What Is Anesthesiology

Anesthesiology is the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery.

The education of anesthesiologists has kept pace with their expanding role in offering the highest quality health care available anywhere in the world. Today's anesthesiologists are physicians who complete a four-year college program and graduate from college before undergoing an additional four years of medical school education just like your surgeon and primary care physician. After this same medical education as other physicians, your physician anesthesiologist must under go an additional four years of medical education specializing in the medical specialty of anesthesiology (the medical practice involving caring for patients undergoing anesthesia). After completion of this 12 years of education, your physician anesthesiologist undergoes an examination process, including a comprehensive written examination and a rigorous oral examination that covers all aspects of medicine and anesthesiology to become Board Certified. With 12 years of education your anesthesiologist is the most educated and most qualified person to administer and/or direct your medical care during your anesthetic experience. We apply our knowledge of medicine to fulfill our primary role in the operating room to ensure your comfort during surgery and to make educated medical judgments to protect you during this vulnerable experience. These medical judgements include treating and regulating changes in your critical life functions -- breathing, heart rate, blood pressure, level of consciousness -- as they are affected by the surgery being performed and the medication being administered. We are the medical specialists who are the doctors who will immediately diagnose and treat any medical problems that might arise during your surgery or during your recovery period in the postanesthesia care unit. Fellowships in an anesthesia subspecialty and in education or research may also be taken for an additional 13th year of education.

More than 90 percent of the active membership of the American Society of Anesthesiologists have been certified as Diplomates of the American Board of Anesthesiology.

Scope of Practice

The medical expertise of this specialist has caused a dramatic expansion of the role of the anesthesiologist. Although historically, anesthesiologists have been known primarily as physicians who administer anesthesia to alleviate pain and suppress consciousness of the patient undergoing surgery, they also provide medical care and consultations in many other settings and situations in addition to the operating room.

The anesthesiologist is the perioperative physician ("peri-" meaning "all-around") who provides medical care to each patient throughout his or her surgical experience. This includes medically evaluating the patient before surgery (preoperative), consulting with the surgical team, providing pain control and support of life functions during surgery (intraoperative), supervising care after surgery (postoperative) and medically discharging the patient from the recovery unit.

In the operating room:
An estimated 40 million anesthetics are administered each year in this country. Anesthesiologists provide or participate in more than 90 percent of these anesthetics. In the operating room, they are responsible for the medical management and anesthetic care of the patient throughout the duration of the surgery. The anesthesiologist must carefully match the anesthetic needs of each patient to that patient's medical condition, responses to anesthesia and the requirements of the surgery.

Within the confines of the operating room suite, which is often comprised of several separate operating rooms, the activities of the anesthesiologist are seen by few people outside of the surgical and nursing team. Even the patients themselves are unable to recall much of their involvement with this vital specialist because most of the anesthesiologist's critical work is done while the patient is anesthetized! The role of the anesthesiologist in the operating room is to: 1) provide continual medical assessment of the patient; 2) monitor and control the patient's vital life functions -- heart rate and rhythm, breathing, blood pressure, body temperature and body fluid balance; and 3) control the patient's pain and level of unconsciousness to make conditions ideal for a safe and successful surgery.

In the postanesthesia care unit (recovery room)
This is where patients are transferred after surgery, allowing them to emerge fully from the effects of the anesthesia under the watchful eyes of skilled nursing personnel with anesthesiologist consultation immediately available. While safety is of course the foremost priority during surgery, it is also of utmost concern that the patient be monitored and continually assessed while fully regaining consciousness. In most cases, the anesthesiologist decides when the patient has recovered enough to be sent home following outpatient surgery or has been stabilized sufficiently to be moved to a regular room or ward in the medical facility.

For pain management:
In addition to the patient's pain being relieved or blocked entirely during a surgical procedure, it is equally important to provide adequate pain relief postoperatively for the patient's comfort and well-being. After surgery, the anesthesiologist is involved in prescribing pain-relieving medication and techniques that are best for each individual patient to maintain a level of comfort and to follow proper rest.

Because of their specialty training, anesthesiologists are uniquely qualified to prescribe and administer drug therapies for acute, chronic, cancer and childbirth pain. In childbirth, the anesthesiologist manages the care of two people, providing pain relief with epidural or spinal blocks for the mother while managing the life functions of both the mother and the baby.

