Guardians of the Operating Theatre: Dr. Visalatchi Karuppiah on Anesthesiology and Patient Care
Dr. Visalatchi, a junior resident in Anesthesia who has just completed her final residency exams, joins Dr. Nirainila Joseph in this installment of DocScopy from MedBound Times. She did her MBBS at Trichy SRM Medical College Hospital & Research Center, Tiruchirappalli, Tamil Nadu, India. She then did MD in Anesthesiology and Critical Care at the All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
In this interview, Dr. Visalatchi sheds light on the field of anesthesiology, reflects on her residency journey, and underscores the essential contributions of anesthesiologists to patient care. She also discusses her future goals and offers words of wisdom for upcoming anesthesia residents.
Dr. Nirainila Joseph: Please introduce yourself to our readers.
Dr. Visalatchi Karuppiah: This is Dr. Visalatchi Karuppiah. I started my career in the field of Medicine in the year 2014 when I joined the MBBS course at Trichy SRM Medical College. After this, I joined MD Anesthesiology and Critical Care in AIIMS, Jodhpur in 2021. Currently, I am in the Junior Residency period and have completed my final exams.
Dr. Nirainila Joseph: Congratulations on completing your final exams! How do you feel about your performance and how are you feeling as you wait for your results?
Dr. Visalatchi Karuppiah: Thank you for the wishes. I am satisfied with my performance and I am stress-free after my exams as I have done my best in the exams. As I started reading from the first day of my residency, I was able to cover the portions on time and remain stress-free.
Dr. Nirainila Joseph: That is great to hear! Now let's go into our topic of discussion, Anesthesiology. Can you provide an overview of the field and its importance in healthcare? What are the primary responsibilities of an anesthesiologist in different medical settings?
Dr. Visalatchi Karuppiah: Anesthesiologists are also known as the 'Perioperative Physicians'. We play a major role in the perioperative period which starts from the preoperative evaluation till the postoperative recovery of the patient. As we know, for many conditions surgery is the cure, the anesthesiologist will assess the patient's current health condition, fitness for surgery, risk stratification, optimization of the medical conditions, and managing them both intraoperatively as well as postoperatively. Our main responsibilities lie in the management of a patient in the perioperative period, critical care settings, emergencies, and pain management of a patient.
Dr. Nirainila Joseph: Given the extensive role you play in patient care, can you explain the different types of anesthesia used in medical procedures, and when each type is typically employed?
Dr. Visalatchi Karuppiah:
1. Local Anesthesia - Local Anesthetics are available in different formulations like gel, solution, spray, and injection. After the application of local anesthetics, that area will be anesthetized. Used by surgeons themselves for superficial procedures E.g. Cataract Surgery, Skin procedures
2. Regional Anesthesia
i) Neuraxial blockade - Drugs deposited in the vicinity of nerve roots when they exit the spinal cord. This is for the procedures on the lower limb, pelvis, genitourinary, and lower abdomen.
ii) Peripheral nerve blocks - Drugs deposited near the individual nerves supplying the area to be anesthetized. This technique is commonly used for procedures on the lower limb, upper limb, and shoulder.
3. Intravenous sedation - Sedative drugs are given intravenously which makes the patient sedated so that procedures can be done in a patient who is not cooperative. Endoscopy procedures, short-duration procedures like suction and evacuation of conception products, pediatric MRI.
4. Monitored anesthesia care - Here trained anesthesiologists will monitor the patient and they may give sedative drugs if required. E.g. Cardiac monitoring for a case being done under local anesthesia.
5. General Anesthesia - Amnesia, analgesia, unconsciousness, loss of reflexes, and muscle relaxation achieved with the use of drugs. All major & prolonged procedures are the examples.
Dr. Nirainila Joseph: With the range of anesthesia types you've mentioned, how do they contribute to patient comfort and safety during surgical procedures?
