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.