In critical care and trauma medicine:
As an outgrowth of the postanesthesia care unit, critical care units are now found in all major medical facilities throughout the country. The role of the anesthesiologist in this setting is to provide medical assessment and diagnosis, respiratory and cardiovascular support, and infection control. Anesthesiologists also have the medical background to deal with many emergency situations. They provide airway management, cardiac and pulmonary resuscitation, advanced life support and pain control. As consultants, they play an active role in stabilizing and preparing the patient for emergency surgery.

During cardiac laboratory procedures:
In most institutions, anesthesiologists are available during cardiac catheterizations and angioplasty procedures for emergency airway management or resuscitation if necessary.

For diagnostic procedures and nonsurgical treatments:
As medical technologies have advanced, so has the need for anesthesiologists to become involved in caring for patients during radiological imaging or scanning procedures, gastrointestinal endoscopies, in vitro fertilization, lithotripsy procedures, electroshock treatment, nutritional support and respiratory therapy.

Research and Clinical Studies

Some of the most significant strides in medicine and surgery have been directly attributed to anesthesiology's advances in patient monitoring, improved anesthetic agents and new drug therapy. Research at the clinical and basic science levels has been done almost exclusively by anesthesiologists or Ph.D. scientists with the goal of continually improving patient care and safety.

Research is conducted in each of the subspecialties of pediatric, geriatric, obstetric, critical care, cardiovascular, neurosurgical and ambulatory anesthesia. Other areas of study include: blood transfusions and fluid therapy, infection control, difficult airway management, cardiopulmonary resuscitation, complications, new devices and methods of monitoring, pharmacology, pain therapy and organ transplant.

Patient Safety

Complications from anesthesia have declined dramatically over the last 25 years. Since 1970, the number of anesthesiologists has more than doubled and, at the same time and at virtually the same rate, patient outcomes have improved. In just the last decade, estimates for the number of deaths attributed to anesthesia have dropped 25-fold from 1 in 10,000 anesthetics to 1 in 250,000 today.

All this has occurred during a time when the youngest of premature infants in neonatal units survives intricate, lifesaving procedures and 100-year-old patients undergo and recover from major surgeries that were once thought to be impossible.

Educational and Legislative Activities

Anesthesiologists, through their national professional organization, the American Society of Anesthesiologists (ASA), participate in many continuing medical education programs and legislative activities. These include:

The world's largest international educational program for anesthesiologists -- a five-day ASA Annual Meeting with an attendance of more than 18,000.
Comprehensive refresher courses for continuing medical education during the ASA Annual Meeting and regional courses and workshops thoughout the year.
Education, training and applications of new knowledge in the areas of patient safety, standards of care, practice guidelines, and quality improvement.
Patient education programs and materials about the current and emerging technologies in anesthesiology to help the public make educated choices about their anesthesia or pain management care.
Legislative and regulatory activities at the state and national levels through the ASA Washington Office.

History

The Society was founded in 1905 when nine physicians from Long Island, New York organized the first professional anesthesia society. The Society expanded to 23 members in 1911 and named itself the New York Society of Anesthetists.

As its purpose and scope of involvement in anesthesia-related issues grew and attracted other interested physicians nationwide, the Society changed its name to the American Society of Anesthetists in 1935 and then to the American Society of Anesthesiologists (ASA) in 1945. ASA moved its offices from New York to Chicago in 1947 and then to the Chicago suburb of Park Ridge, Illinois, in 1960, where today it serves a membership of more than 34,000.

Membership

The highest decision-making power is vested in the ASA House of Delegates, composed of about 300 delegates who represent the interests of members in the United States and Puerto Rico.

Active members of ASA must be Doctors of Medicine (M.D.) or Osteopathy (D.O.) who are licensed physicians and have successfully completed a training program in anesthesiology approved by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA).

ASA has a special category for residents in anesthesiology training. Resident members must be physicians in a full-time anesthesiology residency program accredited by ACGME or AOA.

Other categories of membership include retired members, life members (past presidents), honorary members and affiliate members (physicians or scientists not in the clinical practice of anesthesiology but who maintain an interest in the specialty).

Publications

Anesthesiology, ASA's internationally recognized, scientific peer-reviewed journal, is published monthly.
The ASA Monitor is published monthly for the membership and provides information on general topics and current issues affecting anesthesiology.
ASA Refresher Courses in Anesthesiology, containing selected scientific Refresher Course presentations, is published annually.
ASA produces and publishes a variety of publications and provides informational services on various aspects of anesthetic care for both medical personnel and the general public. A complete catalogue of publications is available.