4 100 50 87.7 16 88.9 1
(5) Obtain anesthesia consent and attach it to anesthesia chart 22 95.7 4 80 11 100 5 100 10 83.3 3 75 7 63.6 4 100 50 87 16 88.9 1
                   
(6) Instruct the patient about                    
                   
NPO 20 87 4 80 11 100 5 100 11 91.7 4 100 9 81.8 4 100 51 89.5 17 94.4 1
                   
stop smoking 21 91.3 5 100,0 10 90 5 100 10 83.3 4 100 9 81.8 4 100 50 87.7 18 100 0.186
                   
(7) Removal of the following                    
                   
Prosthesis 21 91.3 5 100,0 11 100 5 100 12 100 3 75 11 100 2 50 55 96.5 15 83.3 0.086
Jewelry 23 100 5 100,0 10 90 5 100 11 91.7 4 100 11 100 4 100 55 96.5 18 100 1
Hair Pins 23 100 5 100,0 11 100 5 100 11 91.7 4 100 11 100 4 100 56 98.5 18 100 1
Nail polish 23 100 5 100,0 10 90 5 100 11 91.7 4 100 11 100 4 100 55 96.5 18 100 1
Make up 23 100 5 100,0 9 81.1 5 100 9 75 4 100 11 100 4 100 52 91.2 18 100 0.329

Table 2. Anesthesia assistants and physicians' opinions regarding anesthesiologist assistant role during (pre-operative

Table 3 and Figure 2 shows Anesthesia assistants’ and physicians’ opinions regarding the role of anesthesiologist assistant during the induction and maintenance of anesthesia

Items RTH RTHMC RH SH Total X2(P)
Anesthesia assistants Physicians Anesthesia assistants Physicians Anesthesia assistants Physicians Anesthesia assistants Physicians Anesthesia assistants Physicians
(n= 23) (n= 5) (n= 11) (n= 5) (n= 12) (n= 4) (n= 11) (n= 4) (n= 57) (n= 18)
No % No % No % No % No % No % No % No % No % No %
                                        2.878
 1. Place the patient on 100% O2 for 5 min preanesthesia 16 70 2 40 8 73 4 80 12 100 2 50 10 91 3 75 46 81 11 61 -0.09
 2. Recheck the name, doses of the drugs on the syringe before use 18 78 2 40 9 82 2 40 9 75 2 50 7 64 1 25 43 75 7 39 8.224* -0.004
 3. Administer intravenous anesthetic agents as prescribed 18 78 3 60 11 100 3 60 10 83 4 100 7 64 3 75 46 81 13 72 0.586 (0.004)
 4. Assist in the insertion of endotracheal tube 15 65 3 60 9 82 3 60 12 100 2 50 5 46 2 50 41 72 10 56 1.686 (0.194)
 5. Attach the patient to anesthesia machine 18 78 3 60 11 100 3 60 10 83 4 100 8 73 3 75 47 83 13 72 0.895 -0.344
6. Suction the airway as needed
17 74 3 60 11 100 3 60 10 83 4 100 10 91 3 75 48 84 13 72 1.295  (0.255)
 7. Administer the intravenous blood or fluid as prescribed 14 61 2 40 9 82 3 60 9 75 3 75 10 91 3 75 42 74 11 61 1.043 (0.307)
 8. Assist in the insertion of monitoring catheters                                          
 Central venous pressure catheter 10 44 1 20 9 82 3 60 6 50 4 100 5 46 3 75 30 53 11 61 0.397 (0.529)
Arterial blood gases catheter 11 48 2 40 9 82 3 60 7 58 3 75 5 46 3 75 32 56 11 61 0.138  0.710)
Pulmonary artery pressure catheter 13 57 4 80 9 82 3 60 10 83 4 100 6 55 4 <

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1Department of anesthesia and intensive care, faculty of medicine Ibn Al Jazaar, university of Sousse, Tunisia

2Anbar University, College of Medicine, Department of Surgery, Iraq

Send correspondence to:
Jasim Mohammed Khalaf
Department of anesthesia and intensive care, faculty of medicine Ibn Al Jazaar, university of Sousse, Tunisia, E-mail: jassimkhalaf766@gmail.com

Paper submitted on January 03, 2024; and Accepted on January 22, 2024

Citation: Khalaf MJ. The Anesthesiologist assistants’ Role in the Management of Patients Undergoing General Anesthesia. Int Tinnitus J. 2023;S1:06-17