In an aging society, the role of the anesthesiologist is gaining importance

What is the difference between sedation and anesthesia?

Any medical intervention is an art, and I would say that anesthesiological intervention is, I won't brag, a high-end art. Why? Because we have drugs that are significantly different from drugs commonly used in society. It's hard for me to find a blunt comparison here to show these differences, but anesthesia drugs are like an atomic bomb compared to other weapons a soldier has. That's kind of half joking half serious. Why is this so? Anesthesiological drugs or agents are getting newer, but they have a very low therapeutic index, i.e. if a cardiologist or internist, or any other specialty doctor, prescribes a double or triple dose of a drug by mistake or by accident, more harm will not come to the patient. If I my anesthesia drug overdose three or four times, there would be a very bad effect on the patient, including a tragic effect. Therefore, our knowledge, skill and development of standard procedures, and the constant interaction between the effect of the drug and my action, is the essence of anesthesiology. So this specialty is completely different from others in this respect. We have drugs that are very potent. We have fantastic drugs. The problem is that we don't fully know how they work. The whole magic of anesthesiology (there are different theories of how they work) is that when we administer them, the patient falls asleep, when they stop working, the patient wakes up and returns to normalcy. How this happens, we don't quite know. There is a kind of phenomenon. There is something beautiful about anesthesiology. Now answering the question specifically, there is just this level of magical action that changes when it comes to sedation and when it comes to general anesthesia. In general anesthesia, the patient loses consciousness, loses breathing. We have to secure the breathing and secure the heart function. In sedation, the patient has different levels of consciousness. Only problem is that in a given patient, this level of station can change unexpectedly. Therefore, an anesthesia nurse and a second anesthesiologist are needed to supervise the patient's vitals during sedation. And there is not only individual variability, meaning each patient may act and respond differently, but also age-dependent variability. A special concern of ours, because it stems from danger, is related to older patients. The population in Poland is aging. Patients are getting older. I would say a 65 plus patient is already a major challenge for the health care system, and thus the role of the anesthesiologist becomes even more important.

And what drug is the latest sedation drug remimazolam?

This has been a hit in recent years. Remimazolam and a couple of other such drugs, which have been around a few times in my long anesthesiology career, have revolutionized our anesthesiology practice. Great hopes are pinned on remimazolam. And this is due to the fact that it is a safe drug. It has been tested in various countries and has very good references. In Poland, we do not yet have much experience with this drug, but it has every reason to be well received by the community and, above all, by patients. Such a drug used to be propofol. Recently online I attended a convention of anesthesiology societies in Singapore. There they talked about the large number of drugs that are in clinical phases at the moment, anesthesia drugs that are as strong as a nuclear bomb. This development has no boundaries at the moment. The Far East is leading the way in this area at the moment. Also in the coming years we can expect various innovations of these areas.