The Scope of Anesthesia
The practice of anesthesia has changed
dramatically since the days of John Snow. The modern anesthesi-ologist is now
both a perioperative consultant and a primary deliverer of care to patients. In
general, anesthesiologists manage nearly all “noncutting” aspects of the patient’s
medical care in the immediate perioperative period. The “captain of the ship”
doctrine, which held the surgeon responsible for every aspect of the patient’s
perioperative care (including anesthesia), is no longer a valid notion when an
anesthesiologist is present. The sur-geon and anesthesiologist must function
together as an effective team, and both are ultimately answer-able to the
patient rather than to each other.
The modern practice of anesthesia is not
con-fined to rendering patients insensible to pain (Table 1–1).
Anesthesiologists monitor, sedate, and provide general or regional anesthesia
outside the operating room for various imaging procedures, endoscopy,
electroconvulsive therapy, and cardiac catheterization. Anesthesiologists have
tradition-ally been pioneers in cardiopulmonary resuscitation and continue to
be integral members of resuscitation teams.
An increasing number of practitioners
pur-sue a subspecialty in anesthesia for cardiothoracic surgery , critical
care, neuroanesthesia , obstetric anesthesia , pediatric anesthesia , and pain
medicine . Certification requirements for special com-petence in critical care
and pain medicine already exist in the United States. Fellowship programs in
Adult Cardiothoracic Anesthesia and Pediatric Anesthesiology have specific
accreditation require-ments, and soon those in Obstetric Anesthesiology will as
well. A certification examination will soon be available in Pediatric
Anesthesiology. Education and certification in anesthesiology can also be used
as the basis for certification in Sleep Medicine or in Palliative Medicine.
Anesthesiologists are actively involved
in the administration and medical direction of many ambulatory surgery
facilities, operating room suites, intensive care units, and respiratory therapydepartments.
They have also assumed administra-tive and leadership positions on the medical
staffs of many hospitals and ambulatory care facilities. They serve as deans of
medical schools and chief execu-tives of health systems.
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