Dr. Visalatchi Karuppiah: Patients are comfortable during surgeries with the use of analgesics, and anxiolytics. The preoperative assessment followed by optimization of the patient, continuous monitoring of the patient during the procedure as well as after the procedure and timely intervention by the anesthesiologist ensures the safety of the patient.
Dr. Nirainila Joseph: Ensuring patient comfort and safety during surgery often requires seamless teamwork and the collaboration between anesthesiologists and other healthcare professionals is crucial for the success of surgical procedures. How do anesthesiologists collaborate with surgeons and nurses, to ensure optimal patient care?
Dr. Visalatchi Karuppiah: Clear communication with proper respect.
Dr. Nirainila Joseph: This short and crisp answer truly encapsulates the essential principles for successful teamwork. Now, let's turn to your anesthesiology residency. What initially drew you to the field of anesthesia, and what aspects of the field do you find most rewarding?
Dr. Visalatchi Karuppiah: When I was in my internship, anesthesia postings made me realize how important is anesthesia in the perioperative period and also the safety of the patient that is being provided by the anesthesiologist. After the procedure, when the patient recovers pain free that is the most rewarding aspect for me.
Dr. Nirainila Joseph: It's clear that your experiences during your internship have deeply influenced your career path. What were some of the key rotations and experiences you had during your residency training?
Dr. Visalatchi Karuppiah: Intensive care training with different kinds of patient types, trauma postings, Advanced Cardiovascular Life Support (ACLS), Basic Life Support (BLS) training, and airway management workshops.
Dr. Nirainila Joseph: Were there any opportunities for research or scholarly activities during your residency, and did you participate in any research projects?
Dr. Visalatchi Karuppiah: I have done one research titled " Comparison of the analgesic efficacy of intrathecal morphine and Bilateral Erector Spinae plane block in patients undergoing open heart surgery: An open labeled randomized controlled trial " during my residency.
Dr. Nirainila Joseph: Navigating through residency involves significant supervision and mentorship. How did these aspects shape your training experience in anesthesiology?
Dr. Visalatchi Karuppiah: Almost all the cases done by me were supervised by seniors, senior residents & consultants of my institute. The lectures, and teachings inside the operation theatre (OT) made me strong academically as well. They corrected me in almost all aspects of the procedure whenever I was wrong which helped me in shaping myself.
Dr. Nirainila Joseph: From your experience as a resident, what are some of the biggest challenges anesthesiologists face in the operating room?
Dr. Visalatchi Karuppiah: Difficult airway management, hemodynamically unstable trauma patients, emergency unstable obstetrics, and cardiac cases.
Dr. Nirainila Joseph: You have mentioned some challenging situations that could decisively impact patient outcomes. In what ways do you feel your residency training prepared you for the responsibilities and demands of practicing as an anesthesiologist?
Dr. Visalatchi Karuppiah: By facing different clinical situations along with decision-making, staying calm during critical situations, and having confidence in doing different procedures.
Dr. Nirainila Joseph: What are your career aspirations in anesthesiology, and how do you plan to pursue them after completing your residency? As you near the end of your residency, how do you feel about transitioning to independent practice?
Dr. Visalatchi Karuppiah: I want to practice as an anesthesiologist in a tertiary health center and will acquire experience after which I will go with independent practice. I need more confidence to start with independent practice.
Dr. Nirainila Joseph: That sounds like a solid plan! While waiting for your results, are there any specific activities or projects you are focusing on to stay productive and keep your skills sharp?
Dr. Visalatchi Karuppiah: I am writing a paper for the publication of my thesis which I did during my residency.
Dr. Nirainila Joseph: Thank you for sharing your insights into the field of anesthesia. Wishing you the best of luck for your results and your career ahead. As we conclude, what advice do you have for incoming anesthesia residents starting their training?
Dr. Visalatchi Karuppiah: Be sincere, learn all the skills, ask doubts to seniors, and read while doing the cases.
MedBound Times expresses sincere gratitude to Dr. Visalatchi Karuppiah for sharing her valuable insights on our platform.
