Editorial  |   April 2016
The Future of Anesthesiology
Author Affiliations
  • N. Martin Giesecke, M.D.
    ASA MONITOR
    Editor
Article Information
Central and Peripheral Nervous Systems / Gastrointestinal and Hepatic Systems / Pediatric Anesthesia / Practice Management / Respiratory System / Technology / Equipment / Monitoring / Editorial
Editorial   |   April 2016
The Future of Anesthesiology
ASA Monitor 04 2016, Vol.80, 4-5.
ASA Monitor 04 2016, Vol.80, 4-5.
The only way that it has ever been possible for me to predict the future is to studiously observe the present, add to that my recollections from the past (including paying attention to history), and use an educated guess to prognosticate what will happen. Having always considered myself an amateur naturalist, I have spent many hours observing animal behavior and doing my best to understand the classification of our flora and fauna. Early on in my life as a scuba diver, this knowledge helped me realize that shark attacks on scuba divers were an extremely rare event and that these attacks were usually presaged by humans exhibiting dumb behaviors (e.g., grabbing the tail of a nurse shark). However, the most common reason for shark attacks on scuba divers is that the divers are fishing – typically abalone fishing or spear fishing. Shark sightings on scuba dives is relatively uncommon, unless one is on a “shark dive,” where some type of bait is used to bring the sharks in, or one is able to dive in an area with a relatively healthy population of sharks. A major reason for a lack of shark encounters on scuba dives is the fact that shark (and ray) populations are dropping all over the world as sharks (and rays) are overfished for shark fin soup.
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1 Comment
April 22, 2016
Ernesto Pretto
University of Miami
Too much shark, too little future

We must look to the future of anesthesiology with the knowledge and clear understanding of its historical trajectory. Anesthesiology evolved as a specialty dedicated to life support (resuscitation) during surgery. It is a fallacy to believe our primary raison d'etre has been or is to exclusively provide "anesthesia" (e.g., pass gas). 

As such, the term anesthesiology is uni-dimensional and has never truly described our role as physicians.The advent of nurse anesthesia has served to remind us that we are not draftsmen but architects. Unfortunately, anesthesia has been our primary bread winner, and within the context of the anesthesia care team requires no great effort for the dollars we earn, hence we have become complacent. It is but one tool in the armamentarium. A more accurate description of "anesthesiology" is the ability to design and safely administer titrated resuscitative care on a minute-to-minute basis and, on occasion, on a second-to-second basis to healthy and sick patients under the influence of anesthetics in the perioperative setting. 

Sadly, the new generation of anesthesiologists forgets that a previous generation of anesthesiologists pioneered the fields of critical care medicine and emergency medicine. There are no chapters in our textbooks that describe these efforts. Our sustained involvement in these allied specialties was curtailed due to external economic forces. The fields of anesthesiology, critical care medicine and emergency medicine are sister specialties and constitute a natural progression or evolution of anesthesiology that can be described as an "Acute Care Triad"; taken together they become a seamless new field, "Acute Care Medicine," bound together by a common focus, namely resuscitation. 

Recently, the American Board of Anesthesiology (ABA) and the American Board of Emergency Medicine (ABEM) announced the creation of a new residency program that combines anesthesiology and emergency medicine. In my opinion, this is perhaps one of the most important developments in the field in recent memory and could define the future of anesthesiology. Because with the proper direction, it may allow the gradual transformation of the field from a purely hospital-based physician practice to include an important role outside the O.R. as "Acute Care Specialists." 

As mentioned above, the fundamental expertise of the anesthesiologist is resuscitation. As experts in resuscitation and crisis management, our involvement in the stabilization and transport of selected critical patients in the pre-hospital setting could improve survival and reduce long-term disability and open the possibility of early treatment of patients with acute ischemic syndromes. This vision is a return to a previous natural evolution of the specialty that for many reasons was never realized. Knowingly or unknowingly, officials at ABA and ABEM has once again opened the door to new possibilities. All we need to do is walk through the threshold toward a new and exciting future.

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