Keeping Patients Awake During Surgery?

Anesthesiologists’ Vital Roles in All Anesthetic Procedures

Think anesthesiologists only keep patients “asleep” during surgical procedures? An “awake craniotomy” performed on Massachusetts Senator Ted Kennedy on June 2, 2008 should challenge that notion. In awake craniotomy and similar procedures, patients are anesthetized but are not always under general anesthesia, making them active participants in their own operations and able to respond to requests from the surgical staff who map key areas of the brain.

During these procedures it is the anesthesiologist who keeps a patient painlessly awake, alert and comfortable.

“You have to take care of a patient who has to remain still, comfortable and calm while at the same time is able to comply with what can be very sophisticated neurologic testing. It’s a very delicate balance,” said Keith J. Ruskin, M.D., professor of anesthesiology and neurosurgery at Yale University School of Medicine.

Anesthesiologists participate in the total care of the patient before, during and after surgery. In the operating room, anesthesiologists provide continual medical assessment of the patient. They monitor vital life functions, including heart rate, breathing, blood pressure, body temperature and fluid balance, and control the patient’s pain and levels of consciousness to make conditions ideal for a safe and successful surgery.

“At any time during these ‘awake’ procedures, we have to be ready to treat a variety of emergencies, from pain and agitation to bleeding, seizures or respiratory arrest,” said Dr. Ruskin.

For procedures such as Senator Kennedy’s, an anesthesiologist is involved in the surgical process from the beginning, where they meet with patients in a preoperative visit and assist in planning the procedure.

On the day of surgery, the anesthesiologist applies monitors to the patient, works to position the patient comfortably and administers a combination of drugs and verbal reassurance- coaching the patient through the procedure. The anesthesiologist works with the surgeons during the procedure to relax the brain and improve the surgeon’s field. Their role is not confined to the operating room, however, as the anesthesiologist will also transport the patient to the ICU following surgery.

Dr. Ruskin added, “Throughout all procedures and into recovery, anesthesiologists continuously monitor a patient’s vial signs and are ready to notify and assist if any problems arise.”


Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 43,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.


Reviewed by Ramaz Mitaishvili, MD

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