Physicians specializing in peri-operative care, development of an anesthetic plan, and the administration of anesthetics are known as anesthesiologists. As with other specialties within medicine, doctors wishing to specialize in anesthesia must undertake extensive training. In the U.S., the training of a physician anesthesiologist typically consists of 4 years of college, 4 years of medical school, 1 year of internship, and 3 years of residency.

    These colleges typically set rigorous examinations, which must be passed before training is complete. These examinations encompass the whole field of anesthetic practice, and are usually split into several parts. Completion of the written and oral Board examinations by a physician anesthesiologist allows one to be called "Board Certified" or a "Diplomate" of the American Board of Anesthesiology.

    Other specialties within medicine are closely affiliated to anesthetics. These include intensive care medicine and pain medicine. Specialists in these disciplines have usually done some training in anesthetics. The role of the anesthetist is changing. It is no longer limited to the operation itself. Many anesthetists consider themselves to be peri-operative physicians, and will involve themselves in optimizing the patient's health before surgery (colloquially called "work-up"), performing the anesthetic, following up the patient in the post anesthesia care unit and post-operative wards, and ensuring optimal analgesia throughout.

What is anesthesia?
 

    Although many different definitions can be found in the vast medical literature, a good working definition of surgical anesthesia is the state by which a patient is rendered insensible to pain during surgical, obstetric, therapeutic, and diagnostic procedures. Accordingly, patients can be awake during procedures, as with a regional nerve block, sedated, or asleep (unconscious). 

What are the differences between a general anesthetic and local/regional block?

     Traditionally the term general anesthetic referred to the induction of an unconscious state usually followed by the insertion of some type of airway device such as an endotrachial tube into the patient’s trachea to aid with continuous or assisted ventilation during their surgery.  This usually involves the intravenous administration of medications that produce a lack of consciousness, amnesia, and analgesia (inability to feel pain).  Once the patient is fully asleep, the endotrachial tube is inserted into the patient.  After general anesthesia is induced, the patient is maintained in this state with a combination of gases and intravenous drugs.

     Regional anesthesia refers to anesthetic techniques that depend on a group of drugs, called local anesthetics, that produce transient loss of sensory, motor, and autonomic function in a discrete portion of the body.  Everyday examples include spinal injections for cesarean sections, lumbar epidurals placed for labor, upper extremity nerve blocks for hand, forearm, or elbow surgery.  The key here is the injection of a local anesthetic at the site of specific nerves that normally innervate a specific area of the body, such as an arm or leg.  In doing so, the patient feels no pain during the surgery and often has excellent pain relief for hours after the injection.  At the patient’s request, mild sedation can also be administered in conjunction with a regional anesthetic technique.

Useful links for additional information:
American Society of Anesthesiologists

The Anesthesiology Journal