Feature Articles: Anesthesiology and Perioperative Medicine Guest Editor's Note by Tim J. Lamer, M. D.

The discovery of anesthesia is unarguably one of the most important achievements in modern medicine. Without modern anesthetic techniques and monitoring capabilities, many of the current surgical techniques and operations could not be possible. Anesthesiology began in the 1800's as a practice of medicine specializing in the management of patients who are rendered unconscious or insensible to pain and stress during painful procedures. This early definition of the specialty limited anesthesiologists involvement in patient care to the operating room. Advancements in anesthetic and analgesic agents, monitoring capabilities, regional anesthetic and analgesic techniques, pharmacologic agents to support critically ill patients, and computerized data management systems have expanded the anesthesiologists role to include many activities beyond the operating room. Anesthesiologists are now involved in a variety of clinical and administrative duties encompassing the entire perioperative setting. The contemporary anesthesiologist must be prepared to perform preoperative medical evaluations, order appropriate tests and consults, conduct a safe anesthetic (which includes anesthetic agents, invasive and noninvasive monitoring devices, and pharmacologic and/or mechanical support of all the major organ systems), manage the patient in the postoperative recovery area, participate in postoperative pain and symptom management, and care for critically ill patients in the intensive care unit. This shift in patient care responsibilities from the operating room to the entire perioperative setting has led many departments in the U. S. to change their name to the Department of Anesthesiology and Perioperative Medicine.

This issue of Jacksonville Medicine contains several articles related to perioperative medicine. Dr. Myers describes the importance of the preoperative evaluation and the anesthesiologists role in this process. There are important patient care and cost saving implications. Dr. Sitzman reviews the prevention of perioperative thromboembolic events. This is an excellent example of a perioperative management strategy, which encompasses the preoperative, intraoperative, and postoperative periods. Blood product transfusions continue to be a source of significant concern for physicians and patients because of cost, availability, and transfusion related morbidity. Dr. Leone reviews the current status of artificial blood, an area in which anesthesiologists have made important contributions. Postoperative pain is a major concern for our patients and remains a significant contributor to postoperative morbidity. Drs. Ghazi and Stevens review the current status of post-operative epidural analgesia as it relates to pain control and perioperative outcome. Dr. Helffrich gives an overview of the perioperative services provided by pediatric anesthesiologists. Especially noteworthy are the postoperative pain services and analgesia, sedation, and monitoring services for painful medical procedures. Ambulatory or outpatient surgery has been a significant advancement, which benefits our patients and payors. Dr. McCarthy summarizes advances in anesthetic agents and equipment that have contributed to our ability to offer outpatient surgery services to an increasing number of patients. In addition to the studies outlined above, anesthesiologists are also involved in a variety of other areas including operating room management, airway and code team management, chronic pain management, palliative care, perioperative information services and data management, and conscious sedation policy.

Tim J. Lamer, M. D.
Chair, Department of Anesthesiology
Chair, Division of Pain Services
Mayo Clinic Jacksonville
Guest Editor

Jacksonville Medicine / December, 1998